An ethics agenda for 2007.

In our world right now, much is happening in the name of ethics that is not ethics at all. For example, a common mistake is striving for ethical behavior and ending up only with minimal legal compliance. The two are inextricably intertwined, yet worlds apart.

Is Congress' ethics committee focused on eliminating bribery from government, or on answering the question, "How big does a bribe have to be before we censure a member?"

So what is on your ethics committee agenda this month and next?

As the 1990s began, the 1980s were labeled the "greed decade." We had learned what it is like to live in a society in which money is the only motivation.

"Money, money, money is the incantation of today. Under the blazing sun of money, all other values shine palely, and the mergers-and-acquisitions decade acclaims but one breed of hero. He (or she) is the honcho with the condo and the limo and lots and lots of dough." (1)

Some say that greed is good. I agree, but only when greed is defined as a burning desire to achieve or accomplish more than is truly necessary. Some "greed is good" advocates are misinterpreting Adam Smith, sometimes purposely it seems, when they mislabel reasonable entrepreneurial self-interest as greed.

Smith, by the way, was a moral philosopher before he was an economist. He assumed that honest and truthful application of his theory would result in "good suffusing throughout society." (2)

When greed means love of money for money's sake, good does not suffuse throughout society. Benefits of bad greed accumulate only to the greedy. Societies have to frown on that because, when profiteers benefit from draining money others earn into their personal bank accounts, money stops flowing. A lack of trust sets in that can stagnate the economy.

You may be surprised to realize that moral values can have an economic reason for survival throughout many centuries? Five hundred years before the Bible warned that the love of money is the root of all evil, Aristotle distinguished between reasonable self-interest and greed.

"The love of self is a feeling implanted by nature," said Aristotle. "But selfishness is rightly censured, because selfishness is not mere love of self, but the love of self in excess, like the miser's love of money. (3)

Changing direction?

With the dawn of the 21st century, nothing changed. Greed continues.

As a wise man once said: If we do not change our direction, then we are very likely to end up exactly where we are headed.

Arguably, the American people are fed up with being lied to and cheated by businesses and government. People are tired of business leaders more interested in options Friday and this quarter's bottom line than in the original definition of "being in business," which was to provide reasonably dependable goods and attentive service at a reasonable price.

Don't look at the negative side of greed, though. Look at the positive side. A wide open opportunity still exists for businesses that demonstrate to the public that they honestly do know the difference between mere legal compliance and genuine ethical behavior. A positive impact on market share is not beyond the realm of possibility.

As an aside, note that this column is a flagrant, not subtle attempt to motivate you to embrace truly ethical business practices because it is good for your business and what's good for your business is good for you. Is that really ethics? Shouldn't I be urging you to be ethical for the sake of basic moral turpitude and sensitive, caring altruism?

Forget it. Absolute altruism is no better than rampant greed. How can good diffuse throughout society if forward looking entrepreneurial leaders are bankrupt? Adam Smith's spirit lives; there is absolutely nothing wrong with doing very well even as you go about doing good.

And now my agenda is fully exposed. You and I will someday be patients in the health care system that we are creating, staffing, and funding. And so will our loved ones. I want the health care business to be focused on health care. Talk about reasonable self-interest!

If we should tomorrow morning or the next day or the day after that wake up suddenly, sit bolt upright in bed, and with sudden insight say aloud, "I want my organization and people in it, top to bottom, to reflect and display Genuine Moral Intelligence (GMI), then what should we do next?

We might not do anything, because we might not be in charge of ethics in our organization. The question is: Under whom do we light a fire?

The organization's ethical agenda is most likely controlled by the vice president in charge of complying with compliance requirements. In some organizations, the ethics agenda is left to Sister Respected, who addresses the board at every meeting. In other organizations, ethics is handled by the marketing department, which displays the organization's ethics buzzwords prominently in every ad. These activities are definitely important, but narrowly focused.

Most likely, if GMI blossoms in health care organizations, it will have taken root in the hospital's 21st century ethics committee. Ethics committees, born in response to new challenges created by new medical technology, have matured into oases of GMI in a desert of warped values. It is time for the ethics committee to recognize and respond again to new challenges.

If I had access to top level management in your organization, I would suggest: It is time for the ethics committee to form three sub-committees; one on traditional medical ethics issues, one on business and government ethics applied to health care, and one on issues in biomedical ethics.

This from a former medical staff and executive staff consultant, who champions the cause of eliminating all but truly necessary committees. This is necessary sub-committee work, in my view.

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Indeed, this is actually a first step away from mere compliance toward GMI. That is, this may be the first time you have revised a committee's structure, composition, charge, rules, and guidelines in response to your own inclinations instead of to comply with some federal or state regulation or Joint Commission standard.

Specifically, what might be on the 2007 agenda of each sub-committee?

Traditional medical ethics issues

Current ethics committee members may be most comfortable in this area. The educational documents and programs and the case-specific clinical ethics consultations provided by ethics committees are invaluable. Keep up the good work!

To some extent, however, there is a need for updating even in traditional areas. Certainly it is time, except where religious codes prevent it, for serious consideration of the euthanasia issue. Euthanasia means graceful death. Can we be trusted to offer expertise in the social and political debate between graceful death and a fate worse than death, or should people be suspicious that we might come out in favor of assisted self-determination because the cost of caring for the dying erodes our profit margin?

Let's be truthful here.

Business and government ethics applied to health care

Recommend to the board that "reasonable profit" be ethically defined.

For example, is it important to set aside untouchable funds for research and development, contingencies, and equipment replacement costs or not? That is, does the board want to demonstrate vision and strive to sustain the business, or be concerned only about annual profit? Believe it or not, your board may not yet have engaged in deep enough discussions of such questions.

Go on beyond glass ceilings and sexual harassment to update understanding about genuine ethical issues related to men and women side by side in the health care workplace.

Are there any ethical aspects to the establishment of salaries and wages?

Should the board become involved in the issue of arbitrary pricing in the drug industry, insurance companies, and their own organization?

What would you add to (or quickly subtract from) this list?

Issues in biomedical ethics

Genetic engineering and gene therapy, stem cell therapy, human cloning, you name it. These issues are no longer science fiction and they are no longer impacting only politicians and major medical research centers.

What guidelines should the ethics committee provide its clinical practitioners and the board in these areas? What should the relationship be between the ethics committee and our institutional review board (IRB) that approves research projects in these areas?

Richard E. Thompson, MD, is former vice president of the Illinois Hospital Association, taught ethics at St. Petersburg College and Missouri State University, and is author of Think Before You Believe, Xlibris, 2005. He can be reached at [e-mail].

References

1. M. Magnet. Why We're Obsessed With Money. Medical Economics 64:25, December 7, 1987.

2. Smith, A. Wealth of Nations. London, 1776.

3. Aristotle. Politics, Book II (trans. B. Jowett), intro. H.W.C. Davis, Oxford: Clarendon Press. 1905.

By Richard E. Thompson, MD

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