They must be knowingly factored into any analysis. Generating profit, by itself, is inherently ethically neutral. Ultimately the market decides who "deserves" to survive by where consumers put their money. One must remember that the insured health care consumer selects health insurance based on a number of considerations, one of which is price.
Gradually, American purchasers are becoming more savvy about the costs and consequences of their health insurance choices. An ethical decision always involves a specific situation within a local context see Table 4. In a health care situation, this context would include, at the national level, the parameters of health care policy formulated through legislation. Those of us employed in the health care sector of the economy hold industry-based values Gordon, ; Harrison, -- that is, a somewhat coherent framework of beliefs that interpret our work and place in society.
During the 90's, for example, practitioners of all clinical specialties have tended to share a collective disdain for the negative effects of managed care on patient care. A related value shared by most health care workers is that, within the U. Professional standards of practice for nurses, established by the American Nurses Association and other professional associations, demarcate the boundaries of the discipline. Context would also include local and state laws or regulations, culture, and demographics. Context makes a difference.
Advanced practice nurses, for example, face variations in state practice acts that govern what is, or is not, allowed within the scope of practice. Context influences what we select as the "right" thing to do. The local context would include the influence of gender Gilligan, ; Kohlberg, , and an individual's family and social network, which largely determine how one is socialized.
Schools, churches, communities, treatment by friends and peers, and local leaders all contribute to the developing person's conception of right and wrong. Importantly as a tributary of ethics, local context would also include the organization or setting in which an individual works. Managerial ethics assume a position of profound consequence here in the form of organizational policies and processes, culture, espoused vs. Organizational policies and procedures dictate actions which may have ethical content cf. Through organizational socialization, employees learn what constitutes acceptable behavior.
The ethical conduct of leaders -- or lack thereof -- has a subtle but profound influence on the behaviors of all employees Donaldson, ; Paine, , ; Steward, ; Wilhelm, Much of the literature on business ethics considers situations of relatively blatant and consequential misconduct, e.
An Inclusive Look at the Domain of Ethics and Its Application to Administrative Behavior
Wetlaufer, , physical or emotional injury to others, conflict of interest, etc. In some cases, the organization may be dependent upon the wrongdoing 5. The most prevalent sources of ethical action, however, are the little everyday actions of managers which, though of no immediately visible consequence, build to create the ethical climate. To examine ethical behavior in management, one must bring into view the unavoidable and dynamic influence of money and power e. Their influence can create a bias that, over time, may lead to what one would consider an unethical outcome. The following case scenario see Table 5 is an illustration.
When a situation is presented that calls for an ethical decision, the history of human cultures tacitly flows through the individual-in-context. As described in the preceding discussion, the stream is wide and deep from which a "cup" of ethics, or ethical choice, is drawn. Rarely is the individual faced with an ethical challenge conscious of the depth and breadth of the domain of ethics. Often the imperatives of the local context, e. Time limitations are a constraint.
Through individual critical, principled reasoning about the presenting situation, a decision is made and action taken. If, however, the individual's ethical reflection takes account of the historical, cultural, and contextual elements of the situation, a more complex analysis can occur. In the case of Mrs.
Some of these broader factors would include:. In this community, there may be other borderline-competent elderly living at home. That is, if this type of situation is likely to re-occur, one must take into account not just Mrs.
Community and cultural demographics would play a role as well in how problems of this nature would be addressed. Respect for autonomy is an important ethical principle but insufficient to resolve the situation. The nurse needs to understand local and state law on what constitutes mental competency, and to know the legal process required for assuming power of attorney. It would be relevant to the nurse's thinking to understand the historical catalyst that led to agency policy on discharging incompetent patients living alone at home.
To resolve a conflict between agency policy discontinue service to Mrs.
R and professional responsibility beneficence, nonmaleficence, respect for autonomy , the well-grounded nurse would seek counsel and guidance from agency leaders. On the basis of existing standards for professional conduct and out of respect for one's colleagues, the nurse should consider whether her coworkers would be comfortable with how she chooses to handle the situation. In addition to the potential for future effects on peers from the nurse's actions, colleagues are the appropriate players to judge each other by the standard of what a "reasonable nurse" would similarly do.
The nurse would be well-advised to seek out peer input. The nurse's personal moral stance in how the case should be handled is one factor among many. For example, perhaps this nurse has a commitment to values of altruism and individual rights that could influence her actions. R, the parameters of the Nurse Practice Act in her state, and the implications of her actions for the agency and other clients in the future?
It is sometimes easy to forget that one's professional choices and actions both reflect on and have consequences for one's professional peers. This area is part of comprehending one's immediate context in which an ethical situation arises. For example, if the nurse caring for Mrs. What if something valuable was missing from Mrs.
R's home after the nurse had visited? It is possible that the family could find the nurse negligent in not placing the patient in protective custody. And, there would be the potential for the family to bring suit against the agency because the nurse became involved with Mrs.
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Negative publicity can affect agency referrals, caseloads, and perhaps cash flow and people's jobs. Alternatively, the nurse might get some positive publicity for her selfless care of Mrs. Then might other nurses be asked by their patients if they could provide similar off-duty assistance? If not, considering principles of justice and equality, why not? Regarding the nurse's personal moral stance, it is always valuable for individuals to understand their own values, whether they derive from humanitarian, spiritual, or cultural beliefs.
Morality is a particularly challenging element of ethics because morals are derived, directly or indirectly, from religious teachings, yet one's individual morals are personal and unique. Many nurses carry a humanitarian drive or sense of moral agency that underlies their choice of work in health care. Values associated with morals can cause the nurse to be biased in favor of a particular ethical action. When values are known at a conscious level, they serve to inform one's actions.
When present but not consciously known, values influence one tacitly -- and potentially inappropriately. In ethical decision making, one's individual morality is part of the whole analysis -- but alone, it should not be determinative. It is essential to know clearly the boundary between self and situation. This author disagrees strongly with several authors 6 who assert that the domain of ethics and morality are identical Fletcher et al.
In contrast, this author encourages health workers to incorporate laws, regulations, professional codes of conduct, cultural values, and mandates of the context into ethical reflection. In addition to morality, these elements inform the ethical choices that prompt action. To encourage obedience to morality as a higher order value system than law, government regulation, or agency policy, is deeply problematic. When a conflict exists and one acts on personal morality, the obvious and disturbing question is, whose morality prevails?
Except insofar as morality refers generically to an individual sense of right and wrong, it is not a universal template. Nor is it neutral. Morality assumes its rightful place within a doctrine of relativism, not absolutism 7. One person's moral sanctions are another person's right to freedom and self-determination. While laws, regulations, or policies are based in part on moral beliefs and are hardly neutral themselves, they do strive to set societal and collective rules that are more inclusive of diverse beliefs than do individual forms of religiously- or philosophically-derived morality.
Worthley notes that "rules, like laws, serve best at regulating relationships between strangers or adversaries" , Personal values and nursing's professional values, e. A nurse's sense of righteous disagreement can signal that this is happening. When it does, it is important to be clear about what one's personal moral preferences are, but to recognize that personal preferences should routinely yield to the primacy of law and, in most cases, of agency policy. In all but the most egregious cases of maleficence, or of an anticipated potential for harm e.
The following case Table 5 illustrates a situation calling for ethical analysis by an OR nurse, and for subsequent review of the situation by hospital administrators. It is a composite of several actual malpractice cases. He was part of the neurosurgery team, which included nurses with varying educational backgrounds, OR techs, a PA who scrubbed in, surgery residents, and various staff surgeons. John was raised in a nearby blue collar Italian neighborhood, and he still attended services at his old neighborhood church.
He and his French girlfriend lived in a suburban high rise apartment complex overlooking a lake. Anthony's Medical Center had served all classes of patients for over years, but their location among the inner city poor seemed increasingly to discourage suburbanites from electing to receive care there. Nonetheless, the hospital had Church commitment and support and intended to remain, with renovations, in its current location, devoted to it altruistic mission. There were still nuns and priests in evidence as part of the staff. For the past several years, John and his coworkers had observed that one of the neurosurgeons, Dr.
X, seemed to be gradually losing manual dexterity in performing his surgical procedures. He was increasingly awkward with instruments. Sometimes his hands shook slightly. He had twice inadvertently burned patients with cauteries, although neither resulted in serious harm. The nurses and techs had discussed their observations among themselves, and had even approached the surgeon's PA with concerns. The PA had acknowledged an alteration in dexterity but indicated that he didn't see the changes as being anything dangerous.
John had talked informally to the administrative head of the OR, a nurse manager, and to his nursing director. Both managers requested that staff put their concerns in writing. One of the team nurses had approached the Chief of Neurosurgery, who indicated that he would pay special attention to the quality reviews of Dr. A tech, talking informally about her concerns with one of Dr. X's partners, was told that "only a surgeon can evaluate the surgical skills of another surgeon. And it was true that they couldn't act as Dr. It seemed to be generally "known" by a number of people working around the neuro team that Dr.
Within a year, Dr. Post-operatively, the woman evidenced extensive damage to reasoning and cognitive functioning and suffered from emotional lability. The patient was unable to return to work, and in fact became dependent upon her family for support and supervision.
The surgical damage was explained in the chart as an unfortunate and infrequent, but known, surgical risk for the type of operation she had undergone. Subsequent hospital chart reviews did not result in any action, either by the neurosurgeons or the hospital administration. On the basis of a confidential comment by Dr. X's scrub nurse, and from informal staff discussion, John E. He decided to talk it over further with his OR manager. X's accident, did management conduct themselves in an ethically prudent manner?
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Are management acts of omission here ethically relevant? An outsider reading this case, for example, might wonder if the hospital administration should have taken action before the serious accident occurred. Should the burden of evidence have rested on OR staff alone? Did the traditionally male Catholic Church hierarchy tend to reinforce a doctor-dominant status position within the hospital?
If so, obedience to authority and respect for physician autonomy might be normative for such a culture. Or, stated differently, non-physician concerns raised about surgeons may not be deemed "credible" in a doctor-dominant institution. In his view, the hospital was morally obligated to contribute to the patient's maintenance as a semi-invalid. What about John's coworkers, who shared his views of fault and causality but were reluctant to come forward about institutional responsibility? Significantly, do staff bear any ethical responsibility for Dr.
X's future patients cf. In this author's view, the case of John E. John and his coworkers have no legal right to bring the conduct of a physician under external scrutiny. Nor are they legally bound to come forward if they have additional information that might be valuable to an investigation. If questioned under legal proceedings, however, they have a legal, ethical, and likely moral obligation to tell the truth.
The medical center does not require any input from John about his views. We know that he is ethically uncomfortable with the situation because, on the basis of information he has, he has formed his own conclusions that are at variance with the hospital's official position. Yet his ethical beliefs are John's only legitimate source of further action. If he did nothing more about the case, he would be within the rights and responsibilities of his role. The medical staff members are key players in this situation.
Indeed, this author would argue that inquiry and leadership should rightly come from them. Has any peer talked searchingly with Dr. To what extent will the physician staff members on the surgical quality review committee use this case to make further inquiry about Dr.
X's partner knows about staff concerns; does he choose to act himself, or raise questions that the quality committee might pursue? What is the ethical duty of the Chief of Neurosurgery, or of Surgery? Is there any plan for another surgeon to monitor Dr. The real battleground for the ethical analysis of this problem lies within the medical center's administrative processes, and specifically within the hands of the leadership. If there is validity to John's observations and suspicions, questions should be raised via John's manager to organizational and surgical physician leaders.
What is the likelihood that John E. Through organizational processes, there are inquiries that the management and leadership of the medical center can pursue regarding the case in an effort to determine what did happen and, if Dr. The failure of administrators to act in a situation of this type may constitute a failure of ethical administrative conduct. Whatever path might be selected, there is no straightforward action clearly visible.
In administrative action, conflicting obligations are the rule, not the exception David, ; Davis et al. Customers who viewed this item also viewed. Page 1 of 1 Start over Page 1 of 1. The Works of Richard Baxter: Christian Ethics, Volume I Illustrated. The Essential Works of Richard Baxter. Product details File Size: Transcript May 2, Publication Date: May 2, Sold by: Related Video Shorts 0 Upload your video. Share your thoughts with other customers.
Write a customer review. There was a problem filtering reviews right now. Please try again later. Whoever transcribed this from the original work of Richard Baxter, did a sloppy job. It is deceivingly not advertised as a small part of "A Christian Directory. A tremendous book for anyone interested in sound biblical counseling.
Baxter addresses practically every problem and applies biblical principles to it. The greatest book on Christian living. An amazing work put together by Richard Baxter. One person found this helpful. Kindle Edition Verified Purchase. Must read for today's Christian where most pastors are more theoretical if not legalistic. This book is Very practical and shows how Christians normally receptive to God's grace, Satan's attacks, and how we imitate Christ's example. This book is worth reading again and again.
Good practical advice for much of what life throws at you. See all 14 reviews. Most recent customer reviews. Published 1 year ago. Published on June 3, Average DREEM score, of all domains of the questionnaire, is higher for females with a good perception and younger males have a more positive self-perception of their academic life. The course of geriatrics at the studied university faces some potential facts, but at the same time, presents absence of a psychological support to the student and this reflects their perceptions of self-learning.
Education can be effective when combined with entertainment making it edutainment and this includes dramas, flashcards, board games, etc. Flashcards are handy, valuable, useful, and easy to carry at various locations.
An Inclusive Look at the Domain of Ethics and Its Application to Administrative Behavior
The aim of this study is to use educative flashcards designed for clinical undergraduate students to learn bioethics and its application. Experimental double-blinded study was conducted to use educative flashcards on Bioethics and its application, designed for clinical undergraduate students. Participants were divided into three groups, Group 1 was traditional teaching method where class was taken for 1 h, for Group 2 only flashcards were given, and for Group 3 both classes was taken and flashcards were given.
After a week, semiconstructed pretested questionnaire was given to all the participants. Participants from Group 2 and 3 have fairly more knowledge compared to participants from Group 1 where majority of the answers were not right. Export selected to Endnote. View issue as eBook. National Eligibility Cum Entrance Test should not be considered as sole criteria for gaining entry into medical education in India. Antibiotic prophylaxis for systemic diseases in dental treatment, recommended or not recommended: A survey among dental students.