Eight years ago a hospital built a new family waiting room by enlisting wide community philanthropic support from individuals and businesses. Clinical Manager X, a volunteer community leader for the campaign, overheard that, due to rapid hospital expansion, the new administration wanted to eliminate the waiting room. She approached her superiors, who confirmed this. Superiors requested confidentiality because administration would proceed without public announcement. Manager X is involved with church and civic groups who donated money for the room. She feels obliged to inform them, and even galvanize community protest. What are her options?
When facing clinical moral dilemmas Manager X, like most staff, turns to the ethics committees. In organizational ethics cases like this one however, staff are unsure how to voice concern. Before acting it is best to understand both the range of, and the moral responsibility, for the dilemmas. Among the issues in this case are conflict of interest, confidentiality, and promise-keeping.
We regularly balance competing interests between family and work, but rarely does meeting a professional obligation simultaneously jeopardize civic obligations. How can Manager X resolve the competing interests between obligations to her work and community? First, it is important to examine whether any clear moral directive informs either moral obligation. For instance, when physicians experience competing moral obligations between patients' welfare and business, they often prioritize obligations by relying on a clear professional dictum to "do no harm." Manager X has to ask herself if she made any explicit commitments in her work contract not divulge management plans or her volunteer fundraising to be vigilant in the stewardship of the gift that might help prioritize the competing obligations.
The issue of confidentiality is straightforward in this case—her superiors asked her to keep a confidence and it was not immediately evident that the request was an immoral one. Simple fairness ("do unto others") dictates that we keep confidences because we, in turn, want our confidences held sacred. Even if Manager X's superiors had not requested silence on the matter, her job would most likely require prudent use of sensitive management information. From an organizational ethics stance it is important to examine whether the organization in its job descriptions, policies, and training explicitly reinforced its expectations about confidentiality.
Aside from the practical moral problem of alienating donors who support the mission of the hospital, what commitments has the hospital made to the donors? Moral evaluation of the hospital's promise-keeping would have to include examination of what the donors explicitly requested, what development professionals promised, and whether administration knew about its potential stewardship of the gift.
Plainly, the problems cut across the organization. Manager X's challenges include how she could be a catalyst for administration to rethink its decision. Others groups, such as administration and development, must rethink how the commitments of predecessors will be honored. As hospitals move to address organizational ethics, they must not only identify and examine the problems, but also imagine where they are best resolved, for no one locus will be sufficient.
