Ethics and Professionalism for Healthcare Managers

By Elizabeth Forrestal

Healthcare managers face a host of difficult decisions every day. Many can be loaded with ethical implications that, if not addressed properly, can evolve into major issues for both the manager and the organization as a whole. This book prepares new and aspiring healthcare managers to make better decisions through a solid grounding in ethics and professionalism.

Using a three-part approach to engage students, the authors open each chapter with a case from the field, provide key foundational material related to the ethical or professional dilemma presented, and close with a minicase study and accompanying questions. Rich with cases throughout, the book uses examples that are based on a variety of healthcare settings, including hospitals, physician practices, ambulatory surgery centers, home health agencies, and skilled nursing facilities.

Material covered includes the following and more:

Basic ethics concepts Ethics and the professional Stewardship Professional codes of ethics and ethical principles Ethical decision making Clinical interactions Human resources Health informatics

The text also contains a running glossary, end-of-chapter summary points, exercises, and self-quizzes to reinforce essential concepts.

• Language: English
• Publisher: Health Administration Press
• Release date: Sep 1, 2016
• ISBN: 9781640552265

Book preview

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CHAPTER 1

THE PROFESSION OF HEALTHCARE MANAGEMENT

We serve on the behalf of our community, but we're also responsible for the people who work in our organization.

—Wayne Lerner, 2013 ACHE Gold Medal Award recipient

LEARNING OBJECTIVES

Studying this chapter will help you

explain the concept of profession,

identify characteristics of professions and professionals,

appreciate the values of professionals, and

understand the process of professionalization and healthcare management's stages of evolution.

The purpose of this chapter is to guide you—a future healthcare manager—in developing a sense of healthcare management as a profession and healthcare managers as professionals. In this chapter, we explore the meaning of profession in general and in the healthcare field particularly. We also discuss the characteristics, values (such as altruism), and stages of professionalization in healthcare administration. (Professionalism is discussed fully in Chapter 3 .)

Profession

A body of knowledge shared by a group of individuals with specialized education and training and common values

WHAT IS A PROFESSION?

In everyday language, when we ask people what their profession is, we are actually asking about their job. Sociologists such as Talcott Parsons (1954), on the other hand, are more specific in their use of the word, defining the word by its core set of components. One such definition includes these core components (in italics) (Southwick 1997):

In 2013, Wayne Lerner was one of two recipients of the Gold Medal Award, American College of Healthcare Executives's (ACHE's) highest honor. Lerner, who has served in many healthcare executive positions and is currently the CEO of Holy Cross Hospital in Chicago, has been called selfless—someone who puts his staff and the community his organization serves ahead of himself. In fact, as the chapter-opening quote explains, he viewed service to others as part of his professional duties.

As an example of putting the community first, Lerner fully encouraged and aided the merger between his hospital and another facility because he knew it would be beneficial to people in the area; unfortunately, the consolidation did push him out of his job, a consequence that he anticipated and was willing to face (Selvam 2013). His altruism was no surprise to his peers. His long-time friend Howard Berman, a recent inductee into Modern Healthcare’s Health Care Hall of Fame, said that Lerner was willing to fall on his own economic sword if it would benefit the community (Selvam 2013, 30). In addition, Lerner did not forget his staff members, saying, The most important thing you can do is walk in their shoes…. You need to take a breath once in a while and realize folks within our organization are working one or two jobs in order to support their families (Selvam 2013, 30).

A profession is "a disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognized, organized body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others."

Professionalism is related to this definition. It—according to the Healthcare Leadership Alliance (HLA), a consortium of healthcare professional associations—is the ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and the community, a service orientation, and a commitment to lifelong learning and improvement (Garman et al. 2006, 219).

These definitions support our belief that ethics and professionalism are intertwined. One enhances or strengthens the other. Striving to achieve the high-level education, training, and public service expected of a profession is equally important to your career. As you move through this book, you will repeatedly encounter the core components of a profession, so keep them in mind:

Disciplined

High ethical standards

Special knowledge and skills

Body of learning

Education and training at a high level

Interest of others

CHARACTERISTICS

Leading experts often describe professions and professionals in terms of characteristics. Two characteristics common to professions and professionals are possessing systematic knowledge and adhering to professional norms (Larson 1977).

POSSESSING SYSTEMATIC KNOWLEDGE

Systematic knowledge is the hallmark of a profession. It is represented in our list of profession components as special knowledge and skills and body of learning. Professionals use their systematic knowledge to solve problems and make decisions. For example, healthcare managers use their healthcare operations knowledge and their computer skills to manage medical supply inventories.

Both the general public and individuals in a field recognize that systematic knowledge belongs exclusively to that specific profession. This knowledge—published in various textbooks, journals, manuals, and other authoritative sources—defines the profession's scope of activities and responsibilities. Systematic knowledge in the following areas is needed by undergraduate students in healthcare management, according to the Association of University Programs in Health Administration (AUPHA 2014):

US healthcare system

Population/community health

Organizational development/organizational behavior theory

Management of healthcare organizations

Operations assessment and improvement

Management of human resources and health professionals

Information systems management and assessment

Healthcare law

Governance

Health policy

Leadership

Statistical analysis and application to decision making

Healthcare economics

Healthcare marketing

Financial analysis and management

Ethics in business and clinical decision making

Strategy formulation and implementation

Quality assessment for patient care improvement

Managerial epidemiology

Research methodology

These broad topics are then subdivided into specific skills known as competencies. An example of a competency is apply inventory management measurements and techniques.

Education and training at a high level are the best methods for acquiring systematic knowledge. For example, healthcare management students pursue an extensive and defined course of study at a college or university. Systematic knowledge acquired through experience only, such as on-the-job training or an apprenticeship, is not a sufficient substitute for formal education and training. Experience, though, can reinforce and bolster academic learning. In fact, over time, the results of experience—after they are verified and then published by researchers—may become part of the systematic knowledge. The key point, however, is that professionals attain systematic knowledge after a long and intense period of formal academic study.

Systematic knowledge

Facts, tools, and theories of a field organized into a unique body of knowledge

ADHERING TO PROFESSIONAL NORMS

Professionals follow the standards of behavior or professional norms that exist in their respective profession. Exhibit 1.1 provides examples of these norms. High behavioral standards are taught, role-modeled, and instilled during a student's education and training in the field, interactions with established professionals, and internship (if applicable). Often, norms are implied or understood, rather than openly stated. Because compliance with norms is assumed, professional norms are a form of control, dictating the behavior of every member of a profession.

Professional norm

Internalized standard of conduct to which professionals automatically and unconsciously conform

VALUES

Professional values represent the basic and fundamental beliefs of the profession's members. In this sense, values define a profession and guide its members. As professionals make work-related decisions and take actions daily, they uphold and apply these values.

As a profession develops, its members form a disciplined group known as a professional association, organization, or society. Members of an association share a bond with, or feel a sense of connectedness to, their fellow members. This bond is the result of (1) having similar educational and work experiences and (2) being held to the same norms and values.

Associations influence the actions and attitudes of their members by being referents for their members; that is, members look or refer to them for guidance on various matters. Formally, associations administer disciplinary actions—such as censure and revocation of credentials—to members who violate standards and ethical codes. Informally, members can ostracize other members who breach the rules or disobey norms.

In short, as a referent, the association essentially sets the values of its membership. The membership, in turn, preserves and perpetuates these values by applying them and expecting others to live by them. In healthcare management, the professional values include public service, self-regulation, sense of calling and meaningful work, and autonomy.

Value

Basic and fundamental belief of the members of a profession

Referent

Entity, such as a professional association, to which its members look for guidance

PUBLIC SERVICE

One value that healthcare professionals share is public service. To uphold this value, the professional needs to be altruistic or willing to sacrifice personal needs or gains for the good of others, as illustrated by our earlier case about Wayne Lerner. Altruism is the quality that makes professionals think and act in the interest of serving the community. Without it, healthcare could become a profession of people pursuing their own interests or selfish goals, instead of a public service that everyone can rely on.

Another example of a selfless leader is A. Hugh Greene, the president and CEO of Baptist Health in Jacksonville, Florida, and a Fellow of ACHE (FACHE), the premier credential in the healthcare management profession. In 2013, he was honored with Modern Healthcare’s 2013 Community Leadership Award for his 20-year-long work to provide healthcare access to the homeless and uninsured populations in his area. The president of the Florida Hospital Association explains that Greene advocates for the greater goal and pitches in even when it isn't going to benefit him directly (Landen 2013, 19). Like Lerner, Greene sees community service as the fulfillment of our community social responsibility (Landen 2013, 19).

Both leaders echo the ACHE Code of Ethics, which regards public service as responsibilities to community and society and, consequently, advises healthcare executives to (1) identify and meet the healthcare needs of the community, and (2) support access to healthcare services for all people (ACHE 2011). By using their systematic knowledge of the healthcare system (including managerial skills and tools), healthcare professionals can do a lot to serve their particular patients and communities as well as to improve healthcare delivery and promote health for the good of society overall.

Altruism

Sacrificing oneself for the public good

SELF-REGULATION

Self-regulation is another value in healthcare management. It is a privilege society grants to members of a profession to govern themselves. It includes determining educational standards, establishing qualifications for practice, and disciplining members (Sullivan 2004). For example, state statutes establish boards of nursing home administrators (NHAs) to administer training programs, set qualifications, develop and administer tests, issue licenses, investigate complaints of noncompliance with state statutes, and build enforcement programs for disciplinary actions for NHAs (Sullivan 2004). In exchange for the privilege of self-regulation, the public expects members of a profession to

be competent and practice within their scope or domain,

behave ethically and adhere to a code of ethics, and

serve the greater good.

In healthcare, the primary purpose of self-regulation is to improve society's health. To this end, professional associations have policies, standards, and rules intended to support and promote achievement of high-quality care.

Self-regulation

Ability to govern or monitor oneself

A CALLING AND MEANINGFUL WORK

Many professionals consider their work a calling, something they are born to do and thus want to pursue at all cost. For example, in describing his public service, Greene said, I see it [public service] as fundamental to who we are (Landen 2013, 19). Sullivan (2004) adds that professionals have a great attachment to the intrinsic rewards of their work, such as work that is meaningful and that makes a difference. This attachment is exemplified by a statement by Christie Candio, FACHE, the 2014–2015 chair of ACHE: My goal has always been and continues to be to make a difference in and have a positive impact on the lives of the people we serve (Squazzo 2014, 11).

Answering this professional calling and doing meaningful work are values and are highly valued in any profession. Professionals believe that their work is a large part of their being. As such, they are devoted to helping their profession flourish.

AUTONOMY

Professionals value their autonomy—the ability to independently (1) organize their own work, (2) make decisions that affect them, and (3) take actions. The basis of this autonomy is the professional's systematic knowledge, values and standards, and commitment to public service (Irvine 1997).

Professional autonomy and patient autonomy differ. The former is the professionals’ authority and freedom to regulate themselves and act within their spheres of competence (Wilensky 1964, 146). Professionals believe that they are free to exercise their decision making and only other peer-professionals are competent to question their decisions (Hall 1968, 93).

Patients’ autonomy, on the other hand, is about self-determination, or the right to make decisions regarding their own healthcare. To exercise autonomy, patients (and their families) should be fully informed of their options and healthcare providers (professionals) should respect their rights. Patients’ autonomy is discussed fully in Chapter 9.

The extent of this autonomy depends on the work setting. For example, in private healthcare management consulting firms, a professional's decisions are subject to only her own review and her professional association's review. On the other hand, in hospitals, large healthcare organizations, and government agencies, the professional's work is subject to complex external legislative and administrative rules and to routine supervision.

STAGES OF PROFESSIONALIZATION

Through the process of professionalization, occupations evolve into professions (Hall 1968; Wilensky 1964). Professionalization is generalized into stages, based on how the early professions of the law, medicine, and the ministry evolved into professions. Not all professions follow the exact same sequence of evolution, and not all professions fully demonstrate all the stages.

The general order of the evolution of the healthcare management profession and a brief description of each evolutionary stage are discussed in this section.

STAGE 1: FULL-TIME OCCUPATION

The evolution begins when the occupation becomes full time. For example, hospital administration started as a profession in the early 1900s, when the concept of the modern hospital emerged. At that time, hospitals, seeking to dispel their image as disease-ridden poorhouses, began to adopt the latest medical technology to emphasize that they were modern, scientific institutions (Arndt and Bigelow 2007). Full-time hospital administrators, then known as superintendents, came to be needed to manage the acquisition of and payment for the technology.

Once full time, professionals devote time, money, and attention to their profession—unlike amateurs and temporary practitioners, who are generally excluded from the status of professional.

STAGE 2: FORMAL TRAINING

The second stage is formal training. Professions establish formal education and training in colleges and universities as a prerequisite to full-time practice. In the past, professionals in a field received their training on-site or on the job (as an apprentice, for example) or were hired from related or other disciplines. For example, in the early 1900s, hospital administrators used to be managers in manufacturing companies, and they applied general business practices from their industry to hospital operations (Arndt and Bigelow 2007).

In the 1930s, the first master's program in hospital administration (now referred to as health administration, healthcare management, or healthcare system administration) was established at the University of Chicago (Davis 1984). Other professions followed a pattern similar to that followed by the healthcare management profession. Today, possessing a college degree, at a minimum, is often associated with (and is often a requirement of) being a professional.

STAGE 3: PROFESSIONAL ASSOCIATION

Graduates of formal training programs and/or veteran practitioners and leaders formed the first associations, ushering in the third evolutionary stage. Exhibit 1.2 presents some associations in the healthcare management field; the list presented here is not at all exhaustive.

Professional associations serve as a platform for gaining recognition for the profession and its practitioners. Associations define their respective areas of expertise and educational domain, standards for competent practice, and appropriate behaviors for members. Qualification for membership includes the individual's work functions and responsibilities as well as academic and professional credentials. Exhibit 1.3 lists some of these credentials.

The primary purpose of associations is twofold: to advance the profession and to advocate for their members. As a public service and on behalf of their members, associations issue press releases or statements about current events in their area of expertise. They respond privately or publicly to proposals that affect their membership. In August 2014, for example, the Healthcare Financial Management Association sent a letter to the Centers for Medicare & Medicaid Services (CMS) regarding proposed rules for outpatient payments in fiscal year 2015 (HFMA 2014). Additionally, the associations offer their members access to job postings; opportunities for networking; continuing education programs; publications and other resources; and discounted rates on various products and services, such as books, guides, and advertising. Through myriad activities, associations increase the visibility of their respective profession and membership as well as give them a clear, united voice.

STAGE 4: SELF-REGULATION

The fourth stage is self-regulation, the privilege of a profession to govern itself. To do this, professions control entry into the field and monitor the quality of practice by developing and enforcing standards for

educational and training programs,

academic and professional certification or credentials, and

the licensure process.

First, educational and training standards include a curriculum defined by an accreditation or certification body in the field. To be accredited or certified, educational and training programs must provide evidence that they teach the curriculum. In the 1900s, associations served as the accreditation or certification body; however, in the 2000s, accountability shifted to stand-alone entities that are associated with but independent of associations. In healthcare administration, graduate programs are accredited by the Commission on Accreditation of Healthcare Management Education (CAHME), and undergraduate programs are certified by the Association of University Programs in Health Administration (AUPHA).

Second, associations control the eligibility requirements to earn certification, which represents excellence in practice and service. One type of certification is academic credentials, such as MHA (master of health administration). Another type of certification is professional credentials, such as Fellow of the American College of Healthcare Executives; see Exhibit 1.3 for a nonexhaustive list of credentials in healthcare management. Both academic and professional achievements and experiences are part of the eligibility criteria, and so is passing a rigorous test. In healthcare administration, a certification test includes items on operations, management and leadership, finance, statutes and regulations, facility design and maintenance, quality and risk management, strategic planning, and human relations. Professionals are expected to maintain their certification by participating in continuing education.

Third, through licensure, professions have the legal right to exclude nonqualified individuals. State legislatures pass statutes that (1) define the profession and its scope of practice and then (2) delegate the authority to enforce rules to the profession's regulatory body (such as a board of examiners), which then issues licenses. In healthcare management, some professionals who need a license to practice include nursing home administrators, assisted-living administrators, and risk managers.

To apply for a state license, qualified candidates must provide several documents, including (but not limited to) the following:

Official transcripts of academic degrees from accredited institutions

Other educational records, such as courses taken or training completed

References, at least one of which from an employer

National examination score of at least 75 percent (passing)

Licenses are issued for a specified period, so the documents for a renewal application must show the specified time span. Renewal often requires continuing education documentation.

The regulatory body (or state) maintains a registry of licensed individuals and sanctions those who are incompetent or violate codes of ethics. These sanctions vary, depending on the severity of the violation, and may involve these:

Official letter of reprimand or censure with public notification

Restriction in the scope of practice, such as requiring a preceptor present during practice or banning from performing certain procedures

Suspension of the license to practice for a period or until a stipulation has been met, such as completion of a remedial course

Permanent revocation of license

STAGE 5: CODE OF ETHICS

The final stage is the development and enforcement of a code of ethics. The primary purpose of the code of ethics is to hold members of a profession to high ethical standards.

Codes vary by discipline. However, they share the same underlying principles, emphasizing

beneficence (doing good),

honesty and integrity,

justice,

fidelity, and

sanctity (respect for all individuals’ dignity and life).

Associations, which develop and disseminate their own codes, expect members to uphold the standards in their professional dealings and relationships—with patients and their families, employees, colleagues, superiors, and the community. Codes also serve as the basis of disciplinary actions taken against members who violate accepted behaviors and practice. Here are two examples of codes of ethics for healthcare managers:

Code of Ethics of the American College of Healthcare Executives (ACHE 2011)

Code of Ethics and Disciplinary Procedures of the Medical Group Management Association–American College of Medical Practice Executives (MGMA–ACMPE 2009)

Chapter 5 further discusses various codes of ethics in the healthcare management profession.

Code of ethics

Standard of behavior and conduct for members of a profession

MINI-CASE STUDY: CODING ERROR IN ORTHOPEDICS

For six months now, you have been an assistant administrator in a large orthopedic group practice. You feel fortunate because your capstone experience as a student in a healthcare management program was in a similar physician practice.

Currently, you are reviewing reimbursements received from Blue Cross. Several large federal agencies are based in your city, so many Blue Cross payments are for patients enrolled in the Federal Employee Health Benefits Program. You are confused by the discrepancy you found while matching each patient's medical record with its claim and reimbursement. The claims for office visits of returning patients were submitted using the higher code of consultation.

From your capstone experience, you learned that the office visits of returning patients are not generally coded as consultations. It appears then that the practice is upcoding services to fraudulently inflate its reimbursements. You bring your concerns to your boss, the practice's CEO, who says, Our coders are certified. Plus, our orthopedic surgeons are the best in the area. They only treat the most complex cases, which are equal to consultations. Don't worry about it. The CEO then reassigns you to updating the practice's strategic plan and tells you to drop the reimbursement review.

After thought and preparation, you set up an appointment to meet with the practice's medical director.

A claim is a request for payment that itemizes services, dates, and costs. Healthcare providers (such as hospitals, physicians, and other practitioners) submit claims to payers (such as Medicare, Medicaid, healthcare insurance plans, and workers’ compensation). Patients may also submit claims for benefits based on the terms of their health insurance policy.

Healthcare providers use codes when they submit claims to payers. Payers use these codes—rather than any clinical narrative statements—to determine payment to providers. Coding is the process of transforming clinical narrative statements for diagnoses and procedures into numerical or alphanumerical representations. Two commonly used sets of codes are the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). For example, orthopedic surgeons use ICD codes to represent their patients’ diagnoses (such as knee pain) and CPT codes to represent the services they rendered to patients (such as evaluation and management of knee pain). Several codes exist for evaluation and management, representing various settings (office or emergency department), levels of difficulty (returning patient or consult), and complexity (problem focused or comprehensive). To submit an accurate claim and, subsequently, receive correct payment, providers should make sure that the code recorded matches the service rendered.

MINI-CASE STUDY QUESTIONS

What documents would you bring to your meeting with the medical director?

What professional standards has the CEO violated?

Is it likely that the CEO is licensed?

Which credentials—academic and professional—could the CEO hold?

Would you immediately report the CEO to her association's professional standards committee (or a similar entity that investigates violations of professional standards)?

What laws have been broken? Who should be held responsible?

Should you find another job?

POINTS TO REMEMBER

A profession is a body of knowledge shared by a group of individuals with specialized education and training and common values.

Two common characteristics of professionals are possessing systematic knowledge and adhering to professional norms.

Values important to professionals include public service, self-regulation, a sense of calling and meaningful work, and autonomy.

Professions evolve through a multi-stage professionalization process. Although generally similar, the stages vary slightly from one profession to the next.

The development and enforcement of a profession's code of ethics is one important stage. The code not only sets the ethical standards for professional conduct but also serves as the basis of disciplinary actions taken against those who violate accepted behaviors and practice.

CHALLENGE YOURSELF

Based on what you've read in this chapter, are professional athletes professionals? Why or why not?

How can you acquire and maintain the systematic knowledge of healthcare management?

How can you incorporate the healthcare management profession's norms into your daily thoughts, beliefs, and actions?

Find and categorize examples of behaviors or actions, excluding examples given in this book, for each of the values of healthcare administrators. The behaviors and actions may come from your personal experiences, work experiences, recent events, and historical events.

What professionals are licensed in your state? Do you think all healthcare administrators should be licensed, not just those who work in certain settings? What are the advantages and disadvantages of licensure?

FOR YOUR CONSIDERATION

1.1 What similarities and differences can you find between the codes of ethics of ACHE and MGMA–ACMPE?

1.2 The ACHE Code of Ethics section I. C states that healthcare executives shall Comply with all laws and regulations pertaining to healthcare management in the jurisdictions in which the healthcare executive is located or conducts professional activities. In your other courses have you learned laws or regulations to which this responsibility might be referring? Why would the code make compliance with laws and regulations a responsibility?

REFERENCES

American College of Healthcare Executives (ACHE). 2011. Code of Ethics. Accessed October 10, 2014. www.ache.org/abt_ache/code.cfm.

Arndt, M., and B. Bigelow. 2007. Hospital Administration in the Early 1900s: Visions for the Future and the Reality of Daily Practice. Journal of Healthcare Management 52 (1): 34–47.

Association of University Programs in Health Administration (AUPHA). 2014. Revised Criteria for Undergraduate Certification. Accessed October 9. www.aupha.org/membership/certification.

Davis, M. M. 1984. Development of the First Graduate Program in Hospital Administration. Journal of Health Administration Education 2 (2): 121–34.

Garman, A. N., R. Evans, M. K. Krause, and J. Anfossi. 2006. Professionalism. Journal of Healthcare Management 51 (4): 219–22.

Hall, R. H. 1968. Professionalization and Bureaucratization. American Sociological Review 33 (1): 92–104.

Healthcare Financial Management Association (HFMA). 2014. HFMA Comments to CMS on the 2015 Medicare OPPS Proposed Rule. Accessed October 10. www.hfma.org/Content.aspx?id=24766.

Irvine, D. 1997. The Performance of Doctors. I: Professionalism and Self Regulation in a Changing World. British Medical Journal 314 (7093): 1540–42.

Landen, R. 2013. Offering Service, Leadership When It's Needed Most. Modern Healthcare 43 (46): 18–19.

Larson, M. S. 1977. The Rise of Professionalism: A Sociological Analysis. Berkeley, CA: University of California Press.

Medical Group Management Association–American College of Medical Practice Executives (MGMA-ACMPE). 2009. Code of Ethics and Disciplinary Procedures. Accessed October 17, 2014. www.mgma.com/codeofethics/.

Parsons, T. 1954. The Professions and Social Structure. In Essays in Sociological Theory, revised ed., edited by T. Parsons, 34–49. Glencoe, IL: Free Press.

Selvam, A. 2013. ACHE Gold Medal Award. Selfless Leadership. Lerner's Healthcare Career Spans Four Decades. Modern Healthcare 43 (5): 29–30.

Squazzo, J. D. 2014. An Interview with ACHE's 2014–2015 Chairman. Healthcare Executive 29 (2): 10–16.

Southwick, J. 1997. Can the Professions Survive Under a National Competition Policy? Archives of Conference on National Competition Policy & the Professions 1997. Accessed April 2, 2015. www.professions.com.au/advocacy/archives/item/national-competitionpolicy-the-professions-1997.

Sullivan, W. M. 2004. Can Professionalism Still Be a Viable Ethic? Good Society 13 (1): 15–20.

Wilensky, H. L. 1964. The Professionalization of Everyone? American Journal of Sociology 70 (2): 137–58.

CHAPTER 2

BASIC CONCEPTS OF ETHICS

There is nothing so practical as a good theory.

—Kurt Lewin, social and organizational psychologist

LEARNING OBJECTIVES

Studying this chapter will help you

explain the concept of ethics,

enhance your awareness of the potential ethical perspectives of healthcare professionals,

become familiar with the terms and theories of ethical conflicts, and

examine your own values and ethics.

This chapter introduces you to the different branches of ethics and its various theories. In studying ethics, you examine how you relate to others and to the world in terms of the general nature of morals, specific choices you (or others) make, conflicts you (or others) face, and processes you use in making moral judgments.

Ethics

A system of beliefs and behaviors that people value and use to control their conduct; the study of the moral life

WHY STUDY ETHICS?

The study of ethics dates back to humanity's earliest times. Beginning in the fifth century BCE, the Greeks pondered the meaning of life and the rightness or wrongness of actions. At about the same time in China, Confucius wrote about respecting humanity, acting to do good, and supporting the social order.

In today's healthcare world, the study of ethics is alive and well, assisting administrators, clinicians, researchers, and policymakers grapple with questions and challenges.

Amanda Cashi was a district sales manager for a medical device manufacturer. The manufacturer—then known as Fox Hollow Technologies, Inc., and now known as ev3—made and sold the SilverHawk Placque Excision System. The SilverHawk was a small cutting device that removed atherosclerotic plaque from blood vessels.

Cashi, as a whistleblower acting on behalf of the federal government, filed a lawsuit alleging that the manufacturer violated the federal False Claims Act. According to the US Department of Justice (DOJ), the manufacturer allegedly caused 12 hospitals in nine states to admit patients as inpatients for procedures involving its SilverHawk device, even though many of those patients should have been treated as outpatients at significantly less cost. As a result of this scheme, the hospitals would receive higher Medicare payments and the manufacturer would have higher sales.

In February 2015, DOJ announced that the manufacturer would pay $1.25 million to settle the allegations that it caused hospitals to submit false claims to Medicare. Commenting on the settlement, the acting assistant attorney of DOJ's Civil Division said, Charging the government for higher-cost inpatient services that patients do not need wastes the country's precious health care resources. Cashi, under the False Claims Act's whistleblower provisions, received $250,000 as her portion of the government's settlement (DOJ 2015).

Technology has advanced faster than people's understanding of how it should be used (Marshall 1999). When medical technologies are expensive and budgets are tight, for example, should the healthcare system invest its limited dollars in (1) ever more sophisticated and costly technologies that help a select few or (2) less costly preventive medicine and health promotion that have the potential to help many? (Hiller and Coburn 1988). Examining the ethical components of the many decisions and choices encountered in the healthcare system enables healthcare managers to develop a more comprehensive response or approach.

ETHICAL BRANCHES

An ethical branch is a major category of ethics composed of clusters and families of theories that share characteristics or functions. The four common branches are descriptive ethics, normative ethics, moral psychology, and applied ethics.

Ethical branch

Major category of ethics composed of clusters and families of theories that share characteristics or functions

DESCRIPTIVE ETHICS

Descriptive ethics—also called comparative ethics or empirical ethics—describes how people actually behave in the face of ethical problems and choices. It does not prescribe (command) what people ought to do or proscribe (forbid) what they ought not do. It can be at the level of either the individual or society, providing valuable insights into how people reason, how corporations conduct business, or how societies function.

This ethical branch came to be because people and cultures have different values. When social scientists—such as anthropologists, sociologists, and organizational theorists—write about descriptive ethics, they usually discuss various societies’ definitions of moral behavior and norms (internalized societal expectations). For example, organizational theorists may explain what the people do and what they believe in a corporate culture of deceit and trickery (corporation in this case being a mini-society). No value judgments are made in these writings.

In descriptive ethics, behavior is not judged because universal truths and ethical principles do not exist. As a consequence, some people negatively call descriptive ethics relativism, which means that judgments of moral values, truth, and goodness vary by the individual's or society's historical, religious, or cultural perspective.

Principle

General prescriptive judgment

NORMATIVE ETHICS

Normative ethics—also called prescriptive ethics—stipulates what people should do or should not do in the face of ethical problems and choices. Its name is derived from norms, and as such prohibits courses of action or behaviors that violate societal standards.

To help people determine the proper actions and behaviors, normative ethicists precisely define terms, such as right, wrong, good, obligation, and duty. In this ethical branch, universal truths, such as good and right, exist.

MORAL PSYCHOLOGY

Moral psychology examines how people