REVIEWED BY JAMES A. DONAHUE, PhD
Entrusted: The Moral Responsibilities of Trusteeship
David H. Smith
Indiana University Press, Bloomington, IN
1995, 160 pp., $19.95
While much has been written about the ethical issues that confront medical practitioners in the changing healthcare field, few analysts have addressed the ethical challenges trustees and directors of healthcare organizations face as they struggle with decisions about their organizations' future. The deficiency has been remedied in an insightful book by David H. Smith, professor of religion at Indiana University. Entrusted is a must-read for all who are interested in the role of trustees in healthcare organizations. Its succinctness and readability also make it a superb resource for education and training programs for new (as well as veteran) trustees.
According to Smith, the trustee in a nonprofit organization is entrusted with the responsibility for establishing and defining the identity and vocation of that organization. In this role the trustee is guided by the founding commitments that have defined the organization over time and establish its place in the community and in society. The trustee must determine a shape and future direction for the institution that is faithful to its organizing commitments and consistent with its role in the community.
Three principles serve the trustee. The fiduciary principle requires a commitment from the trustee to the cause that the organization stands for. The common good principle requires a commitment to the overall values and reasonable moral obligations of the larger society. The obligation to establish the identity and the vocation of the organization requires the trustee to define the organization's place in a changing social climate. Smith outlines the implications of these principles in practical ways, citing examples for each.
Smith examines the objections and conflicts that arise as the role of the trustee intersects with the role of the professionals who operate a nonprofit organization. The book's particular strength lies in its understanding of how conflicts between principles can be resolved and how the role of trustees differs from that of those responsible for the organization's operations. Smith draws on a variety of settings--hospitals, universities, museums, philanthropic organizations, religious organizations--to show how the principles he has outlined apply to selected cases.
A delineation in chapter seven of the moral virtues that ideally characterize trustees can serve as a guide for understanding what qualities best serve the organizational purposes of nonprofit institutions. A final chapter of questions and answers about the dilemmas faced by trustees helps to organize the conceptual and practical intersections of the book.
Smith connects ethical principles to organizational purposes and shows how theory and practice interrelate. For trustees in Catholic healthcare institutions, Smith's religious sensitivities provide valuable assistance in clarifying the ethical relevance of the trustee's role. Entrusted provides a much needed contribution to the literature on ethics in the healthcare arena.
James A. Donahue, PhD
Associate Professor of Theology and Dean of Students
Copyright © 1997 by the Catholic Health Association of the United States
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