agrees that ethics is an important part of effective leadership in the field of health care but there is no universally accepted understanding of what constitutes ethical leadership (Milton, 20004). The concept of ethical leadership has been addressed in the literature of a wide variety of fields associated with the health care profession but none have been able to clearly define its terms. The purpose of this paper will be to examine what ethical leadership means to me and how my personal viewpoints and attitudes have been affected by my background and experience.
Having been raised in an Irish family my Irish heritage is an important aspect in the formation of my ethical viewpoint. Although I have lived in the United States for nearly forty years, I cannot escape the lessons and values that I learned growing up in the Irish countryside. My family lived in an Irish town that was highly traditional. The parish priest was the central figure who everyone looked to for spiritual and emotional advice. In my family, he was a constant presence and he played a key role in the development of my views on ethics and morals but the key figure was undoubtedly my mother.
My mother was a gentle and loving person whose primary concern at all times was her family. As the mother of eight children living in a small, two bedroom house with no running water her responsibilities were considerable but I never heard her complain or wish for something different. She never had much in the way of worldly possessions but she taught me at an early age that there was more to life than the accumulation of material things. She taught me the inherent value of just being alive and enjoying each available moment. For my mother, there was nothing more important than hard work and being responsible. The fact that she was able to provide her family with a comfortable home full of love under the circumstances that she was provided left me with the lasting impression that it is possible to be truly happy regardless of one's material surroundings. Surprisingly, even though she had no real education of her own, she also insisted that all of her children not only attend school regularly but that they also study hard and excel. She was accepting of nothing but our best but she never made us feel like we were failures if our efforts somehow fell short. On the rare occasions when this happened with one of us she encouraged us to just do better and, because all of us respected her so heavily, we worked hard to do our best. Without a doubt, she was the most influential person in my life and the one person who I never wanted to disappoint.
My father, on the other hand, presented me with some moral inconsistencies that I have spent much of adult life having to address. Like my mother, my father was a hard working, religious man who provided for his family but suffered from alcoholism. His alcoholism was embarrassing to the family and caused all of us to make excuses for him in order to protect the family's reputation. For the most part his alcoholism did not interfere with his ability to provide for the family but it did interfere with his familial relationships. Very little of his leisure time with spent with my mother or us children. Instead, he would be spending his time in the local pub or drinking at home. Quite honestly, I spent most of my time being afraid of him and this was reinforced by the fact that he beat my mother on a regular basis.
As I have indicated, I have nothing but the highest respect for my mother but I have never understood why she endured the way my father treated her. Although he was not a large man, he was still an imposing individual and I witnessed on many different and difficult occasions incidents that no child should ever have to experience. Needless to say, these incidents, and my mother's willingness to endure them, had a profound effect on me. As indicated in our textbook, "knowing who you are is never simple, it is an ongoing process that can never fully capture the ever-emerging person."
As to my decision to pursue a career in health care, the guiding figure in this regard was undoubtedly the nurse from the local clinic near our home town who cared for my grandfather's diabetic ulcers. Her concern and attention to detail was remarkable and I decided at a very early age (7) that I wanted to be a nurse as well. My respect and admiration for her was considerable and even after all these years she remains my professional inspiration.
III. Ethical Principles
In the field of medical ethics six basic principles have been identified as being essential to the development of ethical leadership (N.Bersoff, 1993). These six principles: autonomy, nonmaleficence, beneficence, veracity, fidelity and justice have varying importance and all provide specific rules of good conduct. No one can be expected to obtain complete command of any of these principles but they serve as wonderful ideals. On occasion, there may be conflicts in the application of these principles and there is no widely accepted method or standard recognized for resolving situations where these principles conflict.
The principle of autonomy deals with the concept of allowing individuals to exercise their moral right of self-determination. Violating a patient's right to self-determination is to treat them as less than persons and to deprive them of their dignity (Hyland, 2002). There are occasions that present themselves in the medical ethics situation when autonomy can and should be compromised such as when a patient is acting contrary to his or her best interests or where society determines a certain act is illegal but in most situations health care professionals should honor the individual dignity of the patient.
The principle of nonmaleficence requires that one should act in ways that do not inflict evil or cause harm to others. This includes avoiding even the risk of harm. The important aspect of this principle is that it can be violated regardless of one's intent. In fact, the principle can be violated even where there has been no harm (Shirey, 2005). Defining harm is also difficult under this principle. In health care, harm is usually identified with pain, disability, or death but, in the larger picture, harm can be almost anything that one can imagine and one must be careful to afford full consideration to any possibility.
On the other end of the spectrum is the principle of beneficence. The principle of beneficence is the obligation to act in ways that promote good. Good is broadly defined under this principle to include acting in ways that prevent harm, remove harm, and also promote good. Although beneficence may appear to be the opposite of nonmaleficence it is not. Under the principle of nonmaleficence health care professionals also have a duty to not cause harm but the principle of beneficence does not always demand that a health care professional provide help. The duty of beneficence only comes into effect once a relationship with the patient is established. Once that relationship is established, however, the principle of beneficence comes into effect.
The fourth principle is one that should be applied throughout society but it has particular importance in the field of health care. Veracity, or the principle of telling the truth, is based on treating patients with respect. Providing patients with enough information to make a rational and reasoned decision regarding their health care is highly important. As a corollary to this principle merely providing the information is not sufficient. A principled health care provider provides the information in terms that are clean and understandable to the patient. This is not possible in all cases and scenarios but the principle of veracity demands that every effort should be made to do so. Because of the nature of this principle, it can be violated by either actually withholding information from the patient or by omitting certain details. In either case, the principle has been violated and neither violation is more serious than the other.
The principle of fidelity is the one that probably offers the most opportunity for ethical conflict for health care providers. This principle demands that health care providers act toward their patients in ways that demonstrate loyalty. This means that keeping one's promises, doing what others expect us to do, and perform one's duties fully and acting in a trustworthy manner.
The final principle applicable to ethical leadership is justice. Under this principle one is expected to act in ways that treat people both equitably and fairly. Any action by a health care provider that discriminates against any individual or class of individuals arbitrarily or without justifiable cause would clearly violate this principle. Obviously, there are practical considerations that must be considered under this principle that may obviate…