dhrpc moral identity and ethical decision making · –development of “a positive ethical...
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DHRPC Moral Identity and Ethical Decision Making
Fabrice Jotterand, PhD, MA
Associate Professor
Department of Health Care Ethics
Regis University
Denver HIV Resources Planning Council
Annual Retreat
June 27, 2014
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Outline
Challenges of DHRPC
Organizational Ethics and Ethical
Climate
Good New – Bad News / Moral Agency
Ethical Decision Making
Some Recommendations
Case Study: VA Health Care Facilities
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Challenges of DHRPC
How to allocate ethically resources to meet
the needs of people living with HIV?
– Conflicting demands
Housing vs. food; mental health vs. dental care, etc.
– Limited resources
Budget constraints
– Competing moral frameworks and values
Pluralistic society
Political context
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Denver HIV Resources Planning Council “Our Mission”
“Our mission is to assist in the coordination
of high quality, culturally proficient delivery of
HIV/AIDS services in the Denver Transitional
Grant Area (TGA).”
“Health Care is a Basic Human Right”
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Denver HIV Resources Planning Council “Our Mission”
“Our mission is to assist in the coordination
of high quality, culturally proficient delivery of
HIV/AIDS services in the Denver Transitional
Grant Area (TGA).”
“Health Care is a Basic Human Right”
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Denver HIV Resources Planning Council “What we do”
“The Council sets priorities for the services most needed in the Denver Transitional Grant Area (TGA), decides how much Part A (Title I) money should be used for each of these services (resource allocation), and develops a plan to provide these services (comprehensive plan). These decisions are based on an evaluation of the needs of people living with HIV (needs assessment). The Council also evaluates the administrative efficiency of the allocation of funds.”
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Denver HIV Resources Planning Council “What we do”
“The Council sets priorities for the services most needed in the Denver Transitional Grant Area (TGA), decides how much Part A (Title I) money should be used for each of these services (resource allocation), and develops a plan to provide these services (comprehensive plan). These decisions are based on an evaluation of the needs of people living with HIV (needs assessment). The Council also evaluates the administrative efficiency of the allocation of funds.”
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Challenges of DHRPC
How to allocate ethically resources to meet
the needs of people living with HIV?
– Standards for prioritizing service categories
– Assessment of needs
– Development of a plan to deliver services
Assumes particular values about resource allocations
What values should guide this process?
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Denver HIV Resources Planning Council
Discuss in groups of 4-6 people:
– What are the core values of DHRPC and why?
Define these values
– How should these core values inform the role of
DHRPC in allocating funds?
– What are the implication(s) for DHRPC that “Health
Care is a Basic Human Right”?
– What is the responsibility of DHRPC as a “moral
agent” in the community?
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Organizational Ethics
Goal of Organizational Ethics:
– Development of “a positive ethical climate”
– Organizational ethical climate:
“It consists of the shared perceptions of the ‘general and
pervasive characteristics of [an] organization [of a
system] affecting a broad range of decisions’” (Victor &
Cullen, 1988, p. 101 cited in Spencer et al, 2000, pp. 5-
6)
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Business Ethics Clinical Ethics
Organization Ethics
Professional Ethics
Ethical Climate
HCOs as moral agents
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HCOs as Moral Agents
Ability to respect moral rules
Ability to make moral choices and act
accordingly
Ability to reason about moral issues
Ability to accept moral responsibility
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HCOs as Moral Agents
HCOs set goals (mission statements, values,
etc.)
HCOs act as a result of collective decisions
HCOs are subject to normative evaluation
HCOs are held accountable for their actions
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Key factors:
– Commitment of the leadership
– Clear statement of the HCO’s mission
– Strategies, structure and policies supporting
HCO’s mission
Creating a Positive Ethical Climate
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Role of leadership:
– To provide a vision for the organization
– To articulate the values defining the organization
– To contribute to a positive ethical climate
Commitment of the Leadership
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Members awareness of ethical or legal
issues
Reporting bad news to management
Reporting ethical or legal violations
Refraining from unethical or illegal conduct
Higher employee commitment to the
organization
Leadership Contribution to a Positive Ethical Climate
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Values, norms defining an organization are articulated in mission statements, value statements, codes of ethics, etc.
These statements form the ethical climate of an organization.
However, policies and day-to-day activities informed by these statements indicates the true nature of the organization’s ethical climate.
Articulating Values
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Values, norms defining an organization are articulated in mission statements, value statements, codes of ethics, etc.
These statements form the ethical climate of an organization.
However, policies and day-to-day activities informed by these statements indicates the true nature of the organization’s ethical climate.
Articulating Values
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Good News – Bad News
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Good News – Bad News
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Trolley Problem
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Moral Agency
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Moral Agency
Character
Values, Norms
Guiding Actions
Ends
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Moral Psychology
Human moral behavior consists of the
interaction between:
– Affective processes – emotions
– Motivational processes - volition
– Cognitive processes – reasoning
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Structure of Moral Judgments
Moral Emotions
Moral Judgments
Moral Reasoning
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Moral Capacity & Moral Content
Moral capacity: ability/disposition to respond morally – Affective/motivational processes
– Moral emotions: determine one’s behavioral response to a moral dilemma
Moral content: particular beliefs, moral actions and ideas – Cognitive processes
– Moral reasoning: influences one’s particular psychological/emotional state by attaching particular values during moral judgments
(Sadler, 2008)
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Structure of Moral Judgments
Moral Emotions (Behavior)
Moral Judgments
(Cognitive and Behavioral)
Moral Reasoning (Cognitive/point of reference)
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Some Recommendations
Develop a robust mission statement (vision,
mission, and values)
Determine core values descriptive of the
DHRPC moral identity
Develop a process (algorithm) to provide a
uniform approach to resource allocations
– DAT Committee
Provide opportunities for continuing ethics
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Case Study: VA Health Care Facilities
The Department of Veterans Affairs is facing a major crisis after multiple reports indicated the alleged cover up of preventable deaths (at least 40 veterans died awaiting care at the VA Phoenix facility) and delays in providing timely medical care to veterans. Evidence shows corruption in handling appointment records within the VA system. Wait times have been falsified in medical appointment records. The records, used in annual performance reviews to determine salary raises, bonuses, promotions, etc., have been manipulated to meet the agency’s standards of 14 days. For instance, a May report indicates that 1,700 veterans have been kept off the books at a VA Phoenix facility to improve performance figures. Other reports suggest that scheduling staff was ordered by superiors to alter the dates of veterans’ requests for appointments.
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Systemic Problems and “Ethical Climate” Challenges
Systemic failures – Shortage of primary care physicians
– Delayed care due to intricate scheduling system
– Inability to absorb in the VA system the increasing number of veterans
Ethical climate challenges – Evidence of corruption in handling appointment
records
– reports suggest that scheduling staff was ordered by superiors to alter the dates of veterans’ requests for appointments
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VA’s Mission
“To fulfill President Lincoln’s promise ‘To
care for him who shall have borne the battle,
and for his widow, and his orphan’”
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VA’s Core Values
Integrity: “act with high moral principle and adhere to the highest professional standards…”
Commitment: “work diligently to serve Veterans and other beneficiaries…”
Advocacy: “…advancing the interests of Veterans and other beneficiaries…”
Respect: “treat all those I serve…with dignity and respect…”
Excellence: “strive for the highest quality and continuous improvement. Be thoughtful and decisive in leadership, accountable for my actions, willing to admit mistakes, and rigorous in correcting them.”
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VA Health Care Facilities
Breach of many of these core values.
Leadership needs to create a positive ethical climate
that fosters responsible business and patient care
practices grounded on the highest moral standards.
Change will not take place overnight and will require
moral courage to implement new standards of
conduct among administrators and clinicians.
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Thank You ! Questions? Comments?
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