: Bioethics has focused on the areas of individual ethical choices--patient care--or public policy and law. There are, however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.

The importance of institutionalizing ethics within an organization cannot be underestimated.

This research compares the importance of moral values for corporations' managements, as reported by 97 knowledgeable employees in eight corporations. Does an employee consensus emerge within corporations and does it differ between corporations? To answer this question, an analysis of covariance technique was used to compare the importance of moral values between corporations versus within corporations. Results corroborate the hypothesis that closely matched corporations do differ significantly from one another in the importance of prevailing moral values. Evidence also suggests that (...) the importance of prevailing moral values may be inversely related with company size. Implications for future research and for the practice of management are delineated. (shrink)

Institutions have ethical lives and characters just as their individual members do. Health care organizations must look critically at how professed institutional values can best be realized in day‐to‐day interactions within the institution and with the wider community.

The increased competition for a share of the market of insured patients, which arose in the wake of failed comprehensive health care reform, has provoked questions about what, if any, standards will govern new “competitive” health care organizations. Managed care arrangements, which typically shift to providers and patients some or all of the financial risk for patient care, are of special concern because they can create incentives to withhold beneficial care from patients. Of course, fee-for-service medical practice creates incentives to (...) provide unnecessary services, and managed care can avoid that type of harm. Still, as Edmund Pellegrino has noted, “managed care, by its nature, places the good of the patient into conflict with … the good of all the other patients served by the plan; the good of the plan and the organization, themselves…; and the self-interest of the physician. (shrink)