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by Donald B. Ardell, Ph. D.
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Wellness in the Headlines
(Don's Report to the World)

Ethical Elements To Address In Worksite Wellness

Sunday April 27, 2008

Emily Friedman, a health policy and ethics analyst, identifies a wide range of never event principles in a provocative article entitled, "Never Events and Health Care Ethics," H&HN OnLine, April 1, 2008. Ms. Friedman urges doctors, nurses and other clinical staff not to condone preventable harm to patients, and to report such occurrences when they occur. In addition, she urges respect for patient wishes, actions to prevent impaired staff from continuing to work and removal of incompetent staff from positions of responsibility. She laments excessive pay and lavish benefits for leaders of nonprofit organizations, and cites embarrassing buyout packages for some who departed in disgrace.

With the exception of comments about respecting the final wishes of patients but never tolerating doctor-assisted suicide, all the never event specifics seem clear and unarguable. Who could defend condoning such cases that clearly should be never events? Ms. Friedman advises never lying, stealing, taking bribes, tolerating discrimination of any kind, allowing conflicts of interest or gouging low-income and/or uninsured patients. Well, hell, everybody will muscle his way into line to support all that. She might have added a few bonus items to that never event list, such as, don't kill people, don't shelter Osama bin Laden, don't start fires or set off bombs and, for god's same, don't trade state secrets with North Korean or Iranian secret agents.

The Devil, unfortunately, hides out in the details of all such situations. Ms. Friedman, to her credit, gives excellent examples of the complexities in every case associated with the dozen never event rules offered. In almost all cases in the health and the wellness arenas, however, chicanery takes place. Why? Because of obfuscation of the facts. The ethical tipping point can be just complex enough, with shades here and there, that people who stand to gain by interpreting a situation a certain way will be strongly tempted to do so in the manner that favors their interests. That's human nature. It is no friend of good ethics.

Veronese, Apollo and Daphne, 1565-70, The San Diego Museum of Art

What approach to ethics, then, can better guide caring health professionals who want to do the right thing? What about wellness seekers and others -- how might we best understand the applicable ethical code to apply and navigate self-interests and choices? In other words, how to protect against becoming involved in or party to never events? Sensible folks will understand that commandment-like proscriptions against false gods, stealing, murder, lusting for someone's wife (or presumably, husbands on the part of heterosexual women) will not stay many corporate chieftains or other ethically-challenged, conflicted persons from going astray. After all, with so much at stake and rationalizations so reasonable sounding, it's too human to make judgments that seem ethical at
the time, though not in retrospect to a judge, jury or community. What are we to do?

The philosopher Paul Kurtz has written extensively on the idea that developing our capacities for human reason is the best basis for encouraging ethical choices. Daily life is, after all, filled with difficult dilemmas, even when we share principles and values. As society changes, moral problems arise for which there are few precedents or models. Competing values and principles contend for our attention.

We need to be highly aware of our interests and values, and familiar with and able to recognize and articulate the needs and interests of others. It seems the most promising way to develop this capacity is the same path a musician must take who seeks to perform at Carnegie Hall - practice, practice, practice. 

It's basically useless to repeat generalized mantras like no stealing, killing, pillaging or plundering. Of course not. Only schizoid maniac gangster thugs do these things. But, what about the thousands of subtler choices we all have to make?

To be effective and ethical in dealing with these situations, we require exposure to and familiarity with a variety of ideas for improving human life, contributing to the common welfare and functioning ethically in the face of hypothetical (and real) complex situations. By simulating such sessions or examining ethical case studies and other methods, our ethical instincts and functioning can be self-assessed and other-assessed under safe conditions. Options can be analyzed and thus fine-tuned. This is the thinking behind the notion that ethics would be a profoundly important subject area to introduce and orchestrate as part of worksite wellness programs. In such instances, broad principles, such as those enumerated by Ms. Friedman, could be studied, with rich hypothetical details added to specific cases, at varied levels for different segments of the workforce. Not everyone would come to the same ethical choices, but all would become more familiar with and practiced in applying their ethical sensibilities.

Working the ethical "muscles" for mental fitness is as important as training bodily muscle groups that power physical fitness.

Most people who are steeped in absolute dogmas and creeds struggle with the realities of ethical diversity, and tend to fall back on judgments learned of a broad nature, rather than ethical deliberations related to specific applications. Yet, the reality is we live in a society where good, loving people who are committed to the same constitution and who surely favor all the ethical guides noted by Ms. Friedman have deeply felt, varying ethical takes on a wide range of issues. These include but are certainly not limited to a woman's right to choose to give birth or not (abortion) and other women's rights issues, capital punishment, when (or if) war is justified, euthanasia, the extent of sexual freedoms, the appropriateness of religious displays in public places (and on coins and pledges of allegiance), decisions on candidates of high office and so on and on. 

We can base our ethics on one of two alternate sets of guides: 1) doctrines, fiats, rules and commandments tied to the promise of rewards or punishments in the promised next life (which, unfortunately, tend to set people against each other); or 2) secular ideals based on reason that appeal to "the pursuit of happiness, moral freedom, tolerance, responsibility and rational moral inquiry." (See Paul Kurtz, Two Competing Moralities, Editorial, Free Inquiry Magazine, Volume 21, Number 3.)

For worksite wellness purposes, the latter seems a safer bet. Unlike the former, deliberations about secular ethical ideals are amenable to those who find traditional doctrines appealing, thus giving religious-oriented employees the opportunity to fully participate in ethical deliberations and integrating, as they wish, secular ethical foundations with favored religious frameworks.

If a place is made at the worksite wellness table for ethical deliberations and the process is managed skillfully and artfully, there ought to be fewer never events. That's my wellness theory, in any event. Good luck.

Domain: mental
Subdomain: factual knowledge

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