Ethical Decision Making for Healthcare Executives

August 1993
February 1997 (revised)
November 2002 (revised)
November 2007 (revised)
November 2011 (revised)

Statement of the Issue

Ethical decision making is required when the healthcare executive must address a conflict or uncertainty regarding competing values, such as personal, organizational, professional and societal values. Those involved in this decision-making process must consider ethical principles including justice, autonomy, beneficence and nonmaleficence as well as professional and organizational ethical standards and codes. Many factors have contributed to the growing concern in healthcare organizations over ethical issues, including issues of access and affordability, pressure to reduce costs, mergers and acquisitions, financial and other resource constraints, and advances in medical technology that complicate decision making near the end of life. Healthcare executives have a responsibility to address the growing number of complex ethical dilemmas they are facing, but they cannot and should not make such decisions alone or without a sound decision-making framework.

Healthcare organizations should have mechanisms that may include ethics committees, ethics consultation services, and written policies, procedures and guidelines to assist them with the ethics decision-making process. With these organizational mechanisms and guidelines in place, conflicting interests involving patients, families, caregivers, the organization, payors and the community can be thoughtfully and appropriately reviewed.

Policy Position

It is incumbent upon healthcare executives to lead in a manner that sets an ethical tone for their organizations. The American College of Healthcare Executives (ACHE) believes that education in ethics is an important step in a healthcare executive’s lifelong commitment to high ethical conduct, both personally and professionally. Further, ACHE supports the development of organizational mechanisms that enable healthcare executives to appropriately and expeditiously address ethical conflicts. Whereas physicians, nurses and other caregivers may primarily address ethical issues on a case-by-case basis, healthcare executives also have a responsibility to address those issues at broader organizational, community and societal levels. ACHE encourages its members, as leaders in their organizations, to take an active role in the development and demonstration of ethical decision making.

To this end, healthcare executives should:

  • Create a culture that fosters ethical clinical and administrative practices and ethical decision making.
  • Communicate the organization’s commitment to ethical decision making through its mission or value statements and its organizational code of ethics.
  • Demonstrate through their professional behavior the importance of ethics to the organization.
  • Offer educational programs to boards, staff, physicians and others on their organization’s ethical standards of practice and on the more global issues of ethical decision making in today’s healthcare environment. Further, healthcare executives should promote learning opportunities, such as those provided through professional societies or academic organizations, that will facilitate open discussion of ethical issues.
  • Develop and use organizational mechanisms that reflect their organizations’ mission and values and are flexible enough to deal with the spectrum of ethical concerns—clinical, organizational, business and management.
  • Ensure that organizational mechanisms to address ethics issues are readily available and include individuals who are competent to address ethical concerns and reflect diverse perspectives. An organization’s ethics committee, for example, might include representatives from groups such as physicians, nurses, managers, board members, social workers, attorneys, patients and/or the community and clergy. All these groups are likely to bring unique and valuable perspectives to bear on discussions of ethical issues.
  • Evaluate and continually refine organizational processes for addressing ethical issues.
  • Promote decision making that results in the appropriate use of power while balancing individual, organizational and societal issues.

Approved by the Board of Governors of the American College of Healthcare Executives on November 14, 2011.