Ethical problems abound in the health care environment. Health care administrators often encounter a dilemma when working in an environment which may not be favorable to the full practice of ethical decision making (Malloch & Porter-O’Grady, 2009). Issues relating to cost-cutting, patient safety, quality care and employee welfare also highlight dilemmas involving the ethical principles of autonomy, justice, beneficence and nonmaleficence (Morrison, 2011). The ACHE code of ethics is a standard which advocates a systematic process for self reflection founded on theory with the goal of assisting health care administrators in making the right decisions (Ethics self-assessment, 2012).
The ACHE recommends a comprehensive ethics self-assessment in the areas of leadership and relationships with the community, patients and their families, the board, my colleagues and staff, the clinicians and buyers/payors/suppliers (Ethics self-assessment, 2012). The questionnaire does not result in an ethics score as it is intended to facilitate personal ethical reflection. I regarded this self assessment as an opportunity for self criticism so that I may further improve myself as a professional. I took my time in answering the questions, though I did not answer those pertaining to reporting to the board because this is not one of my responsibilities, so that I can look back on my practice and honestly judge myself. Following self reflection, I answered “always” to all of the questions because I feel that this captures my perspective, attitude and actions.
Based on my answers, I recognize that abiding with ethical standards is not a very problematic aspect of my professional life. With no red flags, I realize that I have a strong ethical grounding. In answering majority of the questions, I did not hesitate to choose “always” because I could easily recall many incidents where I did consistently decide to practice the stated action. I think that my ability to work within the ethical principles in health care without much difficulty is because these principles also represent my personal values and beliefs. This underscores the reality that who I am as a person affects how I do my job and that my individual ethics have an influence on my professional decision making.
In my personal relationships, for instance, I put premium on the welfare of friends and family in much the same way that I value and work for the welfare of patients. When making family decisions, I pause to consider who will benefit from a course of action and that it should be the whole family in the same way that I make professional decisions which I know will be for the collective good. I value open communication at home because I want to be involved in the lives of the members of my family and is reflected in the way that I facilitate communication in the workplace to feel the “pulse” among staff and colleagues and to mediate the resolution of conflicts. As such, ethical decision making is somewhat of a habit to me because it is a spillover of how I make decisions and act in my personal life. Thus, I consider this area of professional practice as one of my strengths as a nurse leader.
However, basing professional decisions based on my personal or individual ethics alone is questionable. In a health care environment focusing on the evidence base of clinical and management decisions, it is imperative that my professional decisions should also be based on theory that is widely accepted so that I can enjoy the satisfaction of knowing that I have made quality decisions. For me, the ACHE code of ethics is a valuable tool in decision making because it affirmed my personal principles and articulated them into specific actions having theoretical underpinnings. Because it is comprehensive in that it covers my responsibilities to the profession, the patient, the organization, employees, the community and society (ACHE code of ethics, 2011), it has generated in me a greater awareness of the actual breadth and depth of professional ethics.
The general effect of knowing about and abiding by the code of ethics is the confidence that the congruence between my personal and professional values and beliefs is consistent with accepted standards and thus I am on the right track. Knowing that I am bound to be successful in this aspect of practice gives me the motivation to sustain the way I make decisions in the workplace and to further enhance my practice by reflecting and taking on all ethical responsibilities as they apply to my position. By continuous practice, fulfilling these responsibilities will eventually become an automatic behavior on my part. When in doubt, the ACHE code of ethics is also one resource that I can use so that I can act with certainty.
I am aware that ethical decision making will not always be straightforward and that I may one day face a highly challenging ethical dilemma that would be difficult to overcome To prepare myself for this eventuality, I would have to continuously improve in this area. I can start by knowing by heart the resources or tools are available that can be useful in ethical decision making. The ACHE code of ethics, the ethics self assessment and the ethics toolkit are some of these resources. Attending ethics seminars will also be helpful in that I will gain awareness of current trends in ethical decision making and the type of problems I will likely encounter. During seminars, case studies and experiences are also presented which give insights on how I will handle similar issues. Reading articles on ethical decision making will update me of current knowledge in this area. Finally, conferring with more experienced colleagues and learning from them is also a good way to achieve improvement.
In conclusion, ethical decision making is one responsibility of health care administrators and they must be able to perform this in an acceptable and systematic manner. The ACHE code of ethics provides a standard which can guide this activity. Because how decisions are done impact patients, the profession, the organization, employees, the community and society, health care administrators must continually improve their capacity to make ethical decisions. Taking the ethics self assessment and reflecting will determine how individual ethics affect their decision making and the areas which need to be enhanced.
References
ACHE code of ethics (2011). Retrieved from http://www.ache.org/abt_ache/code.cfm
Ethics self assessment (2012). Retrieved from http://www.ache.org/newclub/career/ethself.cfm
Malloch, K., & Porter-O’Grady, T. (2009). The Quantum Leader: Applications for the New World of Work. Massachusetts, MA: Jones & Bartlett Publishers, LLC.
Morrison, E. (2011). Ethics in Health Administration: A Practical Approach for Decision Makers. Massachusetts, MA: Jones & Bartlett Publishers, LLC.
