The Tracks We Leave: Ethics in Healthcare Management
By Frankie Perry
Health Administration Press, Chicago
2001, 202 pp., $45 (paperback)
REVIEWED BY JOHN A. GALLAGHER, PhD
Frankie Perry, executive vice president of the American College of Healthcare
Executives and a member of the college's ethics committee, has composed a concise
text that can contribute to the enhancement of the ethical skills of hospital
and health care system managers.
The author narrates five case studies (concerning medical errors, conflicts
of interest, gender discrimination, physician impairment, and workforce reduction)
and provides an ethical analysis of each case. Drawn from the actual experiences
of health care executives, the cases are developed in sufficient detail to draw
the reader into the complexity and moral ambiguity they must have posed for
the men and women who were called on to resolve them. Perry's cases would provide
substantive material for administrative rounds or trustee education.
The text also contains a series of essays by other authors, each of whom provides
a perspective on issues raised in individual cases. Of particular interest is
the essay by Joan Iver Gibson, "Deciding Values." Gibson argues for a "contextual"
approach to administrative ethical decision making. Her point is that value-driven
decision making should occur in relationship to "the full context, history,
tradition, current conditions, institutional values, as well as specific people,
roles, and relationships that are at work" (p. 22). In other words, values need
to be actualized in response to the specific details of the issues they are
intended to resolve. Thus ethical decision making is seen as a very concrete
activity in which decision makers need to tailor ethical responses that are,
first, fitting and congruent with the concrete complex realities and, second,
realistically attainable. Administrators who are perhaps befuddled at times
by abstract, principled approaches to ethical issues might find this mode of
ethical reflection more consistent with their training and experience.
The Tracks We Leave is well worth the attentive review of any health
care executive interested in sharpening his or her skills in ethical analysis
and in improving the ethical performance of his or her organization.
John A. Gallagher, PhD
Corporate Director, Ethics
Catholic Healthcare Partners
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.