+1443 776-2705 panelessays@gmail.com


Topic of Interest Posting: Initial Post Due by Thuesday at 11:59 pm EST
Pick a topic from the list and discuss it in terms of the concept analysis and evaluation. Support your statements with credible evidence and offer an example. (Note: Select a topic that will allow you learn something new and is of interest to you.)

· Ethics and Human Rights in Healthcare: Quality, obligations, influence on populations, and importance.

· ACHE Code of Ethics: Ethical principles, application to manager’s career, and behavioral influence.

· Ethics and Law: Ethical conflicts, ethical implications, and ethical principles relevance to laws.

· Clinical Ethics and Operational Management: Applied to autonomy, beneficence, non-maleficence, honesty, justice, and the manager’s role in ethical operations.

You will provide a response to at least two peers for the Initial Discussion by Friday at 11:59 pm ESTsharing information that may help them better understand their selected topic of interest. (Help them answer their question of interest. Offer guidance to better topic understanding)


Lessons Learned Posting by saturday at 11:59 pm EST
You will 
share the information that you learned

 from your course readings, your peers, and additional research related to the
 question of your interest

Assess 
how your initial understanding of the topic differs from your present viewsDefine the lessons (minimum 1) learned and the outstanding questions (minimum 1) that you still may have had on the topic. 

A minimum of two APA references with correlating in-text citation(s) 

are required from the week content 

8 5

L e a r n i n g O b j e c t i v e s

C H A P T E R 6

E T H I C A L F R A M E W O R K

Studying this chapter will help you to

? appreciate the relationship between ethics and law,

? categorize the relationship between ethics and law using the four-quadrant model, and

? understand the implications of ethical unawareness.

“It is not desirable to cultivate a respect for the law, so much as for the right.”

—Henry David Thoreau, philosopher and writer

00_ForrestalCellucci (2294).indb 85 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

C
o
p
y
r
i
g
h
t

2
0
1
6
.

H
e
a
l
t
h

A
d
m
i
n
i
s
t
r
a
t
i
o
n

P
r
e
s
s
.

A
l
l

r
i
g
h
t
s

r
e
s
e
r
v
e
d
.

M
a
y

n
o
t

b
e

r
e
p
r
o
d
u
c
e
d

i
n

a
n
y

f
o
r
m

w
i
t
h
o
u
t

p
e
r
m
i
s
s
i
o
n

f
r
o
m

t
h
e

p
u
b
l
i
s
h
e
r
,

e
x
c
e
p
t

f
a
i
r

u
s
e
s

p
e
r
m
i
t
t
e
d

u
n
d
e
r

U
.
S
.

o
r

a
p
p
l
i
c
a
b
l
e

c
o
p
y
r
i
g
h
t

l
a
w
.

EBSCO Publishing : eBook Academic Collection (EBSCOhost) – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS
AN: 1838990 ; Elizabeth Forrestal.; Ethics and Professionalism for Healthcare Managers
Account: s4264928.main.eds

E t h i c s a n d P r o f e s s i o n a l i s m f o r H e a l t h c a r e M a n a g e r s8 6

E
thics requires critical thinking. As a starting point, healthcare managers determine
the relationship between ethics and law in the conflict they face. This chapter uses
a four-quadrant model to explain the relationship between ethics and law. Applying

the four-quadrant model helps healthcare managers sort through this relationship as well
as categorize the ethical conflict they are facing.

Law

A rule enacted by a

legislative body, such

as Congress or a state

legislature; regulation

is a rule established by

an executive agency to

carry out a law CASE FROM THE FIELD
Man of the Year, 1930

Mahatma Gandhi was an ethical leader who broke the law and became Time maga-

zine’s “Man of the Year.” Born in 1869 in western India, he was given the name Mohan-

das Karamchand Gandhi. He became known as Mahatma—or Great Soul—in the early

1900s as he worked for the rights of Indian people in India (Severance 1997).

When Gandhi was born, India was a colony in the British Empire. His family poor

and mother widowed, he decided that, if he were a lawyer, he could attain an admin-

istrative post to support his mother. Therefore, in 1888 at the age of 18, he left India,

defying his caste leader, to study law in London (Hay 1989). There, he became a member

of activist, intellectual societies such as the Theosophical Society. Henry David Tho-

reau’s essay on civil disobedience greatly influenced Gandhi’s future political thinking

(Hendrick 1956). He passed the bar examinations in 1890 and returned to India in 1891.

Gandhi worked for India’s independence from Great Britain, using Satyagraha, a con-

cept he invented that refers to nonviolent political action. The word itself has no equivalent

in English, but it implies a convergence of truth, noninjury, and self-suffering (Hettne 1976).

In 1930, he literally mobilized the Indian people to show their support for the inde-

pendence cause by walking in the Salt March (or Dandi March) (Suchitra 1995; Weber

2002). The Salt March focused attention on the injustice of the British salt tax. India

has salt deposits, but the British monopolized salt manufacturing and retailing (Varsh-

ney 2003). The British salt laws not only levied a heavy tax but also made illegal many

salt-related actions—from manufacturing to purchase to sale to possession (Suchitra

1995). Essential to health, salt had a universal impact on all segments of Indian society.

The Salt March drew the world’s attention and empathy. In 25 days—between

March 12 and April 6—Gandhi and his 78 followers marched 240 miles from the city

of Ahmedabad near the northwest coast of India to the seaside town of Dandi farther

down the coast (Habib 1997; Suchitra 1995; Weber 2002). Stopping along the way to

speak to villagers, he reached approximately 500,000 people (Suchitra 1995). At Dandi,

he extracted salt, which was a violation of the law (Habib 1997).

Other salt marches were undertaken throughout the country; people made contra-

band salt. To demonstrate their support, 227 village headmen resigned as a means of

00_ForrestalCellucci (2294).indb 86 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

C h a p t e r 6 : E t h i c a l F r a m e w o r k 8 7

et h i C a l Co n f l i C t
Healthcare managers face many ethical conflicts. Examples of ethical conflicts are as follows:

? Taking the right action, such as giving a negative performance appraisal, is
necessary but doing so is difficult or uncomfortable for the people involved.

? Expanding services at a very small, rural hospital to include obstetrics would
be good or beneficent for the community’s families, but the costs of obstetric
services would make the hospital unprofitable, which is a violation of
fiduciary duty (see Chapter 4 for more discussion of this duty).

? Choosing between two equally negative alternatives is stressful but may be
inevitable.

Sometimes, the ethical conflict is resolved by a relevant mandate, such as a law,
policy, or rule. Often, however, healthcare managers deal with ethical conflicts that are not

Ethical conflict

A broad, generic term

for any problem or

situation that has an

ethical component

Beneficent

The act of doing good

DID YOU KNOW?
Salt Hunger

The human body needs salt (sodium) to function properly. Salt is essential to main-

taining blood pressure and to the functioning of muscles and nerves. Without salt, the

human body develops salt depletion or hyponatremia (low blood sodium). Hypona-

tremia may result in muscle weakness, vomiting, and possible convulsions and coma

(PubMed Health 2009). Today, however, we are more aware of the effects of excessive

salt, such as hypertension.

CASE FROM THE FIELD
Man of the Year, 1930 (continued)

noncooperation (Habib 1997). The nationalist movement of civil disobedience resulted

in the arrest and imprisonment of Gandhi and 90,000 supporters (Suchitra 1995). While

full independence did not come for India until 1947, his campaign of civil disobedience

has been credited as the greatest nonviolent battle in history (Weber 2002). In 1931,

Gandhi appeared on the cover of Time magazine as Man of the Year 1930 (Time 1931).

Civil disobedience is illegal, but Gandhi’s behavior is considered by many as ethical.

00_ForrestalCellucci (2294).indb 87 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

E t h i c s a n d P r o f e s s i o n a l i s m f o r H e a l t h c a r e M a n a g e r s8 8

covered by some edict, such as when they feel pressured to do something with which they
are uncomfortable, that they know to be wrong, or for which they have to bend the rules
(Dean, Beggs, and Keane 2010). Thus, laws, policies, and rules can only cover some of the
conflicts managers face. For other conflicts, managers may find that relying on mandates
to provide the answer is not a viable option.

th e fo u r-Qu a d r a n t mo d e l
Ethics and law are related, and the four-quadrant model (see Exhibit 6.1) shows these
relationships. This model was a conceptual framework to classify corporate decision mak-
ing (Henderson 1982). It was meant to prepare business executives for public scrutiny of
their company’s internal decisions.

The model shows that ethics and law, although related, do not have a one-to-one
relationship. For example, an act that is ethical is not necessarily legal. Conversely, an act
that is unethical is not necessarily illegal. Instead, the relationship is categorized into four
quadrants:

? Quadrant I: Ethical and Legal

? Quadrant II: Ethical and Illegal

? Quadrant III: Unethical and Legal

? Quadrant IV: Unethical and Illegal

Of the four quadrants, only two are straightforward—Quadrant I: Ethical and
Legal and Quadrant IV: Unethical and Illegal. The other two quadrants—Quadrant II:
Ethical and Illegal and Quadrant III: Unethical and Legal—require more thought, work,

exhibit 6.1
Four-Quadrant

Model of Ethics
and Law

Quadrant I
Ethical and Legal

Quadrant II
Ethical and Illegal

Quadrant III
Unethical and Legal

Quadrant IV
Unethical and Illegal

Source: V. E. Henderson, 1982. “The Ethical Side of Enterprise.” Sloan Management Review 23 (3): 37–47;

Figure 2, page 42. Used and adapted with permission.

00_ForrestalCellucci (2294).indb 88 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

C h a p t e r 6 : E t h i c a l F r a m e w o r k 8 9

and disentanglement than the straightforward quadrants. We examine each of the four
quadrants from the viewpoint of healthcare managers.

Q u a d r a n t i: e t h i C a l a n d l e g a l

Healthcare managers are ethical and legal when they perform their routine duties honestly
and justly. The following examples represent ethical and legal acts from each function of
management:

? Planning. Healthcare managers act with beneficence and follow the law when
they provide information to support a healthcare organization’s planning
activities, such as applying for a certificate of need (CON). In many states,
healthcare organizations must obtain CON approval before they plan certain
new services or construct new buildings.

? Organizing. Healthcare managers are acting both ethically and legally when
they schedule clinicians to provide services within their scope of practice or
licensure. For example, in skilled nursing facilities, clinical managers schedule
occupational and physical therapists to provide therapies to residents.

? Leading and directing. Healthcare managers consciously exercise ethics when
they put aside personal biases (justice) and act for the good of the unit
(beneficence) during the hiring process. They are following the law when they
do not question job applicants about their religion, national origin, marital
status, and other personal details.

? Controlling. During routine quality audits, healthcare managers may discover
errors in practice management software or other systems. For example, during
software upgrade and testing, a duplicate of the charges was created. The
practice’s manager discovered that these mirrored charges were submitted
to Medicare along with the “real” charges, creating duplicate claims. These
duplicate claims were paid by the Medicare administrative contractor,
resulting in overpayment to the physician practice. The healthcare manager
is acting ethically (honestly) and within the law (complying with Medicare
regulation) when he contacts the contractor to report the overpayment and
arrange repayment.

Acting ethically and legally may seem easy, but doing what is right and legally
permissible can be difficult. For example, whistleblowers who accurately report corporate
misdeeds to the authorities are acting ethically and legally. Often, however, whistleblowers

Certificate of need

(CON)

Required written

approval issued by

a state agency for

proposed new services,

buildings, and other

plans

Claim

An itemized request

that a provider

(organization or

individual practitioner)

submits to a payer

(health insurance

plan, Medicare, or

another payer) for

reimbursement of

services rendered

Whistleblower

An individual who

exposes and reports

corporate wrongdoing

00_ForrestalCellucci (2294).indb 89 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

E t h i c s a n d P r o f e s s i o n a l i s m f o r H e a l t h c a r e M a n a g e r s9 0

become the target of organizational disapproval and criticism, which could make whistle-
blowers feel they have done something wrong. Fortunately, federal law and many state
laws protect whistleblowers. Despite having the high ethical ground and legal protections,
whistleblowers know that facing the censure of colleagues takes courage.

Q u a d r a n t ii: e t h i C a l a n d i l l e g a l

In the United States, ethical but illegal behavior can be described as civil disobedience.
Following are three examples of individuals and groups who refused to follow the law but
did the right thing nonetheless:

1. For six years, Henry David Thoreau (1849) did not pay taxes because
he disagreed with the US government’s actions regarding slavery and the
Mexican–American War. He spent one night in jail for this offense (see the
chapter-opening quote).

2. In 1961, the Freedom Riders—a group of civil rights activists—rode interstate
buses in the South to test the states’ compliance with the desegregation ruling
of the US Supreme Court. These southern states still upheld segregation for
their transit facilities (Ling 2007), so the Freedom Riders were breaking the
local statutes while supporting the greater cause of justice.

3. An example in healthcare was the protest by healthcare professionals and
activists against the decision of North Carolina’s legislature to forego Medicaid
expansion under the Affordable Care Act. In 2013, many of these protestors
were arrested by the capitol police and subsequently charged with disorderly
conduct, trespassing, and violating building rules. In the protestors’ view, civil
disobedience was necessary to protest the loss of benefits (such as preventive
care) for their poor patients (van der Horst 2014).

Q u a d r a n t iii: u n e t h i C a l a n d l e g a l

People can be dishonest, unprincipled, untrustworthy, unfair, and uncaring without break-
ing the law. Actions that are unethical and legal often represent circumstances in which the
legal system and social customs have failed to keep pace with change or new knowledge.
Often, areas that outstrip legal and social processes are scientific research, technology, and
environmental issues. For example, scientists could clone sheep before members of society
decided whether they should clone living beings.

Before 2007, a hospital could be reimbursed for preventable conditions that patients
acquired in the hospital (even if the hospital or provider caused the condition because of
an error or an unsanitary practice). No law or regulation existed that prohibited payment

Civil disobedience

The concept of

resisting certain laws

for the sake of standing

up for what is morally

right

00_ForrestalCellucci (2294).indb 90 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

C h a p t e r 6 : E t h i c a l F r a m e w o r k 9 1

for these charges or claims. Therefore, if a hospitalized patient contracted an infection from
a dirty urinary catheter, for example, the hospital would receive Medicare payment not
only for the care related to the patient’s actual condition but also for the services related
to the infection.

Evidence-based medicine, however, advanced the knowledge of quality in medical
care. As a result, the Deficit Reduction Act of 2005 (effective 2007) eliminated Medicare
payments for preventable, hospital-acquired medical conditions. However, a loophole existed;
the hospital could still receive Medicaid payment. The Patient Protection and Affordable
Care Act of 2010 eliminated this loophole. Effective July 1, 2011, Medicaid no longer
reimburses for healthcare-acquired conditions and other provider-preventable conditions
(HHS 2011). Simply put, although receiving payment for preventable conditions or medi-
cal errors committed by the provider was unethical, it was not illegal until 2005 and 2010.

Quadrant III is difficult because the healthcare sector is dynamic, constantly inun-
dated with new laws, advances in technologies, and new interpretations of existing regu-
lations. Technology and biomedical knowledge, particularly, are created faster than laws
and regulations are written and passed. To be on the safe side and to avoid this quadrant,
healthcare managers could align their actions with those proposed in the Code of Ethics of
the American College of Healthcare Excutives and consciously check their decision making
for potential ethical conflicts.

Q u a d r a n t iV: u n e t h i C a l a n d i l l e g a l

Healthcare managers fall into this quadrant when they deliberately commit acts that are
criminal, morally corrupt, and socially unacceptable. Examples include preparing inflated
fee schedules, submitting fraudulent reports, and issuing inflated patient or client bills.
For these actions, managers and their organizations could face legal liability under the
False Claims Act.

Here are examples of how healthcare managers may act unethically and illegally as
they perform the functions of management:

? Planning. By law, 51 percent of the governing board of a federally qualified
health center must be composed of members who are active consumers of the
health center’s services. The director of one health center is aware that several
members of the board want to expand substance abuse services to homeless
women of childbearing age and their children. The director is opposed to this
idea. To prevent the discussion of this topic during an upcoming strategic
planning session with the board, the director appoints to the board several
former citizens of the community, each of whom she knows is vehemently
against providing support to homeless people. Thus, her action does not
promote beneficence and is illegal.

Fee schedule

A list of medical

services and

procedures and their

costs developed by

healthcare providers

for billing and claims

purposes

Federally qualified

health center

A clinic that receives

government funds for

providing affordable,

good-quality,

comprehensive

healthcare services

to an underserved

community

00_ForrestalCellucci (2294).indb 91 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

E t h i c s a n d P r o f e s s i o n a l i s m f o r H e a l t h c a r e M a n a g e r s9 2

? Organizing. Arranging the physical layout of a facility is a component of
organizing. The manager of a patient accounts department of a rehabilitation
facility reorganized the department’s layout so that its main aisles are
narrower—only 32 inches rather than the required 36 inches. As a result,
clients in wheelchairs cannot access several public areas or offices in the
department. This outcome is the manager’s intention because she believes
some of her staff members were spending too much time straightening out
the bills of clients in wheelchairs. By limiting access to public areas, the
manager is acting unethically and violating the Americans with Disabilities
Act of 1990.

? Leading and directing. Established acts guarantee civil rights, nondiscrimination,
and equal pay for equal work for all employees in all industries in the United
States. Noncompliance with these federal equal employment opportunity laws
is both unethical and illegal for hiring organizations and their managers or
leaders alike.

? Controlling. In 2014, as result of a “takedown” by the Medicare Fraud Strike
Force teams in six cities, 90 people—including doctors, nurses, healthcare
company owners, healthcare executives, and other personnel—were charged
with Medicare fraud. Their alleged crimes included fraudulently billing for
medically unneeded or phony/faked services totalling about $260 million,
violating the antikickback statute, and money laundering (HHS 2014).

DID YOU KNOW?
False Claims Act

The False Claims Act (FCA) is a federal law (Title 13 of United States Code) that prohibits

businesses, groups, and individuals to defraud the US government. In 1863, Congress

passed the FCA in response to contractors who sold the Union Army shoddy provisions

during the Civil War. Making or receiving improper payments to or from the government

is included in this law (but tax fraud is separate). Healthcare organizations are subject

to the FCA because Medicare and Medicaid are government programs involving claims

and payments.

Under the FCA, private citizens may sue on behalf of the government. This suit,

derived from English law, is known as a qui tam (short for the Latin phrase qui tam pro

domino rege quam pro se ipso in hac parte sequitur, meaning who pursues this action

Qui tam

A legal action, under

the False Claims Act,

filed by an individual

(e.g., a whistleblower)

on behalf of the

government

00_ForrestalCellucci (2294).indb 92 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

C h a p t e r 6 : E t h i c a l F r a m e w o r k 9 3

DID YOU KNOW?
False Claims Act (continued)

on our Lord the King’s behalf as well as his own). The private citizens, known as rela-

tors, receive 15 percent to 30 percent of the recovered settlement if the courts rule the

defendants guilty of fraud. A 1986 amendment (Public Law, P.L. 99-562) strengthened

the FCA. The FCA imposes triple damages and civil fines of $5,000 to $10,000 per false

claim. Subsequent amendments in 2009 (under the Fraud Enforcement and Recovery

Act) and in 2010 (under the Patient Protection and Affordable Care Act) expanded the

scope of the FCA.

The FCA’s scope is broad. Conspiring to commit a violation is unlawful, even if the

conspiracy is unsuccessful. Of particular relevance to healthcare managers is the provi-

sion that makes retaining overpayments—even those accidentally received—a viola-

tion. Providers who receive Medicare or Medicaid overpayments must return the money

to the government within 60 days of discovering the error or when the next government

report is due. Moreover, many states have their own FCA.

In 2014, Duke University Health System, Inc. agreed to repay $1 million for falsely

billing federal and state health insurance programs. This repayment was a settlement of

an FCA suit filed by a medical biller in 2012 and joined by federal and state governments

in 2014 (Murawski 2014a; 2014b). In the suit, plaintiffs (the biller and governments) al-

leged that Duke University Health System (1) billed separately (instead of together) for

services that were required to be bundled and, in the process, added an unjustifiable

code (Modifier 59, distinct procedural service) and (2) falsely billed for the presence

of physician assistants at coronary artery bypass surgeries when residents were also

present, a regulatory-prohibited practice (DOJ 2014). The biller had raised concerns

about the billing practices to her supervisor, whose response was “There’s a right way,

a wrong way, and the Duke way,” rather than take action to correct the erroneous bill-

ing practices (Murawski 2014a, 4B). Blaming an undetected software problem, Duke

University Health System admitted no wrongdoing in the settlement.

Duke University Hospital System was ordered to repay an additional $626,000 for

overbilling. Bills were inflated by billing for inpatient hospital discharges that were

transfers, coding for the most costly medical conditions and drugs, and failing to credit

rebates from medical-device manufacturers. The Department of Health and Human Ser-

vices found the overbilling during an audit (Murawski 2014b). Representatives of Duke

University Health System stated that the system was improving its compliance with

federal billing requirements.

00_ForrestalCellucci (2294).indb 93 8/17/15 12:43 PM

Copying and distribution of this PDF is prohibited without written permission.
For permission, please contact Copyright Clearance Center at www.copyright.com

EBSCOhost – printed on 3/21/2022 3:34 PM via UNIVERSITY OF MARYLAND GLOBAL CAMPUS. All use subject to https://www.ebsco.com/terms-of-use

E t h i c s a n d P r o f e s s i o n a l i s m f o r H e a l t h c a r e M a n a g e r s9 4

Overall, healthcare managers act ethically when they are good stewards of their
organizations’ resources. Stewardship (see Chapter 4) enables more people to access and
receive quality healthcare services (beneficence and utility) because there is less inefficiency
and waste. For example,

? as human resources stewards, healthcare managers treat their subordinates,
peers, and superiors honestly. They practice open and fair employee
recruitment, and they conduct just performance evaluations.

? as financial stewards, healthcare managers establish accurate fee schedules,
submit truthful government reports, and prepare correct patient or client bills.

? as community stewards, healthcare managers promote good health in their
community and responsible use of the country’s healthcare dollars.

un aWa r e n e s s o f et h i C a l im P l i C at i o n s
Every day presents opportunities for people to do either what is right or what is wrong.
Unawareness of the ethical implications of actions can lead to moral blindness or the law
fallacy. We discuss both concepts in this section.

m o r a l b l i n d n e s s

People with moral blindness do not “see” or realize that an action has underlying ethical
implications. This blindness may stem from self-centeredness, disregard for others, or general
incomprehension of ethics. Many people might say they understand ethics on a theoretical
level, but they may not apply ethics at the practical level.

The two common effects of moral blindness are defense mechanism and rational-
ization. Using both minimizes the consequences of moral blindness. For the healthcare
manager, the most important consequence is acting in a manner inconsistent with the
profession’s ethical standards.

Defense Mechanism

People use a defense mechanism when they have committed an act that they know is
wrong at some level so they let their conscious mind take over to avoid the anxiety or guilt
from the act. These thoughts or feelings may be too difficult to handle, while forgetting
or avoiding the ethical implications is easier; this may be why people frequently rely on
defense mechanisms. Those who put up a defense mechanism may say, “I didn’t know it
was wrong” or “I just did what I was told to do.”

Moral blindness

Insensitivity to or

ignorance of the ethical

implications of actions

Law fallacy

Invocation of the law

when faced by an

ethical conflict

Defense mechanism

Mental and emotional

strategy to avoid

feelings of anxiety or

guilt over a wrongdoing

Rationalization

Justification or

plausible excuse for

inappropriate actions

or decisions

00_ForrestalCellucci (2294).indb