SECTION I Foundations for Ethics Change happens whether we want it or not. ▸ Introduction ealth care is in a constant state of change and challenge, which is likely to continue into its future. Therefore, this quote from the ancient philosopher, Heraclitus, rings true Hfor healthcare administrators (HCAs). In this introduction, consider an example of how change can affect care and its ethics. For example, the rapid growth of technology promises more efficient and effective care along with the ability to treat health conditions and improve outcomes. Of course, technology’s impressive outcomes will also bring challenges for health administrators in the areas of finance, staffing, and patient demands. How does this climate of change affect the HCA’s ability to pro- vide both fiscally sound and ethics- based health care? First, HCAs need to continue providing an environment where patients receive both appropriate and compassionate care. In addition, they must create, adapt, and support the complex healthcare system structure that responds to change. As stewards of current and future resources, HCAs are required to protect these resources and ensure that they are used ethically. These serious responsibilities can only increase in this epoch of change. To address these concerns, HCAs must also be prepared to go beyond patient care. They must respond to the business needs of health care with respect to the patient, staff members, organization, © Panuwat Dangsungnoen/EyeEm/Getty Images Dangsungnoen/EyeEm/Getty © Panuwat and the community. This challenge requires HCAs to have a base in ethics and apply their professional knowledge and skills. In addition, these challenges mandate a deeper application of ethics through appropriate behaviors that maintain both personal integrity and that of their organizations. In a time of great change, HCAs must also apply ethics that consider individual, organizational, and societal viewpoints. 1 2 Section I Foundations for Ethics To meet this challenge, they must be informed by both qualitative and quantita- tive data to make decisions that are both fiscally sound and ethically appropriate. In this epoch of change, ethics becomes more than a course that is forgotten upon graduation. It is an essential for the successful practice of healthcare administration. ▸ A Word About the Text The Fourth Edition of Ethics and Health Administration: A Practical Approach for Decision Makers contains chapter revisions and new chapters to reflect the current state of health care. For example, Chapter 5 is new and is titled Ethics in the Epoch of Change. It discusses changes in healthcare culture and how they challenge ethics decision-making. HCAs use theories and principles in their decision-making and daily prac- tices. Therefore, this new edition begins with a foundation in theory and prin- ciples. It goes beyond theory to application by including discussions, examples, case studies, and exercises within its chapters. These inclusions are designed to increase a deeper understanding of how to make ethics an integral part of the administrative role. Each chapter contains a “Key Terms” section to build concept recognition. Chapters also include case studies. These stories are based on fictionalized situations from many different healthcare experiences. Feedback from past students indicates these cases are helpful in applying ethics to the real world. The model seen in FIGURE I-1 guides the organization and vision of this text. Since HCAs do not make decisions in a vacuum, the circle organizes its themes and reflects how ethics influences healthcare practice. The outer circle represents the theory and principles that form the foundations for ethical decision making. The next circle represents areas external to the organization that influence the operations of healthcare administration. Internal influences are represented by the next circle in the model. These factors strongly impact the day-to-day practice of ethics in an organization. Finally, the inner circle represents the HCA’s personal ethics and its influence on action and career success. The circle model also serves as an organization plan for the chapters in the book. For example, the Foundations for Ethics section establishes a base in ethics theory and principles. The Practical Theory chapter explores founding theories of ethics that guide most of Western ethical thinking and includes a new section on the ethics of care theory. Using this theoretical groundwork, the Autonomy chapter explores one of the four key principles of healthcare ethics and discusses how it influences the practice of health care. The Nonmaleficence and Beneficence and Jus- tice chapters focus on the remaining key principles and their relevance to healthcare administration. And a new chapter, Ethics in the Epoch of Change, examines the uncertainties of healthcare, the changing healthcare culture, and ethics challenges during major change events. In the External Influences on Ethics section, the Market Forces and Ethics chapter considers the influence of various markets on the application of ethics in healthcare administration. The Healthcare Regulation and Ethics chapter addresses the relationship between regulation and ethics. It also includes advocacy and staff Section I Foundations for Ethics 3 Personal Ethics Internal Influences External Influences Founding Principles FIGURE I-1 A System of Healthcare Administration Ethics competency in relation to ethics theory and principles. Finally, the Technology and Ethics chapter presents an updated and in-depth view of technology’s impact on ethics decision-making, including emerging technologies. The healthcare organization’s influence on an administrator’s ethical deci- sions is the focus of the Organizational Influences on Ethics section. The No Mis- sion, No Margin: Fiscal Responsibility chapter presents the challenges of finance and its influence on ethical decisions. It also presents ethics issues related to the challenges of financing healthcare, nonprofit versus for-profit healthcare organi- zations, and stewardship of finances. The Healthcare Organizations: Culture and Ethics chapter features information on important patient culture and ethics chal- lenges. There are also discussions about professional culture, ethics committees, and models for decision making. The next chapter, The Ethics of Quality, is especially important in times of great change. It presents information about the organization’s response to quality and the nature of quality itself. In light of health care’s patient experience empha- sis, The Patient Issues and Ethics chapter considers the organization’s responsibil- ity to meet changing patient needs and expectations. This topic is presented from both the patient and organizational perspective. The Public Health and Ethics presents information on public health in action in the epoch of change and how it affects both community health and the healthcare system. It also introduces the mission of public health and professionals who are part of this important aspect of healthcare delivery. The Personal Ethics and Morality chapter investi- gates morality and its meaning for the busy HCA. It also includes discussions about the effects of ignoring morality and how to practice personal ethics as an administrator. 4 Section I Foundations for Ethics The Inner Circle of Ethics section discusses how HCAs use ethics in their professional practice. The Codes of Ethics and Administrative Practice chapter provides an overview of organizational and professional codes of ethics and their application to administrative practice. Finally, Practicing as an Ethical Admin- istrator chapter relates to the difficulties maintaining one’s base in ethics as an administrator who practices in a time of great change. It offers practical advice for balancing ethics with expediency and change. This new edition assists readers in seeing the world through “ethical eyes” as well as through financial ones. By applying ethics, one can enhance the overall effec- tiveness of one’s organizations and better meet challenges in a trust-based industry. On a personal level, one can become a person of integrity with a reputation for practical wisdom. One can make decisions that are both fiscally sound and ethically based. In the end, ethics always matter. © Panuwat Dangsungnoen/EyeEm/Getty Images CHAPTER 1 Practical Theory Healthcare administrators without grounding in ethics theory are like boats without rudders. They keep going around in circles and go nowhere. KEY TERMS The following is a list of this chapter’s key terms. Look for them in bold. Act utility Natural law Categorical imperative Normative ethics Consequentialism Original position Conventional Practical wisdom Deontology Preconventional Ethical egoism Premoral Ethics of care Principled moral reasoning Eudaimonia Rule utility I–THOU Sense of meaning Liberty principle Utilitarianism Maximum principle Virtue Moral development ▸ Introduction and Definitions ou watch your house fill with water as you enter a rescue boat. You visit your grandmother in a nursing home and you can still hear her asking to go home. You have to inform your staff about a new policy on infection control. You Yhave to explain the copayments to a patient who is full of fear about her surgery. What do these scenarios have in common? First, they deeply connect to the core concepts of all of health care—trust. From the patients’ view, trust happens on both physical and emotional levels. For example, patients surrender their