1. Ethic Committees and Decision Making Chapter 3 HAS 4400

2. Milton Friedman has long maintained that the "sole aim of corporations is to maximize the profits for its stockholders.“ Yet, the events through the last third of the 20th century demanded that powerful corporations "be attentive" to the consequences their means to profit making was having on the environment, employment levels, and fair wages, among other things. As this latter view became more pronounced, it was referred to as the stakeholder theory, 1 which challenges the Friedman theory as too narrow. 1 William E. Evan and R. Edward Freeman

3. Addressing complex ethical questions must consider: State, federal, and local laws and regulations Organizational policy and procedure Organizational principles and values Professional and individual values of the decision maker Expectations and demands of the local community and a broader society

4. Guidance from Law and Regulation Externally imposed rules Addressing both Practice of medicine Business Extends beyond the institution and individual to relationships with: –Suppliers –Agents –Patients and –Third party payers

5. Guidance from Policy and Procedure Internally imposed –Institutional equivalent of of law and regulation Specific expectations and requirements for those doing the work of the organization

6. Guidance from Organizational Principles and Values Self-descriptive statements that define actual or aspirational standards of: –Personal –Professional –Organizational conduct Business terms –“customer service/customer satisfaction” Ethical terms –Integrity, honesty, and compassion

7. Guidance from Personal/Professional Values A set of principles and values that describe standards of conduct Professionally focused –Patient well-being and privacy Integrity Honesty Compassion

8. Guidance from Society and Community Some expectations of society are codified and others are not. –Respect for the patients and their family –Bedside manner –Responsiveness to unusual circumstances

9. The ethics spectrum Guidance from Law and Regulation Guidance from Policy and Procedure Guidance from Organizational Principles And Values Guidance from Personal/Professional Values Guidance from Society and Community

10. Generic decision-making process 1. Define the situation 2.Identify the options 3.Evaluate the options 4.Select the optimal option 5.Implement the decision 6.Evaluate the outcome

11. Ethical decision-making process 1. Define the situation using the 5points of the ethics spectrum P = Policy and procedures –Are there policies and procedures that I should consider in this situation? L = Law and regulation –Are there laws and regulations that I should consider in this situation? U = Universal organizational values –What organizational values apply to all situations and decision makers? S = Self –What guidance do my personal values provide in this case? S = Society –How do community/society values and expectations apply to this situation?

12. Ethical Decision-making Process 2. Identify the options: Typically characterized as a creative step Encumbered and degraded by premature evaluation

13. Ethical Decision-making Process 3. Evaluate the options –Use the five PLUSS questions for each. 4. Select the optimal option 5. Implement the decision –Until the decision is implemented nothing happens 6. Evaluate the outcome –Examine the consequences (intended and unintended) of the decision. –Once again apply the 5 PLUSS questions.

14. Blanchard and Peale’s “Ethics Check” Ethics Check 1. Is it legal? 2. Is it balanced? 3. How will it make me feel about myself? Consider Will I be violating either civil law or company policy? Is it fair to all concerned in the short term as well as the long term? Does it promote win-win relationship? Would I feel good if my decision were published in the news paper? Would I feel good if my family knows about my decision?