The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further ‘market-style’ reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English (...) NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers. (shrink)

Despite crowdfunding platforms’ growing involvement in financing welfare, related ethical issues have received little scholarly attention. To address this gap, we focus on GoFundMe, the leading welfare crowdfunding platform in the US, to examine whether it facilitates the establishment of a just society that democratizes access to funding. Informed by Rawls’s ethics, we conduct a comprehensive analysis, arguing that GoFundMe’s modus operandi merits criticism. We advance three interrelated arguments for why GoFundMe is morally problematic. First, it distributes information and primary (...) goods unfairly, perpetuating inequalities that disadvantage the most vulnerable. Second, it uses narratives that may distract public attention from systemic flaws in welfare provision, potentially reducing social pressure for institutional reform. Third, its emphasis on individual choice and responsibility may contribute to momentum for neoliberal policymaking. We show why scholars, policymakers, and platforms should engage in debate about regulating welfare crowdfunding activities to improve their ethicality. (shrink)

This article considers the ethical dimensions of attempts to ‘personalise’ health and social care services in the UK. Personalisation is identified as closely related to efforts to introduce elements of neoliberal marketisation into public service provision, particularly through the introduction of consumer choice for services users. We consider two areas of ethical concern surrounding personalisation: its contribution to social justice agendas and the enhancement of service users’ autonomy. While personalisation in general, and consumer choice in particular, has been presented as (...) positively contributing to both social justice and autonomy, we critically revaluate these claims. We draw on the work of Nancy Fraser and relational theories of autonomy to highlight the ethical complexities of personalisation and the potentially negative effects that the extension of consumer choice may have on promoting social justice and supporting substantive forms of autonomy. We suggest that understanding and negotiating these complexities imposes ethical constraints on the ways in which, and extent to which, health and social care services can be defensibly personalised. (shrink)