Health care is a vitally important branch of human activity that allows people to get the necessary treatment and care in cases of illnesses, diseases, and slight weaknesses. Accordingly, the human-oriented character of health care provides for the crucial significance of ethics in all its aspects for this sphere. The special place in this respect is taken by the ethical decision-making and the development of morally active managers in the areas of provision and management of health care. The comprehensive analysis of health care management ethics comprised of the theoretical considerations and practical examples from a professional nurse’s working experience will allow making logical conclusions about the importance of making morally acceptable and ethical decisions.
Own Practice Example
Ethical Decision Making Defined
Thus, before discussing the specific practical examples applicable to the topic of this paper, it is necessary to provide an essential but brief theoretical background to the issues of ethical decision-making. Thus, Reynolds et al. (2002) argue that ethical decision making is the inclination of any public sector organization on the whole, and a health care organization, in particular, to provide the decision making that would respect, appraise, and cherish the values and the interests of all the social, racial, religious, etc. groups of the modern human society (p. 152). This means that, according to Reynolds et al. (2002), ethical decision-making is rather a phenomenon that is still on the way to its integral establishment than an already formed principle of decision making in health care and other areas.
At the same time, Henderson and Atkinson (2003) argue about the already established four principles of ethical decision-making. First of all, they consider ethical decision-making to be the issue of respecting and valuing people’s ideas, needs, and preferences. The four principles that Henderson and Atkinson (2003) single out as the constituents of ethical decision making are:
- Respect for autonomy;
In simpler terms, Henderson and Atkinson (2003, pp. 240 – 241) define respect for autonomy as respect towards individual needs and wishes or every person. Beneficence and non-maleficence refer to the obligations of doing only good and do not do any harm respectively. Finally, justice is the principle according to which a care manager should be driven by laws or codes in his/her decisions rather than his/her own interests or preferences of one of the parties to a controversial situation he/she might be involved in. On the basis of these principles, the activities of morally active managers should be based on the whole, and the specific example from the nurse’s practice can also be analyzed referring to these definitions of ethical decision making.
Ethical Decision Making in Provision and Management of Health Care
The essence of the practical example is in the situation where a receptionist in a GP surgery obviously violated the ethics code for health care workers and caused a controversial situation to happen. The situation involved a young male patient, given the pseudonym Jack Smith for protecting his privacy, whose major health care issues concerned the mental health area.
Thus, Jack Smith had to take an injection at the GP surgery at the appointed time of 10 AM, but he arrived at the facility 10 minutes later, i. e. 10:10 AM. The receptionist of the surgery, without discussing the case with the doctor and the nurses, which he/she should have done, told Mr. Smith that his injection would not take place because he was late. On hearing this, Jack Smith became verbally aggressive and excited, and to settle the situation the receptionist still had to call for the doctor and the nurse. As I was the nurse that had to discuss the situation with a patient and settle this controversial case, I can see that the receptionist lacked the knowledge of ethical decision-making and did not act as a morally active manager in this situation.
The major point that allows stating the above facts is that the code of ethics of the GP surgery states that the issues of patients’ lateness for proceedings are to be discussed with doctors and/or nurses directly, and it is beyond the receptionist’s duties to make such decisions. Thus, one can see how important the knowledge of the basics of ethical decision-making is in health care provision and management.
Morally Active Managers
Drawing from the above said, it can be stated that it is crucial for any health care facility on the whole and the GP surgery in particular to have morally active managers that know their duties and obligations in accordance with the principles of ethical decision making. As defined by Henderson and Atkinson (2003, p. 254), a morally active manager is a person with high professional qualification levels, whose actions are determined by the five major factors:
- Ethical awareness;
- Appreciation of risks;
- Practice wisdom.
Accordingly, if the above-discussed example from the GP surgery nurse’s practice is considered through these guidelines for morally active managers, it can be seen that the receptionist acted as the person lacking the qualities of the morally active manager. At the same time, the nurse had to demonstrate her awareness of these qualities to the fullest extent.
In particular, the receptionist did not display ethical awareness, although if he/she did, she might predict that such an unethical treatment of a patient might cause his anger. Moreover, the receptionist proved to have no patient’s interests among his/her values and cared more about the purely technical details of treatment, like the time of Jack Smith’s arrival, rather than about the necessity of the appointed injection for the patient’s health. Appreciation of risks was obviously not displayed by the receptionist, and the practice wisdom could not be observed in his/her activities either. The only possible chance for the receptionist’s improvement is the potential for the development of reflexivity as the ability to learn lessons from one’s own mistakes in ethical decision-making.
Needless to say, morally active managers, or professionals trying to become ones, face considerable challenges in their practice of ethical decision-making. According to Reynolds et al. (2002), the major challenges that a morally active manager faces in his/her practice concern the processes of “implementing policy and procedural changes” (p. 88). This means that morally active managers can face challenges both from the inside and outside of the organization they work for. The former include the controversy of interests and functions of frontline and middle managers, malpractice of one’s subordinates or bosses, etc. The group of outside challenges for morally active managers includes the dissatisfaction of patients with the managers’ keeping to ethical standards and various legislative acts, like Registered Homes Act 1984 or The Care Standards Act 2000, requiring health care organizations to adopt certain ethical standards (Reynolds et al. 2002, p. 88).
In the specific example discussed above, the receptionist faced both inside and outside challenges and did not cope with any of them. The nurse, whose duty it was to discuss Mr. Smith’s lateness and decide on the injection, also faced the inside challenge as the receptionist, as one of the nurse’s colleagues, acted not in accordance with ethical standards, and the nurse had to correct receptionist’s mistakes. The outside challenge that the nurse faced was the excitement and anger of the patient who was not satisfied with the care standards that the receptionist provided to him. Thus, the challenges that morally active managers face are numerous, but these challenges are situations when the managers can prove they have high professional and ethical qualifications.
Ethical Principles Applicable to All Decisions
Although the work of a morally active manager is obviously a challenging one, authors like Henderson and Atkinson (2003) argue about the set of ethical principles that are applicable and helpful for any decision in any situation (p. 235). This set consists of four major principles focusing on what the morally active managers must know or be willing to understand to succeed in work with people with different backgrounds, problems, and needs. The set of principles formulated by Henderson and Atkinson (2003, p. 235) includes:
- Possessing key skills in understanding people, i. e. listening, observing, and reflecting;
- Asking patients and colleagues about their views to make comprehensive decisions;
- Understanding of the individual differences of the patients and colleagues;
- Engaging in consulting others and being ready to learn something new all the time.
Obviously, the receptionist in the discussed example displayed none of the ethical principles presented by Henderson and Atkinson (2003). If he/she did, he/she would first listen to Jack Smith and consider his reasons for being late to the GP surgery. Then, the receptionist would observe the patient’s behavior and reflect on his condition and the possibility to call the nurse, who should have discussed the issue with Mr. Smith. Essentially, the receptionist would address the doctor and/or the nurse for advice on the issue. In this respect, if the receptionist possessed an understanding of individual differences of the patients he/she worked with, the controversy over Jack Smith’s verbal aggression could be avoided. Again, the only potential positive effect of the discussed example is that the receptionist will learn to ask for advice and will make necessary conclusions for his/her further practice regarding ethical decision making.
So, it is obvious that the practice of ethical decision-making is essential in providing and managing health care. Being a morally active manager means much for providing professional health care services. The example from the GP surgery nurse’s experience proves this point and illustrates the common mistakes that managers lacking ethical awareness make in their work. As a result of the analysis of that example, it is possible, to sum up, that a morally active manager is a professional who understands people in all aspects and can implement this understanding in the practice of ethical decision making.
Henderson, Jeanette and Atkinson, Dorothy. (2003) Managing Care in Context. Routledge.
Reynolds, Jill et al. (2002) The managing care reader. Routledge.