Professional Platform for Ethics and Leadership

¶ … 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.

Primary Influences

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 the application of this principle and decisions in applying this principle are not always clear and easy ones. This principle is particularly problematic in today's society as evidenced by the debate over health insurance that is presently plaguing the country.

IV. Ethical Theories

Each of these principles is important and should be honored as much as possible. Unfortunately in the real world there are situations where one principle may have to be compromised in order to real the best result. For example, there may be a situation where the principle of justice might need to be sacrificed for the sake of beneficence or vice versa. This is to be expected in the health care arena as difficult decisions are often presented. In this regard, as a practicing Roman Catholic I can expect such circumstances to appear often. My responsibility is to establish a strong and consistent moral compass that allows me to be true to my principles. Electing to choose one principle over another is nearly impossible. They are each ideals and, as such, they are barometers for guiding one's behavior. Each situation in my career will be unique and need to be addressed on an individual basis. In the end my decision will need to be directed in such a way that incorporates each principle as much as is possible. Hopefully, what is ultimately decided will be consistent with each of them but I am realistic enough to understand that this might not always be possible. The ultimate goal is to balance everything and make an informed and principled decision.

The fact that I am Catholic and come from a strict Roman Catholic background factors greatly into my decision making process in terms of ethics (Catanzaro, 2001). I recognize this and also recognize that it might, on occasion, place me in a difficult position relative to making what I consider to be a morally correct decision vs. A medically correct one. In the field of health care there is considerable overlap in this regard and I enter the arena with this in mind.

From my point-of-view, the Catholic moral point-of-view has a long and consistent orientation. For Catholics, each human life is considered sacred and deserving of the right to life and, therefore, as a Catholic I have an expressed obligation to do whatever is necessary to care for others and to avoid doing anything that places another in danger of losing his or her life. Similarly, however, I also have the duty to make sure that this duty extends to the procreation stage of life and that I take whatever action is necessary to protect this aspect of life as well.

My moralistic position is not determined by consequences. The morality of an act is determined by the act itself, the motive and intentions of the decision maker, and the particular circumstances surrounding the presentation of the decision. Consequences certainly affect how I view the situation but, from my perspective, the correct decision is determined by what promotes the general good and avoids doing evil and this is decided by what my religion determines good and evil to be. In my view, Catholicism allows me to participate in medical decision making in a clear and simple way even in the most difficult set of circumstances. Through my religious beliefs I know where I stand on difficult issues such as abortion, assisted reproduction, end of life concerns, and the use of genetic technologies. I recognize that my stance on such issues may be considered conservative, out-of-date, or even archaic but I stand ready to defend my views and believe in my heart that they are right. This does not mean that I never question my position on these issues but, in the end, I know that I must allow my Catholic views to determine my decision making.

The moral viewpoint of Immanuel Kant which is heavily dependent on human reason as the best form of moral decision making is, in my opinion, flawed. Kant's reliance on human reason at the expense of tradition, conscience, emotion, and other human conditions ignores a great portion of the decision making process (Benner, 2000). Reason alone cannot, and does not, provide humans with all the answers. Human emotion and intuition are important aspects of our being and to ignore them and rely totally on one's reason in making moral decisions eliminates an important part of the decision making process. Such factors are important in making decisions and cannot be ignored. Relying entirely upon reason makes it easier to make difficult decisions but it does not necessarily result in a morally correct decision.

V. Practical Application

Conflicts will undoubtedly occur in the field of health care which will involve morally sensitive issues. On occasion, assisting patients and family through these sensitive issues is the responsibility of a health care provider. How one decides to approach such situation is dependent on one's religious and moral background but I believe it important to examine the situation from the standpoint of examining the rights, duties, and principles involved and make an attempt to determine which solution is the most morally defensible one (Fry, 2002). This process may be conducted in a sterile, impersonal manner that merely weights the alternatives from a purely practical viewpoint but such weighing fails to take into account the emotional and spiritual aspect of medical care. In this regard, it is important that the health care provided encourage the decision makers to explore all aspects of the process. It is at this point that the guiding principles discussed earlier become so important. Decision making relative to medical care can go the core of our values and it is important to have some guides to provide perspective. A responsible health care provider will direct the decision maker to view his or her options from a broad perspective so that a strict cost/benefit analysis does not guide one's actions.

VI. Nursing and Ethics

Ethical decision making is not an easy process (Watson, 2006). Values and perspectives change from individual to individual. Every profession, nursing included, provides its members with systematic guidelines which attempt to shape the ethical behavior of such members but no set of ethical guidelines can provide all the answers. Conflict and ambiguity will still exist. It is at this point that one's religious and/or philosophical beliefs take over. In this regard, I am comfortable with the fact that I have my Catholic religion and heritage available to me. I am confident that in the final analysis that this will allow me to make the right decision in difficult situations. As a starting point, the codes provided by my profession offer me wonderful parameters for making decisions but it is my religion that must control my ultimate decision. The nursing code is a good starting point but ultimately the codes do not eliminate moral dilemmas and I must act consistent with what I consider to be morally correct (Hussey, 1996). To act in this manner is not to diminish the value of the Nursing code, but rather, to recognize that there is a higher authority that everyone must recognize and honor.