American Association of Healthcare Executives

Ethical Decision-Making for Healthcare Executives

Approved by the Board of Governors Dec. 6, 2021.

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 clinical, organizational and societal ethical issues, including issues of equitable access and affordability, quality, value-based care, patient safety, disclosure of medical errors, allocation of limited resources, mergers and acquisitions, financial and other resource constraints, and advances in medical treatment that complicate decision-making near the end of life. Healthcare executives have a responsibility to recognize and 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 process that considers diverse viewpoints. The application of a systematic decision-making process can serve as a useful tool for leaders, staff and stakeholders in addressing ethically challenging situations.

Healthcare organizations should have resources that may include ethics committees, ethics consultation services, and written policies, procedures, frameworks and guidelines to assist them with the ethics decision-making process. With these organizational resources and guidelines in place, the best interests of patients, families, caregivers, the organization, payers and the community can be thoughtfully and appropriately evaluated in a timely manner.

Policy Position

It is incumbent upon healthcare executives to lead in a manner that promotes an ethical culture, affirms the organization’s mission and values, sets expectations and accountabilities, and models ethical behavior for their organizations. The American College of Healthcare Executives believes 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 competent organizational resources that enable healthcare executives to address ethical conflicts appropriately and expeditiously. Whereas physicians, nurses and other caregivers may primarily address clinical 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 through a systematic process. 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 an ethical culture grounded in the organization’s mission and values that fosters ethical clinical and administrative practices, policies and decision-making through the application of a systematic ethics decision-making process.
Communicate the organization’s commitment to the ethical alignment of its mission or value statements.
Model ethical decision-making and demonstrate the importance of ethics to the organization through their expectations of professional behavior.
Offer educational programs to boards, senior leadership, staff, physicians and others, including the community, regarding their organization’s ethical standards of practice and on the more global issues necessitating ethical decision-making in today’s healthcare environment. This includes education about cultural sensitivity and avoiding implicit bias when making ethical decisions with patients and their families. Further, healthcare executives should promote learning opportunities, such as those provided through professional societies or academic organizations, that will facilitate informed, thoughtful, respectful and open discussion of ethical issues.
Ensure that the organizational resources addressing ethics issues are readily available and include individuals who are competent to address ethical concerns. Organizations need mechanisms for addressing both clinical and organizational ethics challenges, which could mean the creation of a separate committee to address the latter. Committees should include members from multiple disciplines including physicians, nurses, managers, administrators, board members, social workers, attorneys, patients and/or the community and clergy. Healthcare executives must act with intentionality to ensure the diverse expertise and experiences of decision-makers appropriately represents populations likely to be impacted by recommendations or policy directives.
Ensure that ethics resources possess ongoing ethical training and are competent to address a broad range of ethical concerns (e.g., clinical, organizational, business and management).
Seek assistance from ethics subject matter experts and resources when there is ethical uncertainty. Leaders should consider the benefits of consulting a trained ethicist when needed to address clinical issues. Furthermore, encourage others to use organizational resources to address challenging ethical issues.
Evaluate and continually refine organizational processes for addressing ethical issues.
Promote decision-making that results in the appropriate balance of power with individual, organizational and societal issues. Decision-making processes should identify and safeguard against biases and acknowledge privilege to ensure the interests of vulnerable or underrepresented populations are equitably considered.

Policy created: August 1993
Last revised: November 2016