Personal ethical leadership shaped by Irish heritage and family values

¶ … 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.

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.

VII. Effective Leadership

Being an effective leader and an effective follower is an important part of being a professional. As one participates in any profession, one will encounter leaders who are considered to be dark, that is, leaders who engage in destructive behaviors as they attempt to lead. These destructive behaviors may include incompetence, rigidity, intemperance, callousness, or even evilness. Recognizing these features in others is essential and developing the ability to neutralize them is an important step in one's professional development. Such individuals are abusing the power that has been bestowed on them and a good leader decides how to effectively manage power by deciding what forms of power to use and how much power to give to others (Shirey, Authentic Leaders Creating Healthy Work Environments for Nursing Practice, 2006). A balancing of interests is an essential part of being a leader and doing so effectively is what makes one a good leader. In order to avoid casting shadows as a leader one must avoid to be seen as acting arbitrarily or unfairly.

In the role of follower or leader, it is essential to follow a set of ethical standards. Doing so will make it possible to cast light on one's profession and particular job and avoid being considered to be among the shadows. An effective professional is able to determine his obligations, decide when and how to obey or disobey, combat potential cynicism, offer constructive dissent, and discuss both good and bad news effectively. The inability to do these things creates both bad leaders and bad followers and, eventually, leads to the breakdown in the professional relationship.

VIII. Conclusion

My journey from my small town in Ireland to my career in the United States as a career nurse has been a long one. I have been influenced by a great many things and each experience has left me with a lasting impression. The recognition that my role in the delivery of health care is an important one and that I need to be prepared to do perform my role in an ethical manner is a heavy burden. I feel, however, that my background and education has provided me with the tools to perform my role effectively and that I possess the necessary moral compass that affords me with the direction that I need to make good decisions that incorporate not only my own set of moral beliefs but also the principles that have been identified by my profession as being important. Conflicts will occur but as long as I adhere to my basic moral code, I will have made the proper decision.