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Deciding where to stand on ethics

Medical Staff Leader Connection, June 13, 2006

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A person who believes it is important to consider the interests and concerns of other stakeholders in a situation is said to act ethically. A person who acts only in his or her own interest, even when others are harmed, is said to act unethically. In what they say and do, all leaders consciously or unconsciously reveal to colleagues and coworkers their stance on the importance of ethics.

Physicians are usually champions of the professional ethic, which says that each patient should get the best care available, regardless of the impact on others. One frustration of modern-day medical practice is that a pure professional ethic is no longer possible because serving only one patient, with no concern for utilization of resources, will eventually lead a failure to give any patient what they need. Therefore, the best hospital leaders, physician and non-physician alike, learn to balance this ethic with allocation compromises that are better than the only available alternative: the rationing of healthcare.

When choosing an ethical approach to guide one's personal behavior, however, the range of choices is somewhat different. As a medical staff leader, use the following guidelines to decide where you will stand:

• The first choice is to "do what's right." Right in this sense means what is best for others -- altruism. A more feasible ethic is altruism tempered with reasonable self interest.
• The second choice is a compliance-only attitude. This means being concerned only with what is legal. When a person chooses this stance, the main motivation is fear.
• The third choice is to disregard both ethics and the law. A person who does so does not care about what is right or legal.

Most people act most of the time in ways that do not fit cleanly into these categories. Physicians must be allowed the opportunity to learn from their mistakes in the ethical tradition rather than being punished in the legal tradition. A non-punitive environment might encourage people to act ethically in a way that nothing else will.

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