Miserable conditions in hospitals, institutional pathologies and clinical organizational ethics

Ethik in der Medizin 33 (2):159-175 (2021)
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Abstract

Definition of the problemStaff and patients in institutions of organized health care experience and express a variety of adverse conditions of these organizations. Within a theoretical framework of institutional pathology we can explain some of these “miserable conditions” as effects of the activities of organizations belonging to the political system (health policy) and to the economic system (health economy). Clinical ethics committees (CECs) cannot effectively handle such adversities or even address them properly. Standard organizational ethics can address them but cannot handle them effectively.ArgumentsI propose to strengthen organizational ethics by a theory of institutional pathology. Basic nosological distinctions such as disease, illness and sickness, whose primary reference is to biological organisms and persons, can be analogically extended to socially constituted entities (e.g. hospitals) in terms of functional deficiency, miserable conditions, and need for reform of such entities. A very promising focus for analysis are organizational disorders of responsibility allocation. This group of institutional pathological disorders engenders, amongst other kinds of miserable conditions, specifically morally relevant miserable conditions.ConclusionThe institutional pathology paradigm, oriented to concrete institutions and organizations, can help “clinical” organizational ethics to considerably expand, in theoretical ethics as well as in ethically guided practice e.g. for members of CECs and organizational ethics advisors, the capacities for observing, evaluating and, if necessary, amending disturbed relations of responsibility.

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Matthias Kettner
Witten/Herdecke University

References found in this work

What we owe to each other.Thomas Scanlon - 1998 - Cambridge, Mass.: Belknap Press of Harvard University Press.
Morality: its nature and justification.Bernard Gert - 1998 - New York: Oxford University Press. Edited by Bernard Gert.
Morality: Its Nature and Justification.Bernard Gert - 1998 - Philosophical and Phenomenological Research 62 (2):441-446.

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