Book Review — Managing Ethically: An Executive's Guide

September-October 2001


Managing Ethically: An Executive's Guide
Paul B. Hofmann and William A. Nelson, Editors
Health Administration Press, Chicago
2001, 276 pp., $49.00 (hardcover)

The field of bioethics is barely 30 years old, but it has already experienced several stages of development, the most recent being the incarnation of "organizational ethics." In this incarnation, bioethics has shifted its attention from decisions at the bedside to decisions in the board room. Moreover, bioethics is now no longer regarded as the provenance of the ethicist, the ethics committee, or the compliance officer; rather, it is the responsibility of executive leadership as well. Managing Ethically: An Executive's Guide is a product of this development as well as a tool to advance the progress made in health care ethics over the last 10 years.

Managing Ethically is designed to be a useful resource for busy health care executives. Built around 54 "Healthcare Management Ethics" columns that ran in the journal Healthcare Executive between 1992-2000, this text provides snapshot ethical perspectives on a wide range of topics. The book is divided into nine major sections, addressing leadership, community relations, managed care, mergers and integration, use of information, human resources, clinical ethics, organizational ethics, and institutional resources. Four appendixes contain helpful resources, including the American College of Healthcare Executives "Code of Ethics," "Ethical Policy Statements," and "Ethics Self Assessment Instrument" as well as ethics resources in print and on the Internet.

The approach used to produce Managing Ethically has several advantages. One advantage is that the editors were able to draw on the thoughts of a wide range of respected academics and executives and to address subjects that have evolved over time. The articles in each section are arranged sequentially, from oldest to most recent, allowing a reader to see the range of issues that has arisen over the years. Moreover, a wide range of issues are addressed within a given section. For example, the "Human Resources" section covers ethical duties to employeeç, sexual harassment, hiring practices, impaired executives, termination procedures, accusations and rumors of unethical conduct, trust, and physician payment. Anothûr welcome feature is that half the articles begin with a question or scenario, to which the author responds. Indeed, the remainder of the articles would have been improved by this format. Each chapter covers a topic in a practical way; no chapter is more than four pages in length. One omission that should be addressed in a future edition are issues posed by advances in genetics.

Some disadvantages arise in a book derived from a collation of columns. The range of authors and the enforced brevity sometimes yield uneven results. Although some articles stand out ("Beyond the Margin") and overall quality is good, an occasional jarring (for an ethicist) definition (e.g., "in essence, the professional ethic asks . . . what would most of my colleagues do?" p. 179) or argument exists. The same brevity that makes for quick reading also means that authors cannot explain and apply a rich ethical perspective. The result is that the ethical advice at times seems somewhat like inflated common sense ("lead a life that embodies an exemplary system of values and ethics" and "clarify organizational values" p. 14). Precisely what is in question today is how to justify and defend an "exemplary system of values" and how to sustain — over the long term and in the face of competing claims on attention — the deep values that give a health care organization a unique (and even noble) identity.

Ultimately, however, Managing Ethically is more than the sum of its parts because it provides quick and basic perspectives on a complex and evolving field. A future volume that built on this foundation — that detailed real-world struggles to work through the issues here only introduced — would complete a work well begun.

John Brehany, MA, STL
Director, Mission Services and Ethics
Mercy Medical Center — Sioux City
Sioux City, IA


Copyright © 2001 by the Catholic Health Association of the United States
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