Clinical Ethicists’ Perspectives on Organizational Ethics in Healthcare Organizations (study)

The University of Toronto Joint Centre for Bioethics’ published a study on “Clinical Ethicists’ Perspectives on Organizational Ethics in Healthcare Organizations” highlighting four major organizational issues of concern:

  1. Resource allocation
  2. Moral distress and organizational moral climate
  3. Conflicts of interest 
  4. Clinical issues with a significant organizational dimension 

The study concluded that “the extent to which ‘clinical ethics’ cases were embedded with an organizational dimension…suggests that the common distinction between clinical and organizational ethics may be overdrawn in the practice of direct patient care…Where once the clinical ethicist’s role focused primarily on ethics in discrete clinical or research relationships, its focus is expanding to include ethics in a broader range of organizational relationships and issues.” (further detail below)

1. Resource allocation: clinical ethicists asked, “how do we make decisions about resources in terms of money, as well as staff, and how do other resources get distributed? What model or models of distributive justice or resource allocation…ought we to be considering.”

2. Moral distress and organizational moral climate: study participants were asked, “What keeps you up at night?” and “what do you feel best…and worst about in your work?” Moral distress indicate ethical issues in need of attention.  Seven factors were identified as important to maintaining a positive moral climate:

  1. alignment of decisions with the hospital’s stated values
  2. transparency about management processes, decisions and actions
  3. staff involvement in organizational decision-making
  4. opportunities to raise difficult ethical issues safely
  5. public recognition of admirable achievements
  6. respectful relationships among staff
  7. fair employment practices

4. Conflict of interest. Personal prestige and advancement were identified as potential conflicts of interest with providing quality patient care.

4. Clinical issues with a significant organizational dimension. Questoins were raised regarding access to care by uninsured patients, decisions related to disclosures of medical error, and end-of-life care.

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