Blok 9 literatuur Flashcards
What are the four sources of moral disagreement according to G&T, and why it is important for their argument?
- Scarcity
- Limited generosity
- Appreciating the competing claims of more than one fundamental value, struggling internally to resolve the conflict (even though there is abondance). Bron van conflict ligt in moraliteit zelf
- Incomplete understanding
How do democracies of various forms respond to this disagreement and do they succeed?
Two types of democracy emerges, what is their overall aim? To avoid substantive moral disagreement by less controversial procedural means
What is majoritarianism?
claims of each citizen should be weighed equally and the greatest number should prevail
Why according to G&T is majoritarianism problematic?
It assumes that two conditions can be met that in reality are very complex and can hardly be met; those two conditions are?
1. Equal chances of constituting the majority
2. The majority must not infringe the vital interests of individuals
Why is majority rule of interest group bargaining not suffice?
- Procedural indeterminacy To decide whether majority decision is justified you need substantive value(s) (see liberty for example), for this you need deliberation
- Majority rule cannot be justified if it violates the vital interests of individuals
- Before voting there often is a process in which some people are informed about the issue, discuss the issue etc. This is also moral deliberation
- The majority rule only claims that the majority can decide, it cannot claim that the majority is morally right. Therefor the majority rule does not solve moral disagreements
4 general reasons to make a case for moral deliberation
- Moral deliberation contributes to the legitimacy of decisions and policies. (scarcity)
- Deliberation responds to our limited generosity by creating forums in which we are encouraged to take a broader perspective on questions of public policy. (limited generosity)
- Helps to clarify the nature of conflict and to come to a morally justified consensus (disagreement in nature of morality)
- Process fosters learning from each other and develop views and policies that are more widely justifiable (incomplete understanding); trial and error; correction mechanism
Problem with rationality project
- p.9 If you take out the politics of governance, what exactly is left? By suggesting that policy questions are only technical questions that can be solved rationally, these normative choices are not discussed; it misses attention to the normative choices that are part of political choices.
- p. 11 it ignores emotional feelings and moral intuitions
Stone: what is rationality project?
Rationality project = op een rationale manier naar de politiek kijken
3 pillars Stone describes as part of the ‘rationality project’
Model of reasoning = rationale besluitvorming, stappenplan. Rationeel proces waar emotie
geen onderdeel van is. Stappenplan:
1. Identify objectives
2. Identify alternative courses of action for achieving objectives
3. Predict the possible consequences of each alternative
4. Evaluate the possible consequences of each alternative
5. Select the alternative that maximized the attainment of objectives
Model of society = gaat over de markt. De maatschappij is een verzameling van rationele besluitvormers die keuze maken uit eigen interesse. Kiezen niet voor de gemeenschap maar voor zichzelf
Model of policy making, = production model. Procedure hoe beleid gemaakt kan worden.
- What does Stone propose to focus on instead of the rationality model? Describe this for each of the three pillars identified under (2).
Model of reasoning = political reasoning, je probeert op een andere manier naar dingen te kijken. Als je het ander uitlegt, kan je er anders naar kijken. Metaforen werken goed.
Model of society = je gaat kijken wie er betrokken zijn
Model of policy making = welke mogelijkheden zijn er/welke ideeën zijn er en dan kijken wat je kan doen
Principles of business ethics
- Basic individual rights
- Individual self-interest
- The interests of the organization or institution
- The public good / the community good.
How should we rank these? 1 en 4 of equal value. Individual cases: conflict 1 and 4, je moet de casus goed analyseren. 3 (3 staat boven 2.)
- 1 + 4 3 2.
Guidelines for development of financial incentives for physicians (weber 2001)
- Incentives should be not too high
- Incentives should be based on meeting quality criteria, not just reduction of resource use
- Financial incentives should be used sparingly as a method of influencing physician practice patterns.
Explanation of commercial model
Commercial model –> a private good
the cost of medical benefits will be seen as an expense that should be kept as low as possible.
o Commercial model: no difference between healthcare business & any other business.
o Vb wie volgens die frame redeneert: Just compliance (naleving) (Nobel-winning economist Milton Friedman)
o He wrote a paper: the social responsibility of business is to increase its profits.
* Friedman: managers of coperations are employees of the stockholder and therefor responsibilitys for profits. Charity stuff = stealing form the stockholders.
o Just following the law. And doing more is theft of shareholders.
o Central concerns for manager: potential gains of profits / reasonable turn of investements. So like a normal business.
Service model
Service model –> a social or a public good
using as much of every dollar as possible for the healthcare services that the organization is designed to provide. (prevers terms like: medical care / cost ratio).
o Healtcare = social / public good. (everyone invest in it. + caring for sick people is a social obligation that extend beyond the commercial realm)
o Justice-based ethics
o Managers have stewardship responsibility for limited resources available for healthcare services. .
o You need to be able to design and implement Fair procedures for evaluating claims made by different stakeholders
o Setting priorities about the use of resourses.
* So: is it fair to give nurses higher salary compared to other hospitals in the region? In case there is a shortage in nurses.
* It is allowed to refuse clients who are lossmaking for the organization?
* What is a fair procedure to downsize the organization when you loss a contract with one of your commissioners.
What is healthcare business ethics?
- Beyond compliance
o Compliance offers at least a minimal standard of what should not be done
o Weexpectmorefromhealthcareorganisationsthatjustfollowtherules,we
expect them to do good * Beyond integrity
o Manager is trusted to be honest and doing right by others before personal advantage or the organization advantage
o It is more than personal integrity, it requires also the ability to understand issues from the perspective of those who have little opportunity to be heard such as lower skilled workers or uninsured patients→an manager should weight and balance the rights and needs of all important stakeholders - Beyond clinical ethics
o Ethical concerns can be related to patient care (important to understand), but
also to other stakeholders - Ethics is a manger’s business and cannot always be delegated
What is the nature of business ethics?
- According to the commercial model – a private good
o No difference between healthcare business and other business
o Central concerns for a manger relate to potential gains of profits, reasonable
return of investments etc. (like a normal business)
o Just compliance, Nobel-winning economist Milton Friedman reasoning from
this model→irritated by the idea of social responsibility (doing good for the community), social responsibility of business is to increase its profits, business ethics is just about following the law and doing more is theft of shareholders
o Recognizingsocialresponsibility - According to the service model – a social or public good
o Makingcontributionstothehealthcaresystemofferingasmuchservicesas possible given the amount of resources
o Healthcare management is a service profession and healthcare can be the best understood as a social and public
o Managers have stewardship responsibility for limited resources available for healthcare services
o As future healthcare managers you need to be able to design and implement fair procedures for evaluating claims made by different stakeholders and for setting priorities for the use of resources
o Justice-based ethics: justice is about fair distribution, making a difference between legitimate and illegitimate claims
According to Weber healthcare organizations have three different roles, involving different commitments to healthcare managers, different tensions and different ways of dealing with these tensions. Describe these three roles in these terms.
- Caregiver: Managers need to recognize individual patients as part of a community. There are also moral dilemmas about wages, salaries, downsizing etc. Commitments to:
- Deliver high quality care
- Respect patients’ rights
- Stewardship responsibility for limited resources available for healthcare service: able
to design and implement fair procedures for evaluating claims made by different stakeholders and for establishing the priorities for decisions about resources
Managers need to recognize individual patients as art of a community of patients served. This can conflict
Managers need to be able to design and implement fair procedures for evaluating claims made by different stakeholders and for establishing the priorities for decision about resources - Employer: Not unique to healthcare, the needs and interests of all relevant stakeholders are balanced on the basis of a consistent and explicit understanding of priorities. Commitments to:
- Being fair in employing and managing staff in the organization
Ethical tensions are numerous: for instance, related to what is fair wage; decisions about downsizing; etc.
The ethical organization is one in which the needs and interests of all relevant stakeholders are balanced on the basis of a consistent and explicit understanding for priorities - Citizen: It has responsibility to promote the public good, particularly a responsibility to seek to improve the health status of the community.
Responsibility to promote the public good, particularly a responsibility to seek to improve the health status of the community, being socially responsible
Ethical tensions: what is best for patients or employees, may in some cases contrast the public good of health. Everyday work pressures and natural emphasis on the well being of the organization and on the well being of patients make it difficult for most managers to understand what this means let alone in place a high priority on these responsibilities
Ethical tensions: what is best for patients or employees, may in some cases contrast the public good of health. Everyday work pressures and natural emphasis on the well being of the organization and on the well being of patients make it difficult for most managers to understand what this means let alone in place a high priority on these responsibilities
According to Weber there are two kinds of ethics concerns that need to be addressed in any organization, with two ethics related responsibilities for management. Which are these two?
Adherence to ethical standards, management has a responsibility to ensure that established ethical standards are known and observed, that apparent violations of these standards are investigated fairly and promptly, that confirmed violations are corrected in an appropriate manner, and that steps are taken to prevent future violations. Clear ethical standards need to be established and communicated.
Management should be sensitive to and educated about the ways that ethical values are inherent in various business decisions and management also has the responsibility to promote ethically informed and guided decisions by others in the organization (grijze gebied: hoe herken je de dilemma’s en samen bespreken ‘ hoe kunnen we als organisatie het beste hiermee om gaan?.
Weber distinguishes four priority principles of business ethics. He also provides guidance on how to prioritize them. Which principles does he delineate, and how does he suggest to prioritize them?
1: Basic individual rights: what everyone, regardless of power, position or merit should have respected or provided simply because of being human (human rights) and what is due to persons because of agreements or promises
- good available care
2: Individual self-interest: the good things in life, as individuals define them, which they seek for themselves and for those close to them. What people want.
3: The interests of the organization or the institution itself: the good of the organization, normally as defined and interpreted by its leaders.
- finances
- give good quality of care to the patients.
Prioritize: 1 & 4, 3, 2
Which four processes or methods are described in the report to foster integrity within a rule- based approach? Describe each.
Bij een rules-based benadering wordt gebruik gemaakt van formele en gedetailleerde regelgeving om integriteitsovertredingen te bestrijden en corruptie te voorkomen
Deze regels, wetten, normen, codes, protocollen (en de daarbij behorende sancties) functioneren als handvatten. Deze benadering kent ook beperkingen.
- codes of conduct and protocols
- monitoring: using objective indicators to try to find out what the state onf integrity is in an organization e.g. complaints
- establish a whistle=blower regulation (dat iemand een klacht kan indienen, bv klachtencommitee/ anoniem, klokkenluiders regeling = als jij iets aankaart dat je beschermd wordt.)
- sanctions (straffen als codes of conduct niet wordt nageleefd)
Hier is vaak minder over te vinden.
The CEG report also describes a value-based approach to fostering integrity. Which three processes or methods are described in the report to foster integrity within a value based approach? Describe each.
- Sturen op kernwaarden: mission, vision and explicit core values
- Sturen op openheid en bespreekbaarheid: communicating desired behavior
- Zelf het goede voorbeeld geven: message through your own behaviour about what is acceptable or not
Healthcare organisations have more weight on the value-based approaches.
- Jaarverslag.
Which limitations are mentioned managers are faced with when fostering integrity in their organization?
Ruimte en vertrouwen (ongelijke informatie tussen client en professioneel,, dus je moet bepaalde ruimte hebben om goed te kunnen handelen)
beleid vanuit de beroepsgroep (veel policies komen vanuit de professies. Ze vinden die ethische values more important then the things you maybe want to implement as a manager).
beleid vanuit de overheid. (hier kan je als manager ook niet veel aan veranderen)
2How would you organize such moral deliberation in your organization?
- Findings of article molewijk : ze hebben belangrijke punten / elements die belangrijk zijn om adress if you want to organize moral dilaberation.
o Client centered questions
o Different moral questions
o Organize it close to the day to day care (even discussie van molenwijk et eal lezen, hier staat het in).
Belangrijk dat je meer onderzoek doet naar hoe het de kwaliteit van care beinvloed. Invest more in research om te kijken of deze moral deliberation have affect on the quality of care.
moral disagreement what to do?
- Objective factual information
- Unambiguous terminology
- Acceptance of common framework of moral norms (principles)
o This is developed after clinical trials which went extremely wrong. So which norms has to be followed Autonomy, beneficence, non-malifecence, justice. - Use of (counter) examples
- Analyses of arguments (logic)
o Working with examples and counterexamples.
o You have to have a correct understanding of your facts.
5 features of ethics of care:
Care is central: care is about meeting the needs of particular others for whom we take responsibility. Je bent op verschillende stadia van je leven afhankelijk van de zorg van anderen.
- Everything is care. : care is also: the way you treat the things around you.
2 Zorgethiek waardeert emotie in plaats van deze af te wijzen.
- Why is this so important?
- Not all emotion is valued, of course, but in contrast with the dominant rationalist approaches, such emotions as sympathy, empathy, sensitivity, and responsiveness are seen as the kind of moral emotions that need to be cultivated not only to help in the implementation of the dictates of reason but to better ascertain what morality recommends.3 Even anger may be a component of the moral indignation that should be felt when people are treated unjustly or inhumanely, and it may contribute to (rather than interfere with) an appropriate interpretation of the moral wrong.
- Emotions are important to feel what is morally right. Its not they say you always have to follow your emotion, but emotion learns you how a relationship is. (And which parts should be reshaped/ if a relationship is good, what you should cultivate more).
4: Blurring of boundary between the private domain (household) and the public domain/ care is important in the public domain.
- Traditionele visie: the government should not interfere in the household/private sfeer, its all up to you.
- Ethics of care: Private domain is important. Otherwise we miss a very imporant part of morality. We have to take a very close look also at the situation in the household (f.e. imbalance/impower between gender). So: ethics of care does not see the distinction between public and private.
5: Relational conception of persons: interdepence
- Person as relational instead of self-sufficient independent individuals.
