On a research visit in 1999 to the Columbus, Ohio branch of Holy Cross Health System, we were told by the sister who led the organization that many of the doctors at one of their facilities were Jewish. With a mischievous smile she added – “as long as we stay away from a few specific issues we get along wonderfully, because we share the belief that medicine is a calling.” Her comment resonated for me. Although I am Jewish I was electrified by Holy Cross’s deeply felt mission – “to witness Christ’s love through excellence in health care.” (My colleagues Steve Pearson, Ezekiel Emanuel and I have since described the visit in No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence. )
I understand my response to a program based on a theology I do not share better since reading the excellent special section on organizational ethics in the November/December 2006 issue of Health Progress, a publication of the Catholic Health Association. The Association describes its health care activities as a “ministry…rooted in our belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind, and spirit.” I believe the people I have most admired over the years in health care share these values, even though many, including myself, derive different conclusions about reproductive ethics than the Catholic Church does from the view that “every life [is] a sacred gift.”
In the opening essay, John Gallagher puts organizations front and center for health care ethics: “While personal integrity and virtue remain matters of key importance, what is now of at least equal importance is the integrity and virtue of the institution, the institutional structures through which health care is mediated.” David Ozar takes issue with the “Myth of Enough Good People,” which he defines as the belief that “if only there were enough good people making decisions in the organization…then everything that happened in the organization and everything it did would be good as well…” Ozar argues cogently that organizations should be viewed as “single, unitary actors” and held accountable for the ethics of their conduct as organizations the way we hold individuals ethically accountable for their conduct as individuals.
If we see health care as a sacred ministry and health organizations as moral agents, everything health organizations do comes under a spotlight. This is all to the good. Everyone’s work in health care is ennobled by recognizing its deep human importance, and high ethical expectations for everything we do encourage us to do all that can be done.
Not surprisingly, Catholic health institutions have been in the vanguard of developing organizational ethics programs, and the Catholic Health Association is probably the group with the most extensive experience of grappling with organizational ethics issues. Sister Patricia Talone offers practical advice on how to start an organizational ethics committee. And, in another issue of Health Progress, Brian O’Toole presents a useful description of committee function in the Sisters of Mercy Health System.
Everyone concerned with health care organizational ethics – of whatever religious outlook or lack thereof – can learn from the experience of Catholic health programs!