Institutional Integrity in Health Care: Essential for Organizational Ethics

Abstract

Health care delivery has changed radically. Physicians no longer are independent agents who develop relationships with patients and, together with patients, make decisions about appropriate courses of treatment. Instead, health care organizations or institutions, including hospitals and health insurance companies, are powerful entities who greatly influence health care delivery, including decisions about who receives care, what type of care they receive, and when they receive it. Because they have entered the social world of relationships, health care organizations can now be seen as bearers of moral obligations subject to the possibility of acting in ways that are good and bad, right and wrong. As such, health care organizations are, in the words of Peter French, “proper subjects ... of moral assessment” (2003, p. 20). The need to focus on the moral obligations of health care organizations has not gone unnoticed. Ezekiel Emmanuel observed almost a decade ago that

Managed care has fundamentally changed the nature of medical ethical issues. They no longer arise in the context of individual patients and physicians. Instead they arise in the context of complex institutions that establish an organizational framework in which these ethical issues arise. To address medical ethical issues, we must change our focus from articulating principles and rules that apply to individual cases to devising institutional structures that can ensure ethical behavior. (Emanuel, 1995, p. 338)

Similarly, Kevin Wm. Wildes, S.J. has argued that bioethicists must focus not only individuals but on the institutions and the web of relationships and obligations involved in health care. He characterizes a bioethics that looks only at individuals and ignores institutions as inadequate (Wildes, 1997, p. 413).