Content area
Full Text
Introduction
The NHS in England is an organisation undergoing substantial change. The passage of the bill which became the Health and Social Care Act 2012, consolidates previous health polices and introduces further 'market-style' reforms of the NHS: encouraging private and third sector providers to foster a more competitive commercial market in healthcare. Such a changing environment sharpens the need for attention to be paid to the ethical operation of healthcare organisations. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England and the possible ethical implications of this will be discussed. The paper will conclude with suggestions for the development of organisational ethics programmes in the UK to address some of the possible ethical issues raised by this changing healthcare environment.
The growth of organisational ethics
A growing body of work in the area of 'organisational ethics' seeks to direct attention to the ethical attributes and functions of organisations rather than focusing, as much of healthcare ethics has done, on individual relationships. 1-4 Organisational ethics is the examination of 'the ethical implications of organisational decisions and practice on patients, staff and the community'. 3 This is claimed to be a natural progression for bioethics, a turn towards an ecological version of bioethics that considers 'the moral sociology of organisations'. 5 and the broader context of individuals as biosocial organisms. Important questions for study from an organisational ethics perspective are: What are the organisation's alleged aims and values (sometimes contained in a mission statement)? How does the organisation behave ethically in its financial and business arrangements? What are the organisation's work practices, policies, promotion criteria, organisational structures? How does the organisation manage conflicts of interest? What are an organisation's duties to its stakeholders? How do the organisation's activities affect the wider community?
Organisational ethics is another variant of applied ethics such as professional, clinical and business ethics. Areas of applied ethics have traditionally been differentiated by their area of focus, so clinical ethics has considered the issues raised by clinical practice and global ethics issues arising from...