Friday, September 21, 2007

Searching for a Secular Health Care Ethic

Recent articles in the Boston Globe about the effort to create a “church for those who reject religion” and the New York Times asking “Is ‘Do Unto Others’ Written into our Genes?” have important implications for the ethics of health organizations.

All who share the conviction that health care is a calling have to ask – where does the call come from? In my posting on September 10th I discussed the Catholic view that health care is a sacred ministry. Participants in faith-based systems can anchor their sense of mission in the teachings of their faith. But where do secular organizations find their anchor?

The question is eminently practical. Given that one sixth of the economy goes to health care, health organizations rightly see themselves as businesses. But business can swamp calling. The practical challenge is integrating business ethics and health care ideals. Faith-based systems can address this tension through mission offices whose role it is to ensure continuous attention to mission in all aspects of the organization’s activities.

The Boston Globe article describes the humanist chaplaincy at Harvard University and the effort to create a non-theological community of shared ideals. This is the challenge leaders in health organizations must grapple with. The effort to create action oriented non-theological communities in the U.S. goes back at least to Felix Adler's founding of the Ethical Culture Society in 1876. The history of the humanist movement has valuable lessons for secular health care.

The New York Times article presents speculations by evolutionary psychologists that the Golden Rule has adaptive value for our species and may have a genetic basis. While first year philosophy students understand that "is does not imply ought," a sense of mission does not come from logic alone. Believing that care for others is "natural" and embedded in our biology and the history of our species can add emotional spark to a non-theological sense of mission.

I hope readers will share their personal and organizational observations about what nourishes effective, successful mission-driven health enterprises.


Anonymous said...

When you write that “the practical challenge is integrating business ethics and health care ideals," I have to ask if “business ethics” isn’t a contradiction in terms. I recall the annual summary of benefits that I receive every year from the insurance company from which I buy “gap” insurance to supplement Medicare. This summary sedulously itemizes every benefit that I received during the year – often running to three pages. But strangely the summary doesn’t give me a total for the year. I wondered whether it was too difficult for the computer programs that produce the summary to add up a column of numbers. Or did someone in management at the insurance company decide that it wasn’t in the company’s interest to enable customers to compare the total benefits they received with the premiums they paid? When I call and write the company to ask why they omit this important information, they say that most of their customers aren't interested!

Jim Sabin said...

Hi John

Your comment about the lack of a total on your annual medigap summary is interesting. If the reason is the one you speculate about it would be a dumb business decision for the insurer to make. If we have the good luck not to be sick of course our benefits will be less than the premiums we paid. That is the whole idea of insurance. Rather than hide the fact of the total the company could better congratulate you on your apparent good health!

I don't think "business ethics" is a contradiction in terms. While many businesses -- both for-profit and non-profit -- violate ethical norms, others conduct themselves admirably. Unfortunately for the latter, the widely publicized scandals lead to cynicism about all businesses.

Best --