ETHICAL ISSUES in health system management

Ethical issues in health system management

1. ETHICAL THEORIES
Atheoryreferstosetsofrelatedstatementsor
propositionsthathelptoexplainaphenomena
Theoriesvaryintheirexplanatorypower
Theoriescaneitherbepositiveornormative
Positivetheoriesareempiricallytestable
Normativetheoriesareprescriptivestatementsthat
purportstoassistdecisionmakersinaccomplishingtheir
objectives
Theoriesofethicspresentstandardsbywhichaperson
cananalyzeandevaluatehisorherownmoralconduct
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2. ETHICAL THEORIES
Philosophydividesassumptionsaboutethicsintotwo
basictypes:
a)Teleological
b)Deontological
Thesetwoapproachesdifferradicallyintermsof
judgingethicalbehaviour
Teleological philosophies deal with the moral worth of
behaviour determined totally by the consequences of the
behaviour
One's choice should be based on what would be best for
all affected social unit
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3. Deontology
Deontologicalphilosophiesarenormative(prescriptive)
innatureandstressthemethodsorintentionsinvolved
inaparticularbehaviour
Underdeontologicalperspective,onecannotassumethat
theendjustifiesthemeans
Deontologyisthephilosophicalpracticeofdefiningand
adheringtoanabsolutesetofstandardsbywhichethical
behaviorcanbemeasured
Ittriestodefineuniversaldutiesthatserveasmoral
guidestodecisionmaking
Whenamoraldilemmaarises,apersoncanapplythese
universalstandardstodetermineacourseofactionthat
isgood
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4. Theories of Marketing Ethics
1. Hunt –Vitell (H-V) Theory
Thetheorydrawsonboththedeontologicaland
teleologicalethicaltraditionsinmoralphilosophy
TheH-Vmodeladdressesthesituationinwhichan
individualconfrontsaproblemperceivedashaving
ethicalcontent
Giventhatanindividualperceivesasituationas
havingethicalcontent,thenextstepistheperception
ofvariouspossiblealternativesoractionsthatmight
betakentoresolvetheethicalproblem
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5. Hunt –Vitell (H-V) Theory
Thetheoryarguesthatitisunlikelythatanindividual
willrecognizethecompletesetofpossiblealternatives.
Therefore,theevokedsetofalternativeswillbelessthan
theuniverseofpotentialalternatives
Oncetheindividualperceivestheevokedsetof
alternatives,twokindsofevaluationswilltakeplace:a
deontologicalevaluationandateleologicalevaluation
Intheprocessofdeontologicalevaluation,theindividual
evaluatestheinherentrightnessorwrongnessofthe
behavioursimpliedbyeachalternative
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6. Hunt –Vitell (H-V) Theory
Theprocessinvolvescomparingeachalternative’s
behaviourswithasetofpredetermineddeontological
norms
Thesenormsrepresentpersonalvaluesorrulesofmoral
behaviour
Theyrangefromgeneralbeliefsaboutthingssuchas
honesty,stealing,cheating,andtreatingpeoplefairlyto
issue-specificbeliefsaboutthingssuchasdeceptive
advertising,productsafety,sales“kickbacks,”
confidentialityofdata,respondentanonymity,and
interviewerdishonesty
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7. Thedeontologicalnormsincludeboththehyper-
normsandlocalnormsoftheintegrativesocial
contractstheory
Hypernormsareuniversalnormsthatrepresent
principlessofundamentaltohumanexistence
Onthecontrary,teleologicalevaluationprocess
focusesonfourconstructs:
a)Perceivedconsequencesofeachalternativeforvarious
stakeholdergroups
b)Probabilitythateachconsequencewilloccurtoeach
stakeholdergroup
c)Desirabilityorundesirabilityofeachconsequence
d)Importanceofeachstakeholdergroup
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8. TheH-Vtheorypositsthatanindividual’sethical
judgmentsareafunctionoftheindividual’s
deontologicalevaluationandtheindividual’sevaluation
oftotalsumofgoodnessversusbadness
TheH-Vmodelpositsthatethicaljudgmentsaffect
behaviourthroughtheinterveningvariableofintentions
Thetheorysuggeststhatwhenbehaviourandintentions
areinconsistentwithethicaljudgments,therewillbe
feelingsofguilt
TheH-Vmodelidentifiesseveralpersonal
characteristicsthatmightinfluencespecificaspectsof
theethical,decisionmakingprocess
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9. These include the following:
Religion:highlyreligiouspeoplewouldhavemoreclearly
defineddeontologicalnorms.However,religiosityisa
complexvariable,andmultidimensionalscales
Individual’svaluesystem:e.g.organizational
commitment
Beliefsystems:people’sbeliefof‘howtheworldworks’
influencestheirethicaldecisions
Moralcharacter:individualswithhighmoralcharacter
wouldhavethestrengthofwilltobehaveinamanner
consistentwiththeirethicaljudgments
Ethicalsensitivity:somepeoplearemoreethicalthan
others.
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10. 2. Teleology
Theteleologicalperspectiveiswhatisknownasa
consequentialtheory
Thismeansthattheevaluationofthedegreeof
ethicalnessdependsontheoutcomesoractionsthat
resultfromthedecisions
TeleologicaloriginatesfromtheGreekwordstelos=
endoraim+logos=reason),or"consequentialism.”
Thebasicintuitionbehindteleologicalethicsisthat
thepurposeofmoraljudgmentistobringaboutwhat
isgoodintheworld,andavoidwhatisbadorevil
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11. Thetaskofteleologicalethicaltheoryistodefinein
explicittermstheprinciplebehindconsequentialist
moraljudgment,andresolvesomefundamentalissues
concerningitsapplication
Theteleologicalperspectivecanbefurtherdivided
intoegoismandutilitarianism
Thedifferencebeingthattheegoistviewpointfocuses
ontheindividualandtheutilitarianonallparties
involved
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12. a) Egoism
Egoismmeansonetakestheactionsthatresultsinthe
greatestgoodforoneself(beitshortorlongterm
perspective)
Forinstance,onedecidestobenicetotheboss(even
thoughthebossisnotliked),notnecessarilybecause
itbringsimmediate"good"orhappiness,butbecause
inthelongrunitislikelytoleadtoapromotion,
whichisagreatergoodthanthemoreimmediate
goodonewouldgetfromnotbeingnicetotheboss
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13. a) Egoism
Amongtheweaknessesofethicalegoismare:
Ittakesnostandagainstblatantviolations,e.g.,interviewer
cheating
Egoismcannotresolveconflictofinterestsamongtwo
individualsorparties
b)Utilitarianism
Arguesthatanactisethicalonlyifthesumtotalof
utilitiesproducedbytheactisgreaterthanthesum
totalofutilitiesproducedbyanyotheract
Underutilitarianism,itisunethicaltoselectanact
thatleadstoaninefficientuseofresource
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14. b) Utilitarianism
Argues that an action is only ethical on condition that it
maximizes the greatest number of positive
repercussions for the greatest number of people while at
the same time minimizing negative repercussions to the
smallest number
Under this theory, it is unethical to engage in an act
which leads to personal gain at the expense of society in
general
Amongtheweaknessesofutilitarianismare:
Itseemstoignoreactionsthatarewronginthemselvesasthe
endjustifiesthemeans
Theprincipleofutilitymaycomeintoconflictwiththatof
justice
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15. 3. Deontology
Theterm"deontology"hasitsoriginsintheGreek
rootsdeon=duty+logos=reason
Itfocusesontheintentionsorthemeansbehindthe
decisiontopursueaparticularalternative,ratherthan
theresults(ends)ofadecision
Theaimofdeontologicaltheoryistodefinethebasic
normativeprinciplesthatprovidesoundjustification
forethicalposition
Deontologicalphilosophiesstressthemethodsor
intentionsinvolvedinaparticularbehaviour
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16. 3. Deontology
Majorlimitationofdeontologyisthatitexcludes
considerationsoftheconsequenceswhichcanbe
sometimesbeverygraveandimportant
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