Presenter: Hi, everyone,
and welcome to this week's lecture
about managerial ethics in global health.
In this week's lecture,
we're going to go over some topics
related to managerial ethics,
including the importance of ethics
in managerial decision-making
and the additional sensitivity of ethical decision-making
in situations where two or more cultures come together.
In this chapter,
we're going to learn how to analyze problems,
promote solutions, and encourage decision-making,
exercise cultural sensitivity
in internal and external communications,
and advocate for the rights and responsibilities
of patients and their families, among other things.
So to begin with, the Code of Ethics
of the American College of Healthcare Executives
speaks of a manager's responsibilities
to four distinct constituencies:
the organization, employees, patients or others served,
and the community and society.
While it's challenging
to manage all of these responsibilities
in a single nature or culture,
it's even more challenging
when the manager's scope traverses national boundaries
and diverse cultures,
such as in the international leadership context.
Because of that, we'll talk about some different topics
within the ethical conduct in organization,
including managerial ethics,
professional ethics, and bioethics.
So to begin with, the study of managerial ethics seeks
to answer questions of what a manager should do
when confronted with ethical issues
related to managerial responsibilities.
Ethical management requires managers
to develop an orientation
that goes beyond their individual self-interest
and leads to a recognition of a moral responsibility
to the organization and its constituencies.
Organizations operating on a global basis
often face particularly tough
or difficult ethical challenges
because of different cultural and market forces
that are exerted on them.
National boundaries and varying cultural traditions
are accepted as part of the landscape
within which global health managers function.
And globalization is arguably leading to greater uniformity
in many dimensions of civilization.
In addition, it's important to understand
professional ethics and bioethics
as they both apply to the supervision
of professional individuals in the delivery of healthcare.
The concerns of bioethics grow out of the day-to-day issues
facing healthcare professionals in the delivery
of clinical and research services.
Even if the healthcare manager themself
does not have a clinical background,
their supervisory responsibility for physicians, nurses,
and other professional practitioners
requires an appreciation for the issues they face
in patient care and research.
This responsibility becomes more complex
in a global context,
especially if the manager and professional practitioners
that cultural orientations different from one another
or of their patients.
For that reason,
it's important to avoid cultural imperialism
and moral relativism.
Cultural imperialism refers to the practice
of imposing a society's own culture
and morality on people of another society,
while moral relativism speaks to the tendency
to consider morality relative to one's own society,
potentially leading to assumptions
that the ethical beliefs of people in another society
are appropriate for them without question.
One way that healthcare managers can help to navigate
these complex ethical challenges in different settings
is the formation of ethics committees.
Many organizations throughout the world
have these ethics committees,
which help to address ethical issues
and meet accreditation standards.
When such committees are used to aid
in the management of a healthcare organization,
particular attention must be paid to their makeup.
In the healthcare delivery setting,
ethics committee would be expected to comprise both managers
and clinical practitioners responsible
for delivering patient care,
as well as external participants
with advanced training in law, ethics, and medicine.
The selection of qualified and interested individuals
to serve on the committee and present diverse perspectives
can have a significant impact
on the organization's ethical climate.
Later in this chapter, we'll divert,
we'll discuss the importance
of what these diverse perspectives include.
Some examples of diversity are demographic diversity,
religious diversity, socioeconomic diversity,
and linguistic diversity.
Particular attention should be paid
to the educational preparation
that committee members receive
prior to initiating their responsibilities
to the organization.
So next, when we talk about the the creation
of these ethics committees
and the formation of an ethical manager
or ethical leader of a healthcare organization,
there's a few key steps or a few key elements
that play a role in developing their right perspective.
Some are depicted on the slide.
Others include not having false pride,
but rather a sense of obligation that drives executives
to demand the best from themselves
and the best from subordinates.
Virtue is also very important.
And scholars write that to understand what virtue is
and to live by what virtue demands are too related,
but different things.
And it's important for managers
to understand the comprehension
by executives of their own culture is a necessity.
And appreciation of other cultures
is a highly desirable skill as well.
Some other skills and competencies
are related to the understanding of human rights,
which include, but are not limited to,
the respect for all human life,
the understanding of human rights,
responsibilities, and needs,
equity, freedom, participatory democracy,
environmental ethics, and solidarity.
So now let's turn to some ethical theories
that a manager might use
in order to drive their decision-making.
The first that we'll talk about is consequentialism.
Consequentialism represents a group of ethical theories
that seek to evaluate an action
as ethical or unethical based on the actions consequences.
One of the most prominent of consequentialist theories
is utilitarian ethics,
which is based on the following principles:
The principle of consequences,
which states that no action is morally right
or morally wrong in itself.
The principle of utility.
The more good consequences an act produces,
the better or more right that act is.
The principle of hedonism.
Good consequences are those that maximize pleasure
and minimize pain.
And the social principle,
which states that the best action
is the one that leads to the highest level of happiness
for the largest possible number of people.
At times, consequentialism in global health
can be counterproductive.
Many people are uncomfortable with the idea
that the end justifies the means.
And they feel that some actions
that might be justified using consequentialism
are in fact inherently wrong
regardless of any good possible outcomes.
In healthcare, some actions that might offer the perception
of positive outcomes could still be ethically problematic.
An example of this is a provider
refraining from certain diagnostic
or therapeutic interventions
to minimize patient pain or discomfort in the short term,
but the patient then losing out on the benefits
of those interventions in the long term.
Consequentialist thinking
might support sacrificing the individual rights of a person
or small group to justify positive outcomes
for a larger group of patients.
Another theory we'll discuss is deontology,
and deontology refers to the approach to ethics
based on moral reasoning, rules, and obligations.
Some of these rules
and guiding principles can be stated as follows:
Act always in such ways that the maximums of your actions
can become general legislation.
We have a moral obligation
to do what our conscience perceives as right.
And act in such ways that you treat yourself
or any other human not as a mere tool,
but as a purpose of its own.
In global health context, deontology has the advantage
of treating every human being with respect
and protecting individuals' dignity.
However, different people's consciences,
which reflect personal opinions
as well as cultural and religious backgrounds,
may lead people to different decisions
in specific situations.
Finally, that leads us to the concept of principlism.
Because ethicists in healthcare
have not reached a general consensus
on either consequentialism or deontology,
the third approach of principlism has gained prominence.
This is an ethical approach
based on four basic principles of bioethics:
beneficence, nonmaleficience, autonomy, and justice,
which we'll discuss in the next slide.
So beneficence refers to the principle of doing good,
doing the best for the patient.
Nonmaleficience refers to doing no harm,
try to prevent negative consequences.
Autonomy means to respect the free will of the patient,
ensure informed consent.
And finally, justice refers to treating all patients
in similar situations equally
in the best possible way without discrimination.
Based on these principles,
principlism has become the most commonly accepted
ethical approach in bioethics
and specifically in global health ethics.
It provides an understandable framework
for the decision-making process of healthcare practitioners,
and it can be adapted to various cultural
and religious backgrounds.
It's important to note, however, that in practical medicine,
the four principles may sometimes come into conflict
with one another.
Now, let's discuss some practical ethical issues
in global health management.
It's very important to avoid cultural ignorance,
and one way to do this is by promoting cultural sensitivity
within your own training
and within the overall organizational culture.
Oftentimes, when we look at global health,
foreign aid is delivered by people
who do not understand the local culture, language,
and ways of life.
Healthcare managers who lack cultural understanding
will have difficulty not only in cooperating
with local providers and colleagues,
but also in working with programs-intended beneficiaries.
It's very important to deeply understand the cultures
within which you work
and within which the organization you lead works.
Now, let's discuss some examples
of managerial ethics issues,
more specifically about broad principles
of cultural ignorance.
So one, leftover medicine refers to the event
when global health managers are often tempted
to promote medical exports from their own country of origin
when working with a recipient country.
These exports might include medical equipment
for diagnosis and therapy,
as well as medications and other supplies.
However, bringing such products to a country
can come to be a problem.
The continued imported products over the long term
can hurt local efforts to manufacture
or sell similar products,
which thereby hamper efforts for self-sufficiency.
One example of this is Gavi or the Global Vaccine Alliance,
and I encourage you to look more into that
and their schema for providing vaccines
manufactured in other countries,
two countries in the global south for examples.
Other examples include tensions
between local and traditional medicine
and evidence-based medicine,
or quote, unquote, "indigenous and western medicine."
Oftentimes, global health organizations
that are not culturally informed
are likely to dismiss local healthcare practices
because of their not being based
in the traditional western medical canon.
Other times, people who wish to participate
in global health programs
are not sufficiently qualified for this job.
This might take place when medical students
and even nonmedical personnel are highly enthusiastic,
but lacking in medical skills and qualifications
and end up working on a particular health situation
of a recipient country in a patient care sense.
This we refer to as guinea pig healthcare.
That is the treating of people from the global south
or recipient countries as guinea pigs,
despite people not being licensed
to practice the same skills in their own country.
There are other examples of issues listed on the slide
that I encourage you to examine in the chapter this week.
So finally, there are some more key principles
and strategies that one can employ
to learn how to be an effective
and ethical global health manager.
The first is social and cultural observation.
One way to learn about the culture of a particular place
and become more culturally under informed
is to read about the country before arriving
or while working there to engage deeply
with local practitioners and local professionals,
and to make observations when you're in that country
of particular practices.
Such practices can be related to respect
or other principles or concepts.
And these may be unfamiliar to you
or they may be not practiced in your home country,
but they're important to understand
in the recipient country nonetheless.
It's also important to understand
your own religious influence
and how that potentially impacts
and influences your actions in the global health context
as well as the beneficiaries.
One way to do this
is to look at the predominant religions in a country
and the religious makeup in particular regions or cities
in which you'll be working.
Another valuable tool for managerial preparation
can be graduate and professional education,
what you all are doing right now.
However, that should not be treated as the final step
in learning how to be an effective major,
or an effective manager.
The study of ethics and morality is a lifelong endeavor,
and you'll constantly have to be aware
and eager to learn about the specific concepts
and specific context in which you work.