Ethical challenges within Veterans Administration healthcare facilities: Perspectives of managers, clinicians, patients, and ethics committee chairpersons

American Journal of Bioethics

Volumn 9, Issue 4, 2009, Pages 28-36

  Foglia, Mary Beth ^a   Pearlman, Robert A ^a   Bottrell, Melissa ^a   Altemose, Jane K ^b   Fox, Ellen ^a  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b DEPARTMENT OF VETERANS AFFAIRS   (United States)

Author keywords

Organizational ethics; Qualitative research; Resource allocation

Indexed keywords

ARTICLE; CONFLICT OF INTEREST; DECISION MAKING; ECONOMICS; EMPATHY; ETHICS; HEALTH CARE ORGANIZATION; HEALTH CARE QUALITY; HEALTH PERSONNEL ATTITUDE; HOSPITAL ADMINISTRATOR; HOSPITAL PERSONNEL; HUMAN; INFORMATION PROCESSING; INSTITUTIONAL ETHICS; PALLIATIVE THERAPY; PATIENT; PHYSICIAN ATTITUDE; PROFESSIONAL STANDARD; PSYCHOLOGICAL ASPECT; PUBLIC HOSPITAL; QUALITATIVE RESEARCH; QUESTIONNAIRE; TERMINAL CARE; UNITED STATES; VERBAL COMMUNICATION;

ATTITUDE OF HEALTH PERSONNEL; CONFLICT OF INTEREST; DECISION MAKING; EMPATHY; ETHICS COMMITTEES; ETHICS, INSTITUTIONAL; FOCUS GROUPS; HEALTH CARE RATIONING; HOSPITAL ADMINISTRATORS; HOSPITALS, VETERANS; HUMANS; NARRATION; PALLIATIVE CARE; PATIENTS; PERSONNEL, HOSPITAL; PHYSICIAN'S ROLE; QUALITATIVE RESEARCH; QUALITY OF HEALTH CARE; QUESTIONNAIRES; TERMINAL CARE; UNITED STATES;

EID: 65249126733     PISSN: 15265161     EISSN: 15360075     Source Type: Journal    
DOI: 10.1080/15265160802716795     Document Type: Article

References (61)

1. American College of Healthcare Executives. 2007. Ethical Deci-sion Making for Healthcare Executives. Available at http://www.ache.org/policy/decision.cfm (accessed February 14, 2009).
2. Asch, S. E. 1955. Opinions and social pressure. Scientific America 19: 331-335.
3. Asch, S. E. 1956. Studies of independence and conformity: A minority of one against aunanimous majority. Psychological Monograph 9(416): 1-70.
4. Aulisio, M. P., Arnold, R. M., and Younger, S. J. 2003.Ethics Consultation: From theory to Practice. Baltimore, MD: Johns Hopkins University Press.
5. Ball, G. A., Trevino, L. K., and Sims, H. P. 1993. Justice and organizational punishment: attitudinal outcomes of disciplinary events. Social Justice Research 6: 39-67.
6. Ball, G. A., Trevino, L. K., and Sims, H. P. 1994. Just and unjust punishment: Influences on subordinate performance and citizenship. Academy of Management Journal 37: 299-322.
7. Beauchamp, T. L., and Childress, J. F. 1994. Principles of Biomedical Ethics. New York, NY: Oxford University Press.
8. Bell, N.K. 2003.Ethical dilemmas in trauma nursing. NursingClinics of North America 25: 143-154.
9. Bies, R.J., and Moag, J.F. 1986.Interactional justice:Communication criteria of fairness. In Research on Negotiations in Organizations, eds. R. J. Lewicki, B. H. Sheppard, and M. H. Bazerman. Greenwich, CT: JAI Press, 43-55.
10. Bischoff, S. J., DeTienne, K. B., and Quick, B. 2000. Effects of ethics stress on employee burnout and fatigue: An empirical investigation. Journal of Clinical Ethics 21(4): 512-532.
11. Borawski, D. 1995. Ethical dilemmas for nurse administrators. Journal of Nursing Administration 25: 60-62.
12. Breslin, J. M., MacRae, S. K., Bell, J., and Singer, P. A. 2005. Top 10 health care ethics challenges facing the public: Views of Toronto bioethicists. BMC Medical Ethics 6: 5.
13. Brewer, J., and Hunter, A. 1989. Multimethod Research: A Synthesis of Styles. Newbury Park, CA: Sage Professionals.
14. Cooper, R. W., Frank, G. L., Gouty, C. A., and Hansen, M. C. 2002. Ethical issues encountered in health care organizations: Oerceptions of nurse executives. Journal of Nursing Administration 32(6): 331-337.
15. Colquitt, J. A., Conlon, D. E., Wesson, M. J., Porter, C., and Yee, Ng K. 2001. Justice at the millennium: A meta-analytic review of 25 years of organizational justice research. Journal of Applied Psychology 8(3): 425-445.
16. Dailey, R.C., and Kirk, D.J.1992.Distributive and procedural justice as antecedents of job dissatisfaction and intent to turnover. Human Relations 45: 305-317.
17. Dougherty, C. J. 1988. American Health Care: Realities, Rights and Reforms. New York, NY: Oxford University Press.
18. DuVal, G., Clarridge, B., Gensler, G., and Danis, M. 2004. A national survey of U.S. internist' experiences with ethical dilemmas and ethics consultation. Journal of General Internal Medicine 19: 251-258.
19. Emanuel, E. J. 2002. Patient v. population: resolving the ethical dilemmas posed by treating patients as members of populations. In Ethical Dimensions of Health Policy, eds. M. Danis, C. Clancy, and L. Churchill. Oxford, UK: Oxford University Press.
20. Foglia, M. B., and Pearlman, R. A. 2006. Integrating clinical and organizational ethics. A systems perspective can provide an antidote to the "silo" problem in clinical ethics consultations. Health Progress 87(2): 31-35.
21. Fox, E.2007.Integrated Ethics: Improving ethics quality. Available at www.ethics.va.gov/IntegratedEthics (accessed February 14, 2009).
22. Gibson, J. L., Martin, D. K., and Singer, P. A. 2004. Setting priorities in health care organizations: Criteria, processes, and parameters of success. BMC Health Services Research 425: 1-8.
23. Gilmartin, M. J., and Freeman, R. E. 2002. Business ethics and health care: A stakeholder perspective. Health Care Management Review 27(2): 52-65.
24. Greenberg, J., and Cropanzano. R, eds. 2001. Advances in Organizational Justice. Stanford, CA: Stanford University Press.
25. Griffith, J. R. 1993. The Moral Challenge of Health Care Management. Ann Arbor, MI: Health Administration Press
26. Hagland, M. M. 1992. New national survey finds MDs, administrators, public at odds. Hospitals 66(17): 44-45.
27. Hebert, P. C., Meslin, E. V., Dunn, N., and Reid, S. R. 1990. Evaluating ethical sensitivity in medical students: Using vignettes as an instrument. Journal of Medical Ethics 16(3): 141-145.
28. Hsieh, H. and Shannon, S. E. 2005. Three approaches to qualitative content analysis. Qualitative Health Research 15(9): 1277-1288.
29. Hurst, S. A., Hull, S. C., DuVall, G., and Danis, M. 2005. How physicians face ethical difficulties: A qualitiative analysis. Journal of Medical Ethics 31: 7-14.
30. Jameton, A. 1984. Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice Hall.
31. Joint Commission on Accreditation of Healthcare Organizations (JCAHO). 1996. Ethical Issues and Patient Rights Across the Continuum of Care. Oakbrook Terrace, IL: JCAHO.
32. Jones, T. M. 1991. Ethical decision making by individuals in organizations: An issue-contingent model. Academy of Management Review 16(2): 366-395.
33. Jonsen, A. R. 1998. The Birth of Bioethics. New York, NY: Oxford University Press.
34. Joseph, J., and Deshpande, S. P. 1997. The impact of ethical climate on job satisfaction of nurses. Health Care Management Review 22(1): 76-81.
35. Kilner, J. F. 2004. Health care resource allocation: Macroallocation and microallocation. In The Encyclopedia of Bioethics, 3rd ed. New York, NY: Macmillan-Reference.
36. Konovsky, M. A., and Pugh, S. D. 1994. Citizenship behavior and social exchange. Academy of Management Journal 37: 656-669.
37. Lemieux-Charles, L., and Hall, M. 1997. When resources are scarce: The impact of three organizational practices on clinician-managers. Health Care Management Review 22(1): 58-69.
38. Lemieux-Charles, L., Meslin, E. M., Aird, C., Baker, R., and Leatt, P. 1993. Ethical issues faced by clinician/managers in resource al-location decisions. Hospital and Health Services Administration 38(2): 267-285.
39. Leventhal, G. S. 1980. What should be done with equity theory? New approaches to the study of fairness in social relationships. In Social Exchange: Advances in Theory and Research, eds. K. Gergen, M. Greenberg, and R. Willis, New York, NY: Plenum.
40. Leventhal, G. S., Karuza, J., and Fry, W. R. 1980. Beyond fairness: A theory of allocation preferences. In Justice and Social Interaction, ed. G. Mikula. New York, NY: Springer-Verlag.
41. McGee, G., and Spanogle, J. P. 2001. Healthcare ethics committees and managed care. American Journal of Managed Care 7: 821-827.
42. Meslin, E. M., Lemieux-Charles, L., and Wortely, J. T. 1997. An ethics framework for assisting clinician-managers in resource allocation decision making. Hospital and Health Services Administration 42(1): 33-48.
43. Miles, M. B., and Huberman, A. M. 1994. Qualitative Data Analysis, 2nd ed.. Thousand Oaks, CA: Sage Publications.
44. Mossholder, K. W., Bennett, N., and Martin, C. L. 1998. A multi-level analysis of procedural justice context. Journal of Organizational Behavior 19: 131-141.
45. Nelson, W. A. 2005. An organizational ethics decision-making process. Healthcare Executive 20(4): 9-14.
46. Oberle, K., and Hughes, D. 2001. Doctors' and nurses' perceptions of ethical problems in end-of-life decisions. Journal of Advanced Nursing 33(6): 707-715.
47. Patton, M. Q. 2002. Qualitative Research and Evaluation Methods, 3rd ed. Thousand Oaks, CA: Sage Publications
48. Phillips, R. 2003. Stakeholder Theory and Organizational Ethics. San Francisco, CA: Berrett-Koehler Publishers.
49. Purtillo, R. 1999. Ethical Dimensions in the Health Professions. Philadelphia, PA: W.B. Saunders Company.
50. Ross, J. W., Glaser, J. W., Rasinski-Gregory, D., Gibson, J. M., and Bayely, C. 1993 Health Care Ethics Committees: The Next Generation. Indianapolis, IN: Jossey-Bass.
51. Seeley, C., and Goldberger, S. 1999. Integrated ethics: Synecdoche in healthcare. The Journal of Clinical Ethics 10(3): 202-209.
52. Sibbald, R. W., and Lazar, N. M. 2005. Bench-to-bedside review: Ethical challenges for those in directing roles in critical care units. Critical Care 9(1): 76-80.
53. Silva, D. S., Gibson, J. L., Sibbald, R., Connolly, E., and Singer, P. A. 2008 Clinical ethicists' perspectives on organizational ethics in health care organizations. Journal of Medical Ethics 34: 320-323.
54. Skarlicki, D. P., and Latham, G. P. 1996. Increasing citizenship behavior within a labor union: a test of organizational justice theory. Journal of Applied Psychology 81: 161-169.
55. Skarlicki, D.P., and Folger, R.1997.Retaliationintheworkplace:The role of distributive, procedural, and interactional justice. Journal of Applied Psychology 82: 434-443.
56. Smith, H.R., and Caroll, A.B.1984.Organizationalethics:Astacked deck. Journal of Business Ethics 3: 95-100.
57. Spencer, E. M., Mills, A. E., Rorty, M. V., and Werhane, P. H. 2000.Organizational Ethics in Health Care. New York, NY: Oxford University Press.
58. Walker, R. M., Miles, S. H., Stocking, C. B., and Siegler, M. 1991. Physicians' and nurses perceptions of ethics problems on general medical services. Journal of General Internal Medicine 6: 424-429.
59. Weaver, G. R., and Trevino, L. K. 1999. Compliance and values oriented ethics programs: Influence on employees' attitudes and behaviors. Business Ethics Quarterly 9: 315-335.
60. Webster, G. C., and Bayliss, F. C. 2000. Moral residue. In Margin of Error, eds. S. B. Rubin, and L. Zoloth. Hagerstown, MD: University Publishing Group.
61. Worthley, J. 1997. The Ethics of the Ordinary in Healthcare: Concepts and Cases. Chicago, IL: Health Administration Press.