Patricia Werhane

Bioethics, clinical ethics, and professional ethics are mature, well-developed fields of applied ethics that focus on medical research, patient autonomy and patient care, patient–healthcare professional relationships, and issues that arise in clinical and other medical settings. However, despite these developments, little attention has been paid to the organizational aspects of healthcare in these fields. This is surprising, because in the last 30 years healthcare has become more and more institutionalized in provider, management, and insurer organizations. Despite JCAHO's preoccupation with organizational ethics during the last decade, the philosophical underpinnings of their requirements have been less explored in the literature. Clinical ethics remains preoccupied with clinical patient care and professional ethics with individual professional guidelines; even the American College of Healthcare Executives focuses primarily on healthcare managers, not on healthcare organizations

This response addresses the question: how can ethical values play a role in combating fraud? Three points are made. Firstly, ethical values are both self‐ and other‐related. Secondly, changing the prevalence of fraudulent behaviours requires not only a reduction in opportunity for fraud but also a change in mindset of the perpetrators. Thirdly, that change in mindset involves the recognition that there are personal and organizational advantages to be gained by not contributing to or abetting fraudulent behaviour. This latter point is illustrated with reference to the experience of Unilever where sustainable development is seen as contributing to the creation of long‐term shareholder value

The recent Supreme Court decision upholding Roe v. Wade and in particular, the dissent by Justice Sandra Day O'Connor, sheds new light on the issue of abortion. Let us consider any stage of a pregnancy when abortion is medically safe for the mother. If at that stage it is also medically viable to save the fetus, is an abortion performed at that stage of pregnancy morally justifiable? For example, if it is, or becomes, medically safe to perform abortions after first trimester of pregnancy and at the same time saving a fetus is, or becomes, medically viable or not unusual during some stage of the second trimester, can abortions during and after that stage of pregnancy be justified? With a number of qualifications I shall argue the thesis that as a general rule, but not an absolute rule, abortion in these instances is not usually justifiable. For if it is, then one will also have to grant the moral justification for a number of other highly questionable medical practices. This thesis is not to be identified with the stronger claim that abortions of viable fetuses can never be performed. There are surely exceptions such as when the life or health of the mother is in danger. But, I shall argue, the justification for making such exceptions is on different grounds than is sometimes claimed because one must weigh the health of the mother against the life of another human being.

Much of the attention of ethics scholars has focused on balancing self interest with the interests of others, equating self-interest with profit, or at least its acquisition, and presenting a dilemma to both companies and the stakeholder groups that socially responsible business practices might serve. We are in significant agreement with Porter and Kramer’s silver bullet to correct decision making based solely on increasing profit: the creation of “shared value.” However, we suggest three significant points of deviation from this thesis, resulting from our discomfort with features of the mental model(s) that Porter and Kramer use to structure their argument.

The Challenger incident was a result of at least four kinds of difficulties: differing perceptions and priorities of the engineers and management at Thiokol and at NASA, a preoccupation with roles and role responsibilities on the part of engineers and managers, contrasting corporate cultures at Thiokol and its parent, Morton, and a failure both by engineers and by managers to exercise individual moral responsibility. I shall argue that in the Challenger case organizational structure, corporate culture, engineering and managerial habits, and role responsibilites precipitated events contributing to the Challenger disaster. At the same time, a number of individuals at Morton Thiokol and NASA were responsible for the launch failure. Differing world views, conflicting priorities of the engineers and managers on this project, and the failure of either engineers or management to take personal moral responsibility for decision-making contributed significantly to the event.