Ethical Considerations

in Leadership and
Management

Health Care ethics Team

Outline
• Ethical vs. Moral Dilemmas
• Ethical vs. Moral Decision Making
• Principles Involved
• Moral Discernment
• Well informed Conscience
• Ethical Approaches
• Processes of Ethical Decision Making
• Medical Care
• Meaning
• Service value
Ethical vs Moral Dilemma

• Ethical Dilemma - • Moral Dilemma - Evidence

indicates that an act is morally
When moral issues raise right and some evidence
questions that cannot be indicates the act is morally
answered with a simple, wrong; yet the evidence on
clearly defined rule, fact both sides is inconclusive; or
an individual believes that on
or authoritative view. moral grounds, he or she
cannot commit an act.
 Morals

• refer to social convention about right and wrong

human conduct that is so widely shared that it
forms a stable (although usually incomplete)
communal consensus (Beauchamp & Childress,
1994)
Moral Decision Making

• Is having the ability to decide

which is the right course of
action once an ethical issue is
spotted
Moral Decision Making
Process?
• Moral Awareness -
https://www.youtube.com/watch?v=snm01IG_PHU
• Moral Decision making -
https://www.youtube.com/watch?v=WZ2l89wEIwM
• Moral Intent -
https://www.youtube.com/watch?v=c0kJjyZZE7c
• Moral Action -
https://www.youtube.com/watch?v=OBSac1BjVOM
Ethical Decision Making

• Refers to the process of making informed choices

about ethical dilemmas based on a set of standards
differentiating right from wrong.
• Reflects an understanding of the principles and
standards, as well as philosophic approaches
• Requires a systematic framework for addressing the
complex and often controversial moral questions
• https://www.youtube.com/watch?v=n0uwTBrgqxI
 Why ethical decision-making?

• Ethical decision making is required when the healthcare executive must

address a conflict or uncertainty regarding competing values,
such as personal, organizational, professional and societal values
• Healthcare executives have a responsibility to address the growing
number of complex ethical dilemmas they are facing, but they cannot
and should not make such decisions alone or without a sound
decision-making process.
• The application of a systematic decision-making process can serve as a
useful tool for executives and others in addressing ethically challenging
situations.
What is necessary?

• have resources that may include ethics

committees, ethics consultation services, and
written policies, procedures and guidelines to
assist them with the ethics decision-making process.
• With these organizational resources and guidelines in
place, conflicting interests involving patients,
families, caregivers, the organization, payors
and the community can be thoughtfully and
appropriately reviewed in a timely manner (American
College of Healthcare Executive, n.d.)
So?

• Ethical decisions made by health care workers are shaped by the

decision maker and the process used to resolve ethical dilemmas
• although systematic guidelines for resolving ethical dilemmas offer
health care workers a logical approach to the decision-making
sequence, it is inevitable that will condition the ultimate choice of
action. discretionary judgments
• Health care workers are influenced by professional roles, practice
experiences, individualized perspectives, personal preferences,
motivations, and attitudes (Mattison, 2000)
Good decisions are both ethical
and effective:
• Ethical decisions generate and sustain trust; demonstrate
respect, responsibility, fairness and caring; and are
consistent with good citizenship. These behaviors provide a
foundation for making better decisions by setting the ground
rules for our behavior.
• Effective decisions are effective if they accomplish what we
want accomplished and if they advance our purposes. A
choice that produces unintended and undesirable results is
ineffective. The key to making effective decisions is to think
about choices in terms of their ability to accomplish our most
important goals. This means we have to understand the
difference between immediate and short-term goals and
longer-range goals.
Principles involved in EDM

• Principle of Discernment and Decision Making -

https://www.youtube.com/watch?v=xw1pDcbi0EE
(5:20)
• Principle of Well-formed Conscience
> indicates that people are obligated to inform themselves
about ethical norms, incorporate that knowledge into their daily
lives, act according to that knowledge, and take responsibility
for those actions (Lederer, 1995)
http://www.arthurstreet.com/MEDICAL_ETHICS1995.h
tm
Ethical Approaches

• https://www.youtube.com/watch?v=QIde5qRYvq
U
Processes of EDM
(Mastrian, McGonigle and Farcus, n.d)
• ETHICAL Model for EDM
• Examine the ethical dilemmas (conflicting values exist)
• Thoroughly comprehend the possible alternatives available
• Hypothesize ethical arguments
• Investigate, compare and evaluate the arguments for each
alternative
• Choose the alternative you would recommend
• Act on your chosen alternative
• Look at the ethical dilemma and examine the outcomes while
reflecting on the ethical decision
ETHICAL model to decision making

•E: Examine the ethical dilemma (Examine)

• Use your problem-solving, decision-making, and critical-thinking skills.
• What is the dilemma you are analyzing? Collect as much information about the dilemma as you
can, making sure to gather the relevant facts that clearly identify the dilemma. You should be
able to describe the dilemma you are analyzing in detail.
• Ascertain exactly what must be decided.
• Who should be involved in the decision-making process for this specific case?
• Who are the interested players or stakeholders?
• Reflect on the viewpoints of these key players and their value systems.
• What do you think each of these stakeholders would like you to decide as a plan of action for this
dilemma?
• How can you generate the greatest good?
ETHICAL model to decision
making
• T - Thoroughly comprehend the possible alternatives
available (Comprehend)
• Use your problem-solving, decision-making, and critical-thinking skills.
• Create a list of the possible alternatives. Be creative when developing your alternatives. Be open minded; there is
more than one way to reach a goal. Compel yourself to discern at least three alternatives.
• Clarify the alternatives available and predict the associated consequences-good and bad-of each potential
alternative or intervention.
• For each alternative, ask the following questions:
• Do any of the principles or rules, such as legal, professional, or organizational, automatically nullify this
alternative? If this alternative is chosen, what do you predict as the best-case and worst-case scenarios?
• Do the best-case outcomes outweigh the worst-case outcomes? Could you live with the worst-case
scenario? Will anyone be harmed? If so, how will they be harmed?
• Does the benefit obtained from this alternative overcome the risk of potential harm that it could cause to
anyone?
ETHICAL model to decision
making
•H – Hypothesize ethical arguments
(Hypothesize)

• Use your problem-solving, decision-making, and critical-thinking skills. Determine which

approaches apply to this dilemma.
• Identify the moral principles that can be brought into play to support a conclusion as to
what ought to be done ethically in this case or similar cases.
• Ascertain whether the approaches generate converging or diverging conclusions about
what ought to be done
ETHICAL model to decision
making
• I: Investigate, compare, and evaluate the argument for each
alternative (Investigate, compare, evaluate)
• Use your problem-solving, decision-making, and critical-thinking skills. Appraise the relevant
facts and assumptions prudently.
• Is there ambiguous information that must be evaluated?
• Are there any unjustifiable factual or illogical assumptions or debatable conceptual issues that
must be
• Rate the ethical reasoning and arguments for each alternative in terms of their relative
significance. explored?
4- extreme significance
3= major significance
2 = significant
1 = minor significance
ETHICAL model to decision
making
• C: Choose the alternative you would recommend (Choose)

• Use your problem-solving, decision-making, and critical-thinking skills. Make a decision

about the best alternative available. Remember the Golden Rule: Does your decision
treat others as you would want to be treated?
• Does your decision take into account and reflect an interest in the concerns and
welfare of all of the key players? Does your decision maximize the benefit and minimize
the risk for everyone involved?
• Become your own critic; challenge your decision as you think others might. Use the
ethical arguments you predict they would use and defend your decision. Would you be
secure enough in your ethical decision-making process to seeſt aired on national
television or sent out globally over the Internet? Are you secure enough with this
ethical decision that you could have allowed your loved ones to observe your decision-
making process, your decision, and its outcomes?
ETHICAL model to decision
making
• A: Act on the chosen alternative (Act on)

• Use your problem-solving, decision-making, and critical-thinking skills.

• Formulate an implementation plan delineating the execution of the
decision. This plan should be designed to maximize the benefits and
minimize the risks. This plan must take into account all of the resources
necessary for implementation, including personnel and money.
• Implement the plan.
ETHICAL model to decision
making
• L: Look at the ethical dilemma and examine the
outcomes while reflecting on the ethical
decisions (Look)
• Use your problem-solving, decision-making, and critical-thinking skills.
• Monitor the implementation plan and its outcomes. It is extremely important to
reflect on specific case decisions and evaluate their outcomes to develop your
ethical decision-making ability.
• If new information becomes available, the plan must be reevaluated.
• Monitor and revise the plan as necessary.
 Process of Ethical Decision-making
(American Colleges of Healthcare Executives, n.d)

1. Ask “What is the ethical question?”

- In identifying the ethical question, the health care professional needs to
look for the “shoulds”
- These “shoulds” are the normative questions (what should or ought to
happen according to norms or standards) as opposed to description
questions ( what actually happens)
- These “shoulds” relate to your duties and obligations as a professional
- Key distinguishing feature of ethical “shoulds” – they are concerned with
the well-being of others and are not self-interested or self-directed
Process of Ethical Decision-making
(American Colleges of Healthcare Executives, n.d)

2. Ask your first reaction to the case – “What is my ‘gut’ reaction? “What
is my ‘gut telling me to do on emotive level?
- Essential – need to identify your own values, assumptions and biases,
and then set them aside to critically analyze the situation

3. Gather relevant facts - both the known and those that you need to
gather
- Good ethics begins with good facts
- Proceed if you consider why you want to know something and how
will it change your analysis
- If certain facts as unclear- assume one set for analysis then change
the facts to see if your analysis would change
Process of Ethical Decision-making
(American Colleges of Healthcare Executives, n.d)

4. Ask “What are the values at stake in the

scenario?”
- Consider values from various perspectives – who
are the stakeholder? What is their perspective?
- Stakeholder – is someone who will be affected
by the decision to be made.
- The patient, the nurse and the physician, the
parents, other health care workers
Process of Ethical Decision-making
(American Colleges of Healthcare Executives, n.d)

5. Ask “What are the options in this case?”

- Specifically what could the nurse and resident physician
do in this scenario?

6. Ask “What should I do?”, “What do I think is the best

option based on the core values of the stakeholders?”

7. Ask “What justifies this choice?”

- Provide reasons to support your decisions based on
values at stake
- This includes the ethical theories and principles
Process of Ethical Decision-making
(American Colleges of Healthcare Executives, n.d)

8. Ask “How could this ethical problem have been

prevented?” “Are there any systemic changes that
could be made to prevent this problem from
happening again?”
Medical Care

• The provision of what is

necessary for a person’s health
and well-being by a doctor,
nurse or other healthcare
professional (Lexico, n.d)
Medical Care

• Service Value
- Levitt (1960) first to propose – value in marketing
field = If a product can please customers, then it
has its value to exist.
- Customer value is the gap between what the
customers get and what they give up in the
process of service delivery
Service Value (Lee, Chen, CW., Chen, CH.,
& Chen, CY, 2010)
Service Value

• Service value is conceptualized as

the consumer evaluation of the
utility of perceived benefits and
sacrifices (Hsu, 2018)