Ethics and Social Justice at the U.S. Department of Veterans Affairs
This paper examines the ethical and social justice failures of the U.S. Department of Veterans Affairs (referred to as "Agency X"), the nation's largest healthcare provider. Drawing on consequentialist and utilitarian philosophical frameworks, the paper analyzes a series of high-profile misconduct incidents — including manipulated patient wait lists, contaminated equipment, and thousands of preventable deaths — that have jeopardized the health of millions of veterans. The paper evaluates the organization's current strategies for maintaining responsible conduct, then applies an eight-step ethical decision-making model to recommend the gradual privatization of Agency X and the redirection of eligible patients to Medicare-accepting private providers. Expected outcomes, equality and justice implications, and the role of guerrilla government employees in resisting reform are also discussed.
- Introduction: Agency X's mission, scope, and ethical stakes
- Ethical Issues Through Two Philosophical Theories: Consequentialism and utilitarianism applied to VA failures
- Major Ethical Challenges and Conflicts of Responsibility: Timeline of high-profile VA scandals and misconduct
- Strategies for Maintaining Responsible Conduct: Peer review, inspector general, and whistleblower hotline
- Recommendations and the Ethical Decision-Making Model: Privatization rationale and eight-step decision model
- Expected Outcomes, Equality, and Justice: Short- and long-term impacts on workers, patients, and equity
- Conclusion: Privatization as the consistent, ethical solution
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What makes this paper effective
- It applies recognized philosophical frameworks — consequentialism and utilitarianism — directly to a real government agency, grounding abstract ethical theory in concrete, documented failures.
- The use of a structured table to catalogue high-profile incidents (Table 1) and a step-by-step ethical decision-making model (Table 2) gives the argument an organized, evidence-driven architecture.
- The paper integrates multiple types of sources — government data, news investigations, peer-reviewed journals, and legal definitions — to support its recommendation with credible, varied evidence.
Key academic technique demonstrated
The paper demonstrates applied ethical analysis: it does not merely describe wrongdoing but systematically evaluates the organization's actions against named philosophical standards (consequentialism, utilitarianism) and a formal decision-making model (Corey et al., 1998). This move from theory to framework to recommendation is a hallmark of graduate-level policy and public administration writing.
Structure breakdown
The paper opens with contextual framing and a statement of purpose, then moves through philosophical grounding, an empirical catalogue of failures, current oversight strategies, a recommendation with rationale, an eight-step model application in table form, expected outcomes, and an equality-and-justice analysis. It closes with a conclusion that ties the philosophical, empirical, and policy threads together. The structure mirrors a standard public-policy analysis report.
Introduction
With a $168.8 billion annual budget (Facts about the VA, 2015), nearly 9 million enrolled patients, and 300,000 employees — together with a nationwide network of 1,221 outpatient clinics, 144 hospitals, and 300 Vet Centers — one U.S. government cabinet-level agency is responsible for operating the nation's largest healthcare system (VA facilities, 2016). The organization also provides training opportunities for more than 90,000 physicians, representing more than half of the doctors trained in the United States each year (Fast facts about VA, 2016). The mission of this federal organization, hereinafter alternatively referred to as "Agency X," is drawn from President Lincoln's Second Inaugural Address, in which he promised that the nation would "care for him who shall have borne the battle, and for his widow, and his orphan."
Given the importance of this mission and the enormity of its healthcare operations, there is an overarching need for ethical practices and social justice at Agency X. Unfortunately, ethical standards have been sorely lacking in many areas, adversely affecting the quality of healthcare services to the point where thousands of veterans' lives have been jeopardized. This paper provides an analysis of the ethical and social issues faced by Agency X and its public administrators, followed by a summary of the research and important findings concerning ethics and social justice at this organization in the conclusion.
Ethical Issues Through Two Philosophical Theories
Although it has failed to achieve it on numerous occasions, the stated mission of Agency X is highly congruent with a consequentialist perspective that holds that "among all the possible courses of action, an agent should pursue the one that, overall, brings about the greatest amount of good — or, in jargon, the one that maximizes good" (Borghini, 2016, para. 2). An application of consequentialist philosophy to Agency X's operations would therefore indicate that its public administrators must ensure that bureaucratic mechanisms are in place to provide access to the healthcare services needed by the organization's millions of patients for optimal clinical outcomes.
Given the organization's mixed track record of success in achieving its mission, however, it remains questionable whether Agency X can be regarded as applying a consequentialist philosophy to its operations. As Narita (2009) points out, "Consequentialism is an ethical doctrine according to which a fact is good only if it has good consequences" (p. 37). As discussed further below, many of the consequences directly caused by Agency X in recent years have not satisfied this fundamental ethical requirement.
Similarly, another form of consequentialism — utilitarianism — holds that "the rightness or wrongness of an action is determined by its usefulness in bringing about the most happiness of all those affected by it" (Smart & Williams, 1973, p. 37). The actions by Agency X in recent years cannot be viewed as useful in achieving this desirable outcome, and the health of thousands of patients has been threatened by its failures — an eventuality that cannot be regarded as contributing to their overall happiness, which is a hallmark of utilitarianism. In this regard, Schwelk (1999) reports that "one of [utilitarianism's] major objectives was to imbue a sense of the inevitability of human progress toward a consummation in which the utilitarian ethic will emerge triumphant and the conquest of the sources of human suffering will be all but complete" (p. 20). Unfortunately, rather than conquering the sources of human suffering for thousands of its patients, Agency X has itself become a source of that suffering, as discussed below.
Major Ethical Challenges and Conflicts of Responsibility
Although Agency X has experienced its share of high-profile scandals over the years, serious problems began to emerge during the late 2000s that have created major ethical challenges and conflicts for the organization. A representative sampling of these incidents is provided in the table below.
Table 1: Representative Samples of Recent High-Profile Incidents Involving Agency X
Incident 1: Agency X notified more than 6,000 patients who attended a sponsored medical center in Murfreesboro, Tennessee, that they may have been exposed to infectious diseases due to contaminated endoscopic equipment.
Incident 2: An agency-sponsored medical center in Augusta, Georgia, notified more than 1,200 people that they may have been treated with contaminated equipment.
Incident 3: Agency X sent letters to more than 3,000 people who may have had colonoscopies at facilities in Miami, warning that they may have been exposed to hepatitis and HIV. Hospital officials confirmed that tubing used in endoscope procedures was rinsed but not disinfected.
2011: Nine patients in Ohio tested positive for hepatitis after routine dental work at an Agency X clinic in Dayton, Ohio. A dentist at the medical center acknowledged not washing his hands or changing gloves between patients for 18 years.
CNN Investigation: A CNN investigation revealed that patients were dying because of long waits and delayed care at Agency X hospitals. The organization confirmed six deaths tied to delays at its medical center in Columbia, South Carolina.
January 30, 2014: At least 19 patients diagnosed with cancer in 2010 and 2011 died because of delays in simple medical screenings such as colonoscopies or endoscopies at various Agency X hospitals or clinics.
2014 (Spring): A retired Agency X physician revealed that the organization maintained a secret list of patient appointments designed to hide the fact that patients were waiting months to be seen. At least 40 patients died while waiting for appointments. Employees at numerous other healthcare facilities admitted to manipulating patient waiting-list data, and an investigation was launched at 26 Agency X facilities.
June 9, 2014: An internal audit of hundreds of Agency X facilities revealed that 63,869 patients enrolled over the previous ten years had yet to be seen for an appointment.
June 24, 2014: A report issued by Oklahoma Senator Tom Coburn's office found that more than 1,000 patients may have died in the preceding decade because of malpractice or lack of care at Agency X medical centers.
November 10, 2014: Agency X terminated or disciplined 5,600 employees as a result of these scandals.
March 10, 2015: Agency X released a report showing that more than 1,600 patients waited between 60 and 90 days for appointments at facilities in Los Angeles. Approximately 400 patients waited six months for an appointment, and the average wait time as of January 15, 2015 was 48 days.
September 2, 2015: Agency X released a review of alleged mismanagement at its eligibility center showing that more than 307,000 deceased veterans were listed as enrollees with pending applications. Estimates indicated that more than one-third (35%) of all pending records were for deceased patients, many of whom may have died while awaiting treatment.
Source: Adapted from Facts about the VA, 2015, para. 3
Conclusion
Although highly complex problems generally require highly complex solutions, the research showed that the current problems being experienced by Agency X can be readily solved by privatizing this massive federal organization and allowing eligible patients to receive healthcare services in their communities from providers who currently treat Medicare patients. Certainly, implementing this recommendation involves a number of complex issues, but the overriding solution itself is straightforward.
The research was consistent in showing that Agency X is either unwilling or unable to take the steps necessary to fix the problems that have been repeatedly identified throughout its national network of healthcare facilities. Privatizing this organization would be consistent with both the consequentialist and utilitarian philosophical perspectives. The application of an ethical decision-making model also provided significant support for this solution, despite the objections that will likely be raised by healthcare providers, their unions, and some patients.
In the final analysis, it is reasonable to suggest that this recommendation will become reality if political and public pressure continues to mount — and current signs indicate that privatizing Agency X will occur at some point in the foreseeable future, irrespective of who holds the presidency. The mission to care for those who have served the nation demands nothing less than a solution that genuinely delivers on that promise.
References
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