Logical Confusions and Moral Dilemmas in Health Care Teams and Team Talk

  • Edmund L. Erde
Part of the Philosophy and Medicine book series (PHME, volume 12)

Abstract

The call for teams of health care professionals is pervasive ([8], [12], [56]). The language of teams and teamwork — what I shall call “team talk” — in medical contexts apparently dates from the earlier decades of this century ([5], [8]). In this essay, I will offer what I believe Theodore Brown was calling for in “An Historical View of Health Care Teams”, namely, a philosophical analysis of the concept of team with applications of that analysis to the medical context. My goal is to articulate a synthetic understanding of the salient features of the ethos, ideology, rhetoric, and ethics of teams in health care. I will discuss all four (in various degrees) since I do not believe that any could be understood properly in isolation. Beginning with some brief historical, sociological, and attitudinal observations, I will discuss some ethical issues which emerge from a consideration of medical culture and from the larger social setting of workers’ rights. Finally, I will outline the rhetoric of team talk and critically discuss the ethics of this rhetoric.

Keywords

Income Schizophrenia Assure Fishing Defend 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliography

  1. 1.
    American Nurses’ Association: 1973, ‘Code for Nurses With Interpretive Statements’, in Perspectives on the Code for Nurses, pp. 44–60.Google Scholar
  2. 2.
    Anderson, R. M., Terrucci, R., Schendel, D. E., and Trachtman, L. E.: 1980, Divided Loyalties, Purdue University, West Lafayette, Indiana.Google Scholar
  3. 3.
    Annas, G.: 1974, ‘Hospital as a Human Rights Wasteland’, The Civil Liberties Review 1, 15–35.Google Scholar
  4. 4.
    Ashley, J. A.: 1976, Hospitals, Paternalism, and the Role of the Nurse, Teachers College Press, New York.Google Scholar
  5. 5.
    Barker, L. F.: 1922, ‘The Specialist and the General Practitioner’, JAMA 78, 773–79.Google Scholar
  6. 6.
    Bosk, C.: 1979, Forgive and Remember, University of Chicago Press, Chicago.Google Scholar
  7. 7.
    Bradley, B.: 1976, Life on the Run, Quadrangle/The New York Times Book Co., New York.Google Scholar
  8. 8.
    Brill, N. I.: 1976, Teamwork: Working in the Human Services, J. B. Lippincott Co., New York.Google Scholar
  9. 9.
    Burns, C. R.: 1974, ‘Comparative Ethics of the Medical Profession Outside the United States’, in The Humanities and Medicine, Special Issue, Texas Reports on Biology and Medicine 32, 181–190.Google Scholar
  10. 10.
    Collier, A. T.: 1964, ‘Conflicts of Interest in the Glass Age’, Federal Bar Journal 24, 351–357.Google Scholar
  11. 11.
    Coleman, A. D. and Bexton, W. H. (eds.): 1975, Group Relations Reader, GREX, Sausalito, California.Google Scholar
  12. 12.
    Ducanis, A. J. and Golin, A. K.: 1979, The Interdisciplinary Health Care Team, Aspen Systems Corporation, Germantown, Maryland and London.Google Scholar
  13. 13.
    Erde, E.: 1981, ‘Pathos and Pathology: Physicians in The Last Angry Man, M+A+S+H, and The Magician’, Studies in Science and Culture l(in press).Google Scholar
  14. 14.
    Ewing, D.: 1977, Freedom Inside the Organization, D. P. Dutton, New York.Google Scholar
  15. 15.
    Flathman, R.: 1976, The Practice of Rights, Cambridge University Press, Cambridge.Google Scholar
  16. 16.
    Fortune editorial, February 1951. (This issue was under the general editorship of Russell Davenport.)Google Scholar
  17. 17.
    Freedman, B.: 1980, ‘A Prolegomenon to the Allocation of Responsibility and Hierarchical Organizations: The Hospital Context’, Legal Medical Quarterly 4, 35–43.Google Scholar
  18. 18.
    Freidson, E.: 1970, Profession of Medicine, Harper and Row, New York.Google Scholar
  19. 19.
    French, P.: 1975, ‘Types of Collectivities and Blame’, The Personalist 56, 160– 169.Google Scholar
  20. 20.
    Furlong, W. B.: 1980, ‘Football Violence’, The New York Times Magazine 130, 38–41; 122–134.Google Scholar
  21. 21.
    Gibb, J. R.: 1976, ‘Dynamics of Leadership and Communication’, in W. R. Lassey (ed.), Leadership and Social Change (2nd rev. ed.), University Associates, La Jolla, California, pp. 85–99.Google Scholar
  22. 22.
    Gordon, E. and Adams, P.: 1971, ‘You Can’t Be a Team By Yourself, International Nursing Review 1, 76–79.Google Scholar
  23. 23.
    Graham, S.: 1981, ‘States Move to Catch Incompetent Doctors, But Progress is Uneven’, The Wall Street Journal 104 (May 1, 1981), 1.Google Scholar
  24. 24.
    Guttmann, A.: 1978, From Ritual to Record, Columbia University Press, New York.Google Scholar
  25. 25.
    Harragan, B. L.: 1977, Games Mother Never Taught You, Warner Books, New York.Google Scholar
  26. 26.
    Henning, M. and Jardim, A.: 1977, The Managerial Woman, Doubleday, New York.Google Scholar
  27. 27.
    Hollander, E. P.: 1964, Leaders, Groups, and Influence, Oxford University Press, New York.Google Scholar
  28. 28.
    Kane, R. L. and Kane, R. A.: 1969, ‘Physicians’ Attitudes of Omnipotence in a University Hospital’, Journal of Medical Education 44, 684–690.Google Scholar
  29. 29.
    Katz, J: 1977–78, ‘Cover-up and Collective Integrity: On the Natural Antagonisms of Authority Internal and External to Organizations’, Social Problems 25, 3–17.Google Scholar
  30. 30.
    Lachs, J.: 1978, ‘“I Only Work Here”: Mediation and Irresponsibility’, in R. T. DeGeorge and J. A. Pichler (eds.), Ethics, Free Enterprise and Public Policy, Oxford University Press, New York, pp. 201–13.Google Scholar
  31. 31.
    Ladd, J.: 1970, ‘Morality and the Ideal of Rationality in Formal Organizations’, The Monist 54, 488–516.Google Scholar
  32. 32.
    Lassey, W. R. (ed.): 1976, Leadership and Social Change (2nd rev. ed.), University Associates, La Jolla, California.Google Scholar
  33. 33.
    Lewis, C. E.: 1968, ‘The Physician as a Health Care Team Leader’, Group Practice 17, 20–24.Google Scholar
  34. 34.
    Lohr, S.: 1981, ‘Overhauling America’s Business Management’, The New York Times Magazine 130, 14–27; 42–43.Google Scholar
  35. 35.
    Londey, D.: 1978, ‘On the Action of Teams’, Inquiry 21, 213–218.CrossRefGoogle Scholar
  36. 36.
    Maclntyre, A.: 1981, ‘The Nature of the Virtues’, The Hastings Center Report 11, 27–34.CrossRefGoogle Scholar
  37. 37.
    Manning, B.: 1964, ‘The Purity Potlash: An Essay on Conflicts of Interest, American Government, and Moral Escalation’, Federal Bar Journal 24, 239–256.Google Scholar
  38. 38.
    Mansbridge, J. J.: 1975, ‘The Limits of Friendship’, in J. R. Pennock and J. Chapman (eds.), Participation in Politics, Nomos XVI, Leiber-Atherton, New York, pp. 246–275.Google Scholar
  39. 39.
    Marcus, R. B.: 1980, ‘Moral Dilemmas and Consistency’, The Journal of Philosophy 77, 121–136.CrossRefGoogle Scholar
  40. 40.
    McCarthy, S. J.: 1979, ‘Why Johnny Can’t Disobey’, The Humanist 39, 30–34.Google Scholar
  41. 41.
    McMahon, J. A.: 1980, Letter about National Hospital Week.Google Scholar
  42. 42.
    Milgram, S.: 1968, ‘Obedience and Disobedience to Authority’, The International Journal of Psychiatry 6, 259–276.Google Scholar
  43. 43.
    Miller, E. J. and Rice, A. K.: 1975, ‘Selections From Systems of Organizations’, in A. D.Colman and W.H. Bexton (eds.), Group Relations Reader, GREX, Sausalito, California, pp. 43–68.Google Scholar
  44. 44.
    Nagi, S. Z.: 1975, ‘Teamwork in Health Care in the U. S.: A Sociological Perspective’, Milbank Memorial Fund Quarterly 53, 75–91.CrossRefGoogle Scholar
  45. 45.
    New, P. K.: 1968, ‘An Analysis of the Concept of Teamwork’, Community Mental Health Journal 4, 326–333.CrossRefGoogle Scholar
  46. 46.
    Nozick, R.: 1974 Anarchy, State, and Utopia, Basic Books, New York.Google Scholar
  47. 47.
    Packard, V.: 1957, The Hidden Persuaders, Pocket Books, New York.Google Scholar
  48. 48.
    Rawls, J.: 1971, A Theory of Justice, Harvard University Press, Cambridge.Google Scholar
  49. 49.
    Rawls, J.: 1955, ‘Two Concepts of Rules’, The Philosophical Review 64, 3–32.CrossRefGoogle Scholar
  50. 50.
    Robertson, J. A.: 1977, ‘Involuntary Euthanasia of Defective Newborns: A Legal Analysis’, in D. J. Horan and D. Mall (eds.), Death, Dying and Euthanasia, University Publications of America, Inc., pp. 139–195.Google Scholar
  51. 51.
    Rogers, D. W. and Blendon, R. J.: 1978, ‘The Academic Medical Center: A Stressed American Institution’, New England Journal of Medicine 298, 940–950.CrossRefGoogle Scholar
  52. 52.
    Sherif, M. and Sherif, C.: 1964, Reference Groups, Harper and Row, New York.Google Scholar
  53. 53.
    Sherif, M. and Sherif, C.: 1969, Social Psychology, Harper and Row, New York.Google Scholar
  54. 54.
    Siegel, S. and Zajonc, R. B.: 1967, ‘Group Risk Taking in Professional Decisions’, Sociometry 30, 339–349.CrossRefGoogle Scholar
  55. 55.
    Spotts, J. V.: 1976, ‘The Problem of Leadership’, in W. R. Lassey (ed.), Leadership and Social Change (2nd rev. ed.), University Associates, La Jolla, California, pp. 254–74.Google Scholar
  56. 56.
    Tichy, M.: 1974, Health Care Teams: An Annotated Bibliography, Praeger Publishers, New York.Google Scholar
  57. 57.
    Veatch, R.: 1973, ‘Generalization of Expertise’, Hastings Center Studies 1, 29–40.CrossRefGoogle Scholar
  58. 58.
    Veatch, R.: 1980, ‘New Principles for Physicians?’, The Hastings Center Report 10, 16–19.CrossRefGoogle Scholar
  59. 59.
    Ward, J. W.: 1964, ‘The Ideal of Individualism and the Reality of Organization’, in E. F. Cheit (ed.), The Business Establishment, John Wiley and Sons, Inc., New York, pp. 37–76.Google Scholar
  60. 60.
    Whitehouse, F. A.: 1951, ‘Teamwork - A Democracy of Professions’, Exceptional Children 18, 45–52.Google Scholar
  61. 61.
    Wisdom, J.: 1965, Paradox and Discovery, Basil Black well, Oxford.Google Scholar
  62. 62.
    Wolff, R. P.: 1973, The Autonomy of Reason, Harper and Row, New York.Google Scholar
  63. 63.
    Yanda. R. L.: 1971, Doctors as Managers of Health Teams, AMACOM, New York.Google Scholar
  64. 64.
    Zald, M. N. and Berger, M. A.: 1978, ‘Social Movements in Organizations: Coup d’Etat, Insurgency, and Mass Movement’, American Journal of Sociology 83, 823–861.CrossRefGoogle Scholar
  65. 65.
    Zimbardo, P. G.: 1972, ‘Pathology of Imprisonment’, Trans-Action 9, 4–8.Google Scholar

Copyright information

© D. Reidel Publishing Company, Dordrecht, Holland 1982

Authors and Affiliations

  • Edmund L. Erde
    • 1
  1. 1.New Jersey School of Osteopathic MedicineUniversity of Medicine and Dentistry of New JerseyUSA

Personalised recommendations