Preserving Our Values: Habermas, Hospital Ethics, and the Business of Health Care
Johnson, Paul F., The Midwest Quarterly
THERE IS A TROUBLESOME and dangerous malady threatening the operation and vitality of some of our social institutions today. Call it "Creeping Corporatism." It's the idea that somehow the work of our various institutions can be done more effectively if the skills controlled by a professional managerial class are brought to bear upon the work process through a more tightly regimented corporate structure. The process moves from the statement of desired outcomes to the redesigning of production methods to the marketing and consumption of the finished "product." We can see it all over the lot: our elections, professional sports, higher education, health care. Most of us who vote are at least mildly distressed at the way the candidates for public office are "packaged" and presented to us through professionally managed media campaigns. The social scientific methods of data-gathering and survey-taking produce an endless stream of polling results that tell us precisely ([+ or -] 3 points) what we are already thinking and expecting and wanting for the future--and thereby relieve the candidates themselves of any obligation to tell us what they are really thinking. "First, get elected" is the first rule of the political jungle; "hire professional help" the second. Those of us in higher education are struggling to think about what we do in the classroom in a way amenable to the social-scientific methods of "learning outcomes" and assessment rubrics that are being urged upon us by the ever-more assertive accrediting agencies. But it is hard to describe the marvelous and mysterious growth of a young mind, over the course of a semester no less than over the full four years of college experience, in rigorous and mathematically quantifiable terms; hard to think of students as consumers; to regard liberal education as a product or commodity to be marketed like any other, or to think of Deans in their traditional capacity as faculty advocates as "vice-presidents." Free agency in baseball is defended on the hardnosed, real-world terms of economic analysis, but it is hard to cheer for the mercenary shortstop who hires on in late July to help with the pennant run, who makes more money at one turn at bat than most people earn in a year of honest toil, and who will be gone in October only to reappear next year in the uniform of a hated rival. The vague and for the most part inarticulate sense of distress in all of these contexts is symptomatic of an underlying malady that we had better make some effort to understand.
Without having to deny the salubrious potential of economic theory and the principles of business management, we may well pause to consider the ancillary harm and the unintended consequences of an over-zealous application of social-scientific methodology to domains in which they are insufficiently attuned to the values which inform our institutions. A test ease, and the subject of the present essay, is the condition of our ethical values in health care at a time when our medical institutions are more and more given over to the ministrations of a professional management regime. What price do we pay, in non-monetary terms, for the greater efficiency of health care delivery? What values may be lost? How do we negotiate the line between managerial efficacy and values-sensitivity? The focus here shall be on the hospital ethics committee and its prospects under the rapidly developing circumstances in the field of health care, but the results could be generalized in any number of different directions.
Most hospitals today have an ethics committee. Although the formal accreditation review process for hospitals, conducted under the auspices of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), does not specifically require the existence or regular meeting of such a committee, an active and well-situated ethics committee goes a long way toward demonstrating compliance with JCAHO regulations, and hence toward securing the many indispensable benefits which flow from accreditation. …