Michael Welker | Eva Winkler | John Witte, Jr. | Stephen Pickard (Eds.): The Impact of Health Care (Leseprobe)

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38 Günter Thomas erences of the medical staff or even the patients. It is true, however, that organizations, and thus hospitals, rely on boundary setting and selectivity in environmental sensitivity. Inclusion in the organization—that is, the treatment of patients—cannot be boundaryless and can only ever be “discriminating” and, thus, boundary setting. Complex and costly organizations, such as health-care organizations, can be “merciful” only within narrow limits and can act beyond rights and obligations as well as beyond their internal logic. The problem of limitation also occurs in the core of the organization. All organizations that not only provide the solution to aproblem, but also are instrumental in discovering and identifying the underlying problem to be solved, are tempted todiscover more and more of their own underlying problem. Thus, an additional problem reveals itself, namely, that problem identification can get so out of hand that, in principle, there can and must be “even more” problem solving. This inflationary expansion can be observed in many places in medicine, religion, pedagogy, economics, and, not least, in law. Attempts tocounteract it are manifold. Funding Organizations in particularneed acertainty of expectation in financing, which is why they prefer organizations in financing—specifically, insurance companies. In the Federal Republic of Germany, health-insurance companies, as independent actors, do not necessarily represent the interests of other organizations— that is, medical practices and hospitals. Depending on state-specific regulations, health insurers pursue their own financial agenda, but help determine what can be done in hospitals. The interestsand values of the various organizations in the health-care system need not coincide. What is indisputable, however, is that for all the supposed boundlessness of humanity, love, and ahuman rights ethos based on solidarity, the financial possibilities of any health-care organization are limited. The Financiers Public or government funding of health care requires the approval of voters. Voters must be willing to contribute money to acommunity of solidarity, for example, through insurance premiums or public budgets. Voters thus ultimately regulate the exclusion and inclusion of potential patients in the health-care system. An international comparison shows how unlikely and preconditioned apublic health-care system with corresponding medical services is. Alook at the United States shows that even ahigh degree of religiosity does not necessarily lead
Mercy under Conditions of Scarcity and the Need for Organization 39 quickly to such communities of solidarity that support the health-care system and are socially far-reaching. Increased individual compassion and willingness to help may be accompanied by areluctance toform national and, in complex ways, organizational communities of solidarity. Human Actors and Clinical Staff Organizations are not made up of people, but they operate largely in the medium of people. Thus, medical personnel are part of the hospital only in avery specific sense. Nevertheless, nurses and physicians always interpret and vary the rules of the organization in multiple ways: “duty by the book” can be interpreted as sabotage. This consideration makes it clear that physicians and nurses bring their own ethos and values to the framework of the hospital organization. One could speak ofamoral style or avalue style with which they give life to the spaces of the organization, which are in part morally overdetermined and in part morally underdetermined. Patients Against the background of the rules of the organization, the financing of the organization, and the legal regulations, potentialand real patients (including their relatives) develop very specific expectations of the organization and the medical staff. In these expectations toward the health-care organization and its representatives, value attitudes are realized at the same time. The Challenges It would be surprising, indeed downright naïve, to assume acomplete fitofmultiple value preferences. In my opinion, however, it would also be insufficiently complex to try to identify primarily value conflicts. Without assuming acomplete fit and without assuming awar of value orientations in the organizations of the health-care system, it is amatter of specifically recognizing value conflicts as well as mutual reinforcements in the value orientations. It is undisputed that for awell-functioning health-care system, corresponding positive value preferences preserving the function of the organization are necessary among all actors: excessive patient expectations can “lead the medical system to the brink” just as much as inadequate funding, just as much as an organization working with the wrong goals, or even medical staff without an ethos. The first challenge, then, is to sensibly orchestrate the various value sys-
Page 1: Michael Welker Eva Winkler John Wit
Page 4 and 5: 6 Table of Contents Karla Alex and
Page 7 and 8: Preface to the Series Five hundred
Page 9 and 10: Preface to the Series 11 family, ed
Page 11 and 12: Introduction Eva C. Winkler and Mic
Page 13 and 14: Introduction 15 Anthony D. Ho uses
Page 15 and 16: Introduction 17 first presents glio
Page 17 and 18: Time for aNew Oath? The Role of the
Page 19 and 20: Time for aNew Oath? 25 cision-makin
Page 21: Time for aNew Oath? 27 the sense of
Page 24 and 25: 36 Günter Thomas b) The tradition
Page 29 and 30: Ethical Tensions in the Medical Tre

Michael Welker | Eva Winkler | John Witte, Jr. | Stephen Pickard (Eds.): The Impact of Health Care (Leseprobe)

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