Monday, January 14, 2008

Genes, Organizational Ethics, and Calling

Many people – myself included - see health care as a calling. But as I asked a few months ago - where does the calling come from?

For those who ground their sense of calling in religion, the answer is easy – the call comes from God. Secular individuals and organizations, however, can’t take that route.

Steven Pinker’s article on “The Moral Instinct” in yesterday’s New York Times, which draws heavily on Jonathan Haidt’s book “The Happiness Hypothesis,” speaks to the issue of secular “calling.”

Haidt speculates that five moral “themes” have been wired into us through evolution:

it is bad to harm others, and good to help them
people should get what they deserve (fairness)
we should be loyal to our group(s)
we should respect legitimate authority
we should seek purity and sanctity, and avoid defilement

Haidt and Pinker’s perspective is that these sentiments are “natural” – they are attitudes characteristic for our species, though not universal to every person. Individuals, groups, and societies give different weights to these values, and attach them to different phenomena. But the values themselves, Haidt and Pinker argue, create a basic moral vocabulary.

I think Haidt and Pinker’s hypothesis about the hard wiring of moral sentiments sheds light on why folks at the front lines of health care cringe at the application of market terminology to the field, such as: “health care industry;” “providers;” “consumers;” “marketing;” and, “brand identity.”

Concepts like these, and others from business and economics, explain a lot about how health organizations function, and are crucial for running them. Mother Theresa was a superb marketer!

Those who work in faith-based organizations can say – “We have to recognize that we are economic entities functioning in a market economy, but we always have to remember that we are doing God’s work.” Those in secular organizations can’t say this. But they feel it – even though they may not be able to explain why.

Haidt and Pinker would say – those feelings arise from our hard wired moral sentiments. Health care is all about helping sick people have fair chances in life. Good hospitals, clinics, health plans, and other health organizations, are committed to these goals just as religious organizations are. And the Hippocratic Oath is replete with references to authority, holiness, and purity.

Health organizations and their leaders have to walk a complex line. They are economic entities in an economic world. Without an economic margin they can’t pursue their mission. But whether or not they are founded on a conventional theology, they are, at heart, religious entities as well. When that is forgotten those who are part of the organization ultimately become cynical and alienated, and those who deal with it ultimately cease trusting it.

Pinker and Haidt would say - listen to your genes. They are calling you!

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