Lauren Taylor

Principlistic equality, the idea that the four principles of bioethics should be considered as nonhierarchical in the abstract, is core to the original conception of principlism, but it is unclear whether clinicians endorse principlistic equality in practice. We surveyed 227 primary and urgent care clinicians (62.8% response rate), finding just over half of respondents (51.9%) endorsed a hierarchy among the principles. Among this group, non-maleficence was most often over-weighted (by 57.1% of these respondents), followed by autonomy (42.0%), justice (35.7%), and beneficence (34.8%). Practicing in a safety net setting (OR = 0.51, 95% CI = 0.27–0.96) and spending less than half of one’s time in direct patient care (OR = 0.23, 95% CI = 0.09–0.58) were associated with significantly lower odds of endorsing principlistic equality. Several clinician characteristics were associated with giving additional weight to certain principles. Our findings provide insight into how clinicians value the four ethical principles, which could inform education and training initiatives in bioethics.

From aggressive billing practices to neglectful or discriminatory care, news stories about the misconduct of healthcare organizations abound. Yet there has been limited ethical scrutiny of hospitals and other healthcare organizations in the bioethics literature. In this paper, we explore what philosophy and organizational theory can offer in terms of concepts for articulating the obligations of healthcare organizations, specifically hospitals. We highlight how the concepts of institutional agency and responsibility, administrative harms and burdens, and communicative blame provide theoretical resources that can help bioethics get closer to a more robust organizational ethics. We advance two claims: first, these concepts help us make sense of how hospitals or healthcare organizations—not just individuals and the broader systems they operate within—can be morally responsible or blameworthy. Second, critical reflection on these concepts as they apply to several historical examples suggest some prima facie obligations of organizations that provide patient care.

Principlistic equality, the idea that the four principles of bioethics should be considered as nonhierarchical in the abstract, is core to the original conception of principlism, but it is unclear whether clinicians endorse principlistic equality in practice. We surveyed 227 primary and urgent care clinicians (62.8% response rate), finding just over half of respondents (51.9%) endorsed a hierarchy among the principles. Among this group, non-maleficence was most often over-weighted (by 57.1% of these respondents), followed by autonomy (42.0%), justice (35.7%), and beneficence (34.8%). Practicing in a safety net setting (OR = 0.51, 95% CI = 0.27–0.96) and spending less than half of one’s time in direct patient care (OR = 0.23, 95% CI = 0.09–0.58) were associated with significantly lower odds of endorsing principlistic equality. Several clinician characteristics were associated with giving additional weight to certain principles. Our findings provide insight into how clinicians value the four ethical principles, which could inform education and training initiatives in bioethics.

Hospitals and health systems have become prime movers in US health care, employing more than 77% of the physician workforce and growing in scale through persistent market consolidation (Muoio 2024). These entities’ business practices have recently come under sharp scrutiny for appearing to run contrary to some of the more idealistic norms of medicine. While the law is a valuable tool in discouraging and punishing bad organizational behavior, it frequently struggles to keep pace with a changing marketplace. What ethical concepts, if any, can provide a check or constraint on their behavior? Sociologist Fred Hafferty, one of the leading scholars of professionalism in medicine, explores these and other questions in conversation with ethicist and management scholar Lauren Taylor.

To many participants in today’s US health-care system, it can seem as if health care has lost its way. Complex, fragmented systems. Difficulty accessing care. Strain on physicians. Financial burdens for patients. Yet there are also many opportunities to improve care, patient and provider experience, and—ultimately— health. It won’t be easy, according to SCAN Group and Health Plan President and CEO, Dr. Sachin Jain, MD, MBA. It requires nothing less than examining the paradigms of thought and practice that tend to maintain “business as usual” in the health-care industry. It will require reenvisioning mission, moral leadership, and what patient-centeredness means in health care.

Despite their benevolent intent, health-care delivery organizations often cause harm. While some harms are unavoidable in the course of doing business— and are perhaps morally justified—other harms constitute organizational wrongs, which are never justifiable. When a health-care delivery organization acts wrongly, the organizational wrong imbues individual employees with a responsibility to mitigate those wrongs. This article explores the question of individual responsibility in relationship to organizational wrongs and proposes strategies that complicit individuals can adopt to mitigate organizational wrongs.

This article discusses tensions related to expectations about the health-care sector’s investment in the social drivers of health. As social-care roles and responsibilities are defined, the health-care sector needs a clearer set of ethical principles to guide policy and practice. Norman Daniels’s accountability for reasonableness (A4R) approach offers a framework for the development of more formal approaches, by structuring organization-wide conversations about the relevant values and providing a vocabulary for talking about the ethical dilemmas involved in questions of justice and organizational responsibility.

The ethical obligations of health-care delivery organizations are complex, often generating deep disagreements about what justice requires of organizations operating within unjust social conditions. This article maps such disagreements onto the implicit tension between ideal and nonideal perspectives on justice and offers a dynamic way of bridging them. The ideal-nonideal tension and its potential resolution are illustrated with an organizational ethics case on social and medical care integration. By identifying and relating ideal and nonideal perspectives in a dynamic framework, the authors offer a new set of analytic and pragmatic tools by which health-care managers can navigate a broad range of complex questions of organizational ethics and health justice.

Bioethics is taking an institutional turn, where organizations are being taken seriously as moral agents. Within US healthcare, this is difficult to do without confronting “the market” as a highly influential context for organizational behavior. In the 1990s, pioneering thinkers such as David Mechanic,1 Brad Gray, and Mark Schlesinger2 undertook a first round of organizational ethics scholarship focused on how market forces influence health insurer behavior — motivated by a particular concern for health maintenance organizations (HMOs).3 And more recently, owing partly to a transfer of financial risk4 to healthcare delivery organizations,5 rapid consolidation within health system markets,6 and the pronounced uptick in physician employment,7 the behavior of healthcare delivery organizations is also being assessed in relation to market forces.

This essay summarizes key insights across the essays in the Hastings Center Report's special report “Time to Rebuild: Essays on Trust in Health Care and Science.” These insights concern trust and trustworthiness as distinct concepts, competence as a necessary but not sufficient input to trust, trust as a reciprocal good, trust as an interpersonal as well as structural phenomena, the ethical impermissibility of seeking to win trust without being trustworthy, building and borrowing trust as distinct strategies, and challenges to trustworthiness posed by the contingent nature of science. Together, these insights stand to advance an area of research that we believe has been historically stymied by conceptual confusion and a long‐standing insistence on treating trust as a purely instrumental good.

For global health academics and practitioners, it can feel as though we are living in a tyranny of partnerships. The primary trappings of professional success in global health—funding and publications—increasingly rely on the presence or absence of institutional partnerships. Funders often require letters of support from collaborators, and the literature routinely lauds partnerships as the "secret sauce" necessary to solve intractable problems. Commonly, the term describes relationships between entities in the Global North and the Global South, serving as a euphemism for relationships that, at their core, are premised on a transfer of resources from the former to the latter. Many partnerships...

Since early 2014, i have studied what life is like for staff in a mental health sanatorium at a Ghanaian prayer camp. I have traveled to the camp on six occasions to observe its rhythms and routines and interview staff about their work. What follows is an informal reflection on the role of prayer camps as a source of mental health care in Ghana. The text is based on my experience conducting the research at the camp, rather than a formal reporting of results. As such, I make minimal references to theoretical frameworks and previous literature and instead have relied on my own field notes and recreated conversations I had with one staff member in particular.Despite longstanding records of human rights abuses, many...

The health policy community has a growing interest in the impact of nonmedical determinants of health, such as housing, nutrition, and social supports, on both health outcomes and costs. This interest has been spurred by the Affordable Care Act’s emphasis on prevention, Robert Wood Johnson’s grant‐making focus on a Culture of Health, and an uptick of research demonstrating the potential returns to health care from investments in social services. Much of this policy‐making, grant making, and research has focused on older Americans.The direct policy implications of this strategy can be elusive. It has become clear that more than medicine will be necessary to improve older Americans’ health status. Real improvement likely requires the development of additional social service offerings, including housing that is accessible to people with disabilities, Meals on Wheels‐type nutrition supports, and transportation. But who should bear the costs and control the finances associated with these programs? In this essay, I explore the question of how policy‐makers should consider financing nonmedical investments in older Americans’ health. As the reader will recognize, I stop short of arguing for what will work. Rather, I identify the strands of an emerging strategy—namely, for health care dollars to be diverted into social service programming—and offer several cautions. It may be that policy‐makers still wish to continue down this path, but my hope is that this essay will allow them to so with greater attention to the risks and unintended consequences of that strategy.

Many health care organizations made public commitments to become antiracist in the wake of George Floyd's murder. These actions raise questions about the appropriateness of health care's engagement in racial justice and social justice movements generally. We argue that health care organizations can be usefully thought of as having two roles: a functional role to care for the sick and a meta‐role as an organizational citizen. Fulfilling the role of citizen may require participating in the pursuit of social justice, including efforts to achieve racial equity. The demands of these two roles will need to be balanced, but the role of organizational citizen has been largely ignored and merits serious attention.

David Dranove and Lawton Burn’s new collaboration Big Med: Megaproviders and the High Cost of Health Care in America provides readers with a comprehensive tutorial on consolidation in United States healthcare markets over the past 40 years. Although the book is most explicitly aimed at those who look around and wonder how we arrived at a healthcare landscape dominated by giants, anyone with a serious interest in the prices of U.S. healthcare will want to have this rigorous and timely treatment on their bookshelf.

In 2013, one year after the enactment of the landmark Mental Health Act, a small team of psychiatrists, psychologists, and statisticians from the University of Ghana Medical School began a controversial field-based randomized-control trial entitled "Joining Forces" at the Mount Horeb prayer camp. Located about 45 minutes outside of Accra, Mt. Horeb is one of the largest and best known prayer camps in Ghana. It is an Evangelical Pentecostal organization whose mission is to "set free those held captive by Satan through a ministry of fasting and prayer". Mount Horeb had a well-documented track record of human...