Book Review — The Tracks We Leave: Ethics in Healthcare Management

May-June 2003

The Tracks We Leave: Ethics in Healthcare Management
By Frankie Perry
Health Administration Press, Chicago
2001, 202 pp., $45 (paperback)


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.