2011 Theme
Doing the Right Thing, Doing the Thing Right
What is the relationship between ethics and compliance, values and rules, organizational culture and quality improvement? How ought we to work and live within the sometimes conflicting frameworks of codes of ethics and conduct, bills of rights, and legislated rules, while honoring our own values and virtues and those of patients and health care providers?
The theme for Health Ethics Week 2011 explores the relationship between doing the right thing (acting ethically) and doing the thing right (following rules, codes, laws). It attempts to highlight a tension between a compliance-based and a virtue-based approach to ethical decision-making.
A compliance-based approach represents a more formal or legalistic way of guiding behaviour. It focuses on the development of rules of behavior, and encouragement or enforcement of compliance with those rules. Departures from the rules are often deemed unethical or at least unacceptable. As a result of often being rooted in a comprehensive set of rules, regulations or guidelines, compliance-based models are frequently more prescriptive, specific and clear.
In contrast, a virtue or
character-based approach focuses more heavily on encouraging the adoption and
practicing of certain values and behavior traits in individuals. The intention
is that these values and characteristics are more likely to lead individuals to
make the right choices when necessary. A disinclination of virtue or
character-based approaches to adopting more specific rules or decision-making
guides often leaves more room for individual interpretation.
Motivation
Sometimes, these
approaches are contrasted as being externally (compliance-based) vs. internally
(virtue/character-based) driven. This distinction stems from the intended source
of motivation to embrace ethical behavior. In the former it is often fear of
consequence or punishment. In the latter, there is a reliance on self-inspired
appropriate behaviour – doing the right thing because it is the right thing.
The Proliferation of Compliance Offices
As a result of recent highly publicized and significant transgressions of ethical behavior in the corporate world and resulting legislation in many western nations, the phrase ethics and compliance has come to be commonplace, and the appointment of Ethics and Compliance Officers has become legion. Codes of ethics or codes of conduct have similarly emerged as a common means of attempting to ensure a minimal set of rules to which all who are governed by the code must adhere.
Concerns are commonly raised about such documents, including suggestions that while organizations may adopt such codes for the sake of meeting a legal requirement or appearing to be committed to ethical behavior, without further strategies devoted to ensuring a widespread understanding of why these are important, or support and help for individuals in making ethical choices, the documents are more or less ineffective. While such criticisms may frequently be true, they are by no means universally so; many organizations have put in place comprehensive programs to encourage reflection on, understanding of, and discussion about ethical norms.
Building an Ethical Culture
An inherent limitation of exclusively compliance-based approaches to ethics is, arguably, that ethics is about more than adherence to rules. No organization or system is likely to be able to develop rules that will apply to every situation that may present itself, and even if it were possible, an organization or world in which individuals largely did the right things, but only begrudgingly and out of fear of the consequences of not doing so, would likely be less than morally ideal. It could be argued that there is something about doing the ethical thing out of concern for others or borne of a sincere sense of obligation to others, that fills out the otherwise hollow core of apparently moral behavior.
To this end, much discussion in the field of ethics has explored the question of how to supplement or supplant rules-based models of ethics with ones that seek to enhance the integrity and moral character of individuals and organizations. The building of an ethical climate within organizations has been suggested as an important objective above and beyond any requirements to adhere to rules or laws. An organization that takes seriously the importance of enhancing its ethical climate might be one in which employees, volunteers, and stakeholders: have a deep appreciation of the values to which the organization subscribes; are provided the space to explore questions of right and wrong without retribution; are encouraged to ask questions about what is and is not ethically appropriate in a respectful manner; and are widely inspired to do the right thing, not just to do their job/the thing right.
Exclusive Approaches
The above description suggests that while rule- and virtue-based approaches to ethics may not be mutually exclusive and in fact may well be complementary, it is important to clarify the distinction between the two, and not to assume that the one implies the other.
To download this information as a PDF document, please click here.