Academic journal article Global Virtue Ethics Review

Deregulating Health Care Ethics Education: A Curriculum Proposal

Academic journal article Global Virtue Ethics Review

Deregulating Health Care Ethics Education: A Curriculum Proposal

Article excerpt

Abstract

Ethics education is an important component of health care management education. However, this article argues that the focus in many health care management ethics courses is misplaced, as the stress is on the need for dealing with increasing control of organization actions, corporate compliance, and issues related to laws and regulations such as the False Claims Act, qui tam, and whistle blowing. This article suggests that we need a "deregulated" approach to address the problem of fraud, waste and abuse in the practice of health care management, and should also incorporate this approach into health care management ethics education. A deregulated ethics curriculum for health care management ethics education, using a modified Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) accreditation process informed by virtue ethics as a case example, is proposed and discussed.

Introduction

Ethics education is an important component in the curricula of many university degree programs, particularly those programs specializing in health care management. In fact, a review of nationally accredited health care management programs reveals that at least seventy percent address the substantive areas of ethics, laws, or regulation (AUPHA, 2002). The need is critical for discussion and examination of ethical issues in the health care systems in many countries. For example, the U.S. Medicare program alone lost $ 20 billion dollars in 1997 just due to fraud upon the system (HCFA, 2000). However this article will argue that, in both the practice and study of health care management, the particular methods used to promote ethical behavior have been inadequate. These methods overly stress the need for dealing with increasing control of organization actions, corporate compliance, issues related to laws and regulations such as the False Claims Act and qui tam, and whistle blowing. After a brief discussion of a potential dilemma facing any ethics course instructor, the article will discuss the context and significance of fraud, waste and abuse in the U.S. health care system, highlighting the dysfunction caused by the current practices promoting ethical conduct. Next, the article will present and discuss the concept of a "deregulated" approach to promoting ethical behavior in both the study and practice of health care management. Lastly, a vehicle for developing this alternative ethical perspective in both study and practice of health care management, through a modified Joint Commission on the Accreditation of Healthcare Organizations JCAHO accreditation process, is offered.

Teaching Ethics or Moral Indoctrination: A Potential Dilemma

There is always a danger when addressing a specific approach to ethical behavior in the context of course or curriculum development for professional programs such as health care management that accusations of moral indoctrination will be leveled. Denhardt (1991) succinctly described the dilemmas faced by instructors when designing ethics courses and the following section paraphrases her argument. An acute problem exists for such instructors in terms of moral indoctrination. Good professional education necessarily involves a socialization process whereby new members are introduced to the values and ethical commitments of the profession. It is generally the role of the instructor to select the topics, design the process for deliberating over these matters, and evaluate the performance of a student. In any profession experiencing ambivalence about its moral commitments, however, even the choice of topics can be problematical. The greater problems arise, though, in determining what (if anything) to present as definitive ethical commitments of the profession and how to evaluate whether students have "learned" the material. This is the arena in which questions of moral indoctrination can arise (p. 95).

One method by which to reduce the potential threat of accusations of indoctrination is to introduce any new or alternative approach to ethical study as one of several methods of analysis available to the student and manager. …

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