Corporate Governance and Ethical Responsibility

Corporate Governance and Ethical Responsibility

Whether someone has followed required procedure matters, but being ethical (above and beyond the requirements) is often considered to be far more significant (Fagothey, 2000). In the case of Dr. DoRight, whether he followed proper procedure is not the issue. The case information clearly states that he was told about the patient deaths, and that he told his higher-ups of the issue. The higher-ups then said they would investigate and would let Dr. DoRight know the outcome. Whether they actually investigated - and whether they did it properly - remains to be seen, but after two years there was no resolution of the issue and no actual results of the investigation that could be provided to Dr. DoRight. In the meantime, patients were still dying and a lack of resolution to the problem meant that patients would likely still continue to die from illegal procedures that were not being performed correctly by the doctors and the other medical staff in the hospital.

The deeper concern of this ethical issue is whether the proper procedure was enough, and whether Dr. DoRight should have gone beyond that and done more when he saw that the required procedure was not enough to address the problem. Discussed here will be the circumstances surrounding that issue, including how it affects the stakeholders (both internal and external) and whether the ethical duty that Dr. DoRight had to the hospital was actually fulfilled. The duty he had to inform his superiors of a problem was fulfilled, but at what point does a person in a position of power (especially where deaths are occurring) step up and go beyond what is required of him or her in an effort to ensure that no other people die as a result of negligence or illegal actions? Both deontology and utilitarianism will be applied to the ethical issues Dr. DoRight has faced. In order to understand whether ethics and procedure mix or whether one has to be sacrificed for the other, potential conflicts between the two areas will be compared and contrasted in the context of Dr. DoRight and the issues that he is facing with the investigation at the hospital.

On a daily basis at the hospital, Dr. DoRight has to deal with both internal and external stakeholders. Internally, there are nurses and other medical personnel, patients, and human resource workers to address and work with. Externally, there are higher ups who are part of the hospital structure but do not work at that hospital. There are also the families of the patients and those companies and businesses that work with the hospital in any capacity. All of these stakeholders are similar in some ways, but they also want different things, as well. Because Dr. DoRight is involved with so many different stakeholders, and because he is in ultimately control of so much of the hospital, it can be difficult for him to be aware of what he needs to address for each specific group. That can allow things to fall through the cracks, even if those issues are serious or affect the patients and their lives. Dr. DoRight may be fearful of losing his job or some of his connections if he makes too much noise about the patient deaths, but he also has a responsibility to the patients and their families. People generally go to the hospital to get treatment and improve.

There can be conflicts of interest between the internal and external stakeholders (Becker & Becker, 2002) Dr. DoRight has to work with these conflicts and mitigate them as much as possible. These include patient advocacy issues and the balance between caring for people and operating the hospital like a business so that there is enough money coming in to pay salaries and care for patients. For Dr. DoRight, this can be a delicate balance. He works with many businesses, and all of those businesses have wants and needs that he must try to meet in order to keep the relationships with them strong. If he loses relationships with some of the businesses, he may find that he is not able to operate the hospital as efficiently or for the same amount of money. That could result in poorer and less effective patient care, and it could also result in the need to lay off or let go a number of staff and medical professional positions because there would no longer be money to pay those individuals. The balance between patient care and actual financial business is a difficult one, and not one that should be skewed too far toward one side or the other. Patients must be treated appropriately, but it is also vital that the business side of the operation is handled correctly. Otherwise, there will not be money available to care for the patients.

Dr. DoRight did report the illegal procedures that were causing patient deaths in the hospital, but he did nothing beyond that. Some would argue that he fulfilled his ethical duty because he reported his concerns to those who were higher up in the company than he was, while others would likely disagree. What is ethical? Does it involve only doing what one's job requires him or her to do, or should that person go above and beyond, or keep pushing for some type of resolution? After two years, patients are still dying and there have been no results of the investigation. In the meantime, Dr. DoRight has simply ignored the issue. It appears as though he has washed his hands of the entire thing, and that he has decided it no longer has any relationship to him because he provided the information to those who were above him in ranking. Is he not curious or concerned in any way that two years of alleged investigation have led to nothing and that patients are still dying? If he is genuinely interested in the proper running of the hospital and the true welfare of the patients, he should have been demanding some answers a long time ago. But he did not, and therefore it seems like he performed only his job duties and not his ethical duty toward others.

The deontology principle can be applied to the ethical dilemma faced by Dr. DoRight. Deontology states that the morality or ethics of an action is based on whether the person performing the action followed the prescribed rules for a person in that specific situation (Kamm, 2007). Since Dr. DoRight did, in fact, follow the rules that the hospital had set for what should be done when there were issues or concerns with patient safety, one could use the deontological principle to argue that Dr. DoRight was actually ethical by just reporting the issue to his superiors and then moving on, leaving someone else to handle the issue. He followed the rules that he was supposed to follow. The deontological argument is not concerned with what the rules are for a given situation (Kamm, 2007). It is only concerned with whether the rules that were put into place were followed (Kamm, 2007). Naturally, there are many ways in which the deontological argument could be considered to be flawed, but given the confines of what is currently accepted as that argument, Dr. DoRight was ethical.

Additionally, the utilitarianism principle can be applied to Dr. DoRight's ethical dilemma. This principle states that it is the outcome that results in the most overall "happiness" which is considered the most ethical (Rachels & Rachels, 2012). In other words, if Dr. DoRight followed the rules but that still caused a low level of happiness and satisfaction based not on just his feelings but on the entire situation, then he was not ethical and more (or something different) should have been done. Of course, not everyone subscribes to the utilitarianism argument, just like with any other ethical argument or principle. For those who do subscribe to utilitarianism, Dr. DoRight would have been considered to be completely unethical due to the fact that he only followed procedure and did not take the time to make sure that the procedure was something that would actually address the problem. Overall happiness has little to do with the rules and much more to do with whether patients are being protected and cared for properly in a hospital setting. If Dr. DoRight has told his supervisors of the issues but nothing has changed - especially after two years - then utilitarianism would indicate that he has failed in his duty to do the ethical thing where this situation is concerned.

Overall, it is easy to see that Dr. DoRight has much more to consider than just whether he followed proper procedure. Following those procedures is important, but it is also possible that much more needs to be done. When a person sees that a procedure is not acceptable or does not do enough to rectify a situation, should he or she then go beyond that procedure in order to ensure that the situation is properly addressed? Some people shy away from this approach because they are concerned that they will be fired or otherwise reprimanded when they take a stand against the way things are currently operating. However, those who have serious ethical and moral integrity will generally do what it takes to get a problem corrected, even if they have to lose out personally or professionally to protect the health and welfare of other people under their care. It does not appear that Dr. DoRight did any of that. He determined that following procedure was enough to fulfill his duties, whether or not that procedure resulted in any resolution for the patients.

It would appear that Dr. DoRight followed the deontological argument that one only has to follow the rules to be ethical. For many people, that is an acceptable choice. For others, the rules would not be important and would not have anything to do with whether something was considered to be ethical. With Dr. DoRight, it is not just the possibility that he feels he has done what is ethical, but also possible that he feels as though there is little else he can do. There are more than 5,000 employees and 20,000 patients for which he is responsible, and his influence extends to many different departments. He has to remain accountable to a large number of people both inside and outside of the hospital. Did he forget there was an issue? Did he assume that nothing could be done? Did he assume his supervisors would simply handle it? There is no way to know which of these scenarios is the correct one, or whether there is a different reason entirely.