Because the study of organizational ethics is in its infancy compared to other areas of healthcare ethics, discussions about it often seem like hot air with no palpable payoff.
The term "organizational ethics" might even strike people as sleep inducing, elusive, and potentially incoherent. If the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) did not require that healthcare institutions address "organizational ethics," it is unlikely that healthcare professionals would care. This issue of the Bulletin enters the discussion without a unified theory or a story about the exact payoff for exploring organizational ethics — except that others might avoid the obstacles that the Park Ridge Center's project on the topic has encountered, and by doing so advance the discussion.
Our project's chief frustration has been to identify and describe the moral characters and dilemmas in organizational ethics. When healthcare ethics began some thirty years ago, people interested in the issues could follow the lead of Marlin Perkins of TV's Animal Kingdom fame — they could simply observe healthcare workers in their natural habitats, witnessing first hand the obstacles to informed consent, termination of treatment, and allocation of resources. In contrast, those who want to understand and address organizational ethics are quickly hampered in attempts to scrutinize or define the landscape. Unlike the doctor-patient relationship of traditional bioethics, it has no one focal point (the entire organization needs scrutiny, which complicates any study). Once anyone starts observing an organization, additional obstacles and questions arise. For example, what counts as a problem or dilemma in organizational ethics? How can these problems be distinguished, if at all, from other areas of applied ethics including bioethics, business ethics, and professional ethics? Does it make any sense to speak of the moral responsibility of an organization when it is individuals or groups who make choices and act? And, what benefits are likely to flow from scrutinizing the underbelly of an organization?
To tell this story in all its complexity, the Bulletin has chosen a most unlikely focus: the case of Michael Swango, physician allegedly turned killer. The choice is odd because most organizational ethics issues do not result in such obvious lethal outcomes, but this case is interesting because it is as much about the failures of organizations as it is a mystery thriller. But our use of the Swango case raises a reasonable question: If the ethical problems in organizations have such potentially serious outcomes, why have the issues not been seen and discussed before? They have, but not as organizational problems. While conflicts in organizational ethics rarely result in such deadly consequences as Swango's deeds, they are publicized, for example, in coverage of some tragic healthcare utilization management decisions (especially denial of services). Beyond organizational decisions that contribute to bad patient outcomes, organizational ethics issues surface in other ways: in conflicts over human relations in areas such as hiring, promotion, and employee termination; in the lack of checks and balances that result in abuse of employees' discretionary power, for example, when people in organizations substitute their mission for the organization's mission.
To complicate our story on organizational ethics, our research project and this Bulletin add another layer of questions: What moral problems, if any, are unique or different for faith-based organizations? In our Media Rx column we examine one case in which press coverage of faith-based health care reports a classic religious tension between the gospel and wealth. In that column we consider whether the Wall Street Journal report on the Daughters of Charity National Health System is overly simplistic, and suggest what a public conversation needs to address. Our "Connect the dots" column, which reviews notable articles on organizational ethics, also considers how the religious perspective adds to moral analysis of organizations.
The public conversation about organizational ethics is intensifying. The research that is emerging from our own project suggests that many of the ethical issues in organizations will be "hidden in the woodwork," refractory to moral analysis, exciting to explore because they are so fresh in the ethics conversation and have such potentially significant consequences. We hope that this issue will stir your moral imagination and motivate you to share your perspectives with us.
