Preventive Ethics - National Center for Ethics in Health Care - US ...

Part III: ISSUES—A Step-by-Step Approach to Preventive Ethics
• There’s a pattern of cases that raise similar ethical concerns (e.g., several
ethics consultations have related to withdrawal of vasopressors in the ICU or
there’s a recurring problem of managers passing off problem employees to other
departments)
• Practices deviate from accepted ethical standards (e.g., hospital employees
are discussing confidential patient information in public or billing information is
inappropropriately manipulated to make the numbers look good)
• Guidance regarding ethical practice is inconsistent or unclear (e.g., the facility has
no policy on appropriate boundaries or professional relationships or the facility
policy contradicts national policy)
• There’s a lack of knowledge about ethical practices (e.g., patients aren’t adequately
informed about advance directives or employees believe it’s ethically permissible to
give inaccurate information in order to make needed purchases)
• Systems or processes systematically undermine ethical practices (e.g.,
performance measures create perverse incentives or the physical layout of the
Human Resources department makes it impossible to keep sensitive conversations
private)
• Systems or processes designed to promote ethical practices aren’t functioning well
(e.g., employees aren’t aware of the facility’s IntegratedEthics program or ethics
consultations aren’t completed in a timely fashion)
• The organization is otherwise failing to promote ethical practices (e.g., leaders’
decisions to fund indirect research costs are perceived as unfair or staff don’t view
ethics as a priority)
It’s important to remember that for an ethics issue to be appropriate for an ISSUES cycle
there must be a gap between current practices and best practices. The team should think
creatively about ways to identify and address ethics quality gaps that might otherwise
become institutional “orphans.” The team should avoid taking on vague and ill-defined
organizational problems (aka institutional “messes”) in which the gap between current
practices and best practices—in terms of ethics standards—cannot be clearly described.
If the answer to Question 2 is no, the issue doesn’t suggest an ethics quality gap, the issue
isn’t appropriate for preventive ethics. The Preventive Ethics Coordinator should determine
whether the issue warrants the attention of another program or office or should be referred
to the IntegratedEthics Program Officer.
If the answer to Question 2 is yes, the issue does suggest an ethics quality gap, the team
should proceed with the ISSUES approach.
This decision rule is depicted schematically in Figure 1.
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