A Comparison of Medical Ethics and Managerial Ethics in the Health Sector
This multidisciplinary doctorate research draws on the disciplines of psychology and philosophy in its consideration and comparison of medical ethics and managerial ethics in the health sector. There is very little research which has compared the ethics of doctors and managers even though they work alongside each other in health organisations. Hence this thesis not only adds to the body of knowledge but also contributes a new perspective to applied ethics via the multidisciplinary approach. The empirical research was conducted in three phases. First, a pilot study which interviewed via the repertory grid method six doctors and managers from a Crown Health Enterprise (i.e. a public sector health provider organisation which manages a number of hospitals). Second, a series of repertory grid interviews conducted with nineteen doctors and managers from seven Crown Health Enterprises throughout New Zealand. In the third phase, the ethical constructs and role perceptions identified in the first and second phases were incorporated into a questionnaire which was distributed to 799 doctors and managers in three Crown Health Enterprises. The questionnaire posed a range of questions on role perceptions, ethical dilemmas faced, influences on ethically challenging decisions, ethical issues, and required respondents to rate an ethical manager, ethical doctor, unethical manager and unethical doctor on a range of constructs and rate which construct contributed the most to being an ethical manager and to being an ethical doctor. The main aim was to identify similarities and differences between doctors and managers. The questionnaire analysis revealed a complex three way interaction between doctor/manager raters and the ethical/unethical doctor/manager being rated. This interaction was best represented by seven of the bipolar constructs. Additionally it was found that a highly ethical doctor was seen as honest, focused on patients' best interests, and principled - has standards which are lived up to privately and publicly. The highly ethical manager was seen as honest, flexible and open to others' ideas, recognises and uses the skills of others for their good and the good of the health service, committed to and works hard for the public health service, and takes a long term/strategic view of issues and the wider implications of decisions. Overall it was concluded that the results showed that medical ethics and managerial ethics can be discussed within a general moral framework which allows for different priorities in each role. And that the fundamental difference in priorities between doctors and managers, lay in their basic role orientation - doctors focused on the patient, and managers focused on the organisation.