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