Ethics, medicine and economics: integration in a hospital environment.

RAPID AND RADICAL CHANGE in almost every facet of society has brought in its wake community anxiety, suspicion and hostility. Current examples in Australia include the impact of globalisation, the introduction of the goods and services tax, and the actions of the banks in phasing out local branches. Even the health industry faces increased levels of public scrutiny and criticism. A recent example has been the aged-care institutions, charged with providing suboptimal facilities and services. 1 Hospitals, too, both in the private and public sector, have received embarrassing media attention — the organ-harvesting scandal in the United Kingdom being but one example. 2 Surprisingly, while such public pressure has resulted in many large companies formulating corporate codes of ethics, few hospitals, with the exception of some with religious affiliations, have adopted such codes. This may be due in part to many hospital staff having their own professional codes of ethical behaviour. However, a hospital is more than the sum of its professional staff, and decision-making at a corporate level raises ethical issues. For example, ethical issues need to be taken into account in the allocation of scarce financial resources and the sometimes fierce interdepartmental battles for funding. The size of many hospital budgets brings them into the ambit of " big business " and, as such, boards must be sensitive to the bottom line of financial accountability. Currently, there is increasing pressure on all businesses, large and small, to establish their activities on a sustainable basis, incorporating " triple-bottom-line " accountability — decision-making must take into account not only financial outcomes but also human rights and the impact on the environment. 3 Only when all these issues are addressed, it is argued, can legitimate and responsible decisions be made. The question might be asked, why bother with a code of ethics when hospitals are governed by highly prescriptive laws and regulations covering just about every aspect of their activities — from occupational health and safety to environmental protection to paternity leave — and where the threat of litigation hangs heavily over the system? The simple answer is that, to maintain and develop a reputation with customers and the community and create credibility and trust in a " brand " or image, any organisation must these days go beyond pure legal compliance with regulations and avoidance of litigation. This requires a willingness to communicate the values under which the organisation will …