Book Review — Business Ethics in Healthcare: Beyond Compliance

March-April 2002

REVIEWED BY ANN NEALE, PhD

University of Indiana Press, Bloomington, IN, 2001, 264 pp., $35 (hardcover)

Business Ethics in Healthcare: Beyond Compliance is an important contribution to the field of health care management and organizational ethics. Leonard Weber, its author, explains that health care business ethics is "beyond" clinical ethics, compliance, and personal integrity. It comprises a variety of ethical considerations pertaining to an organization's responsibility as caregiver, employer, and citizen.

Weber insists that the business of health care is distinctive. He identifies health care organizations as community service organizations, whose purpose is to both meet the health care needs of individuals and promote the health of the community. Because health care management is a service profession, Weber argues, business ethics in health care is "business ethics with a difference."

Because Weber's goal is to help people make better practical judgments, his book "does not describe a range of theoretical positions on the issue." Instead, the author proposes "specific ethics-driven perspectives and responses." According to Weber, the basis for these responses is a community-based ethics; the framework for them consists of "priority principles" that make it possible to order potentially conflicting interests, values, or goods in terms of their importance.

The author proceeds to apply community-based ethics and priority principles to dilemmas that health care organizations face as caregivers, employers, and citizens. Most of his chapters contain summary guidelines, criteria, or principles pertaining to the dilemmas discussed. The book's practical, nontheoretical approach may leave some moral philosophers unsatisfied; but then, the work of moral philosophers often leaves people "in the trenches" scratching their heads. Weber does not offer his ethical framework as a comprehensive moral theory. This reader notes, for instance, that his brief section on a justice-based ethics does not do justice to that perspective.

Weber does a good job of identifying the foundations of health care business ethics: a clear position on the nature and purpose of health and health care, which provides a moral framework; a strong ethical culture; organizational systems that support and reward appropriate behavior; and a serious management commitment to reflection and discussion in an effort to achieve organizational integrity. Weber insists that ethics is every manager's job.

The author's appreciation of the common good is evident in his selection and treatment of specific issues. For instance, he dares to raise the moral relevance of cost and appropriate use of resources in the moral assessment of individual clinical cases. He believes that health care providers need to shift their thinking to accommodate both cost and quality considerations. His community-based ethics, grounded in a notion of justice, recognizes cost control as an ethical value that recommends a standard of using not the best, but the least expensive, intervention that works well. This reviewer appreciates his selection of the important but sensitive issues of just compensation and unions.

The reader may be frustrated at times by the fact that Weber's management focus results in less than complete consideration of an issue. Weber states, for example, that because his chapter on unions and strikes is written for management about management's responsibility, it will not address "important ethical issues that should be considered by union organizers and employees." The "organization as citizen" chapters on socially responsible investing and environmental responsibility provide helpful analysis of issues not uppermost on many managers' radar screens. This reviewer was seriously disappointed not to find a chapter in that section on management's responsibility for advocacy and public policy. Health care managers, who are quick to understand the importance of lobbying for better reimbursement, seem less inclined to engage in sustained efforts on behalf of a more rational, just health system.

Two chapters in the last section, on institutionalizing business and management ethics, address the components of a business ethics program and the organizational ethics committee, a likely component of many such programs.

This book will be very helpful for those attempting to "get a handle" on organizational ethics. It is clearly written, well organized, and, very importantly, addresses many of the tough issues in a way that managers and others on the front lines can understand and appreciate. This reviewer, having perused much of the recent literature in business and health care management ethics, selected it for the graduate course she teaches in health care management ethics. The students rated it very highly.

Ann Neale, PhD
Senior Research Scholar
Center for Clinical Bioethics
Georgetown University Medical Center
Washington, DC

 

Copyright © 2002 by the Catholic Health Association of the United States
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