A Case Study of a Workplace Ethical Dilemma

Part A. Personal Ethics Code 

1. Integrity because a good, strong reputation can't be quantified.  It can provide a cushion to fall back on in difficult social situations. 

2. Objectivity is important because it is the touchstone of fairness.  It is crucial to see all sides of an issue and as the golden rule says: I would also like to be given the same fairness in return. 

3. Competence is important because it instills confidence in the face of life's challenges. 

4. Education learning is a life-long process and has invaluable benefits even for its own sake. 

5. Friendliness is important because I enjoy meeting new people and helping others. 

Moral character & principles

When assessing the response to the question: do I have good moral character?  One has to remember the subjectivity of moral values.   Ethics is thought to be based on long established principles of what constitutes right and wrong behavior.  As Velasquez, Andre, Shanks & Meyer (1987) argue, ethics is not the same as obeying the law or doing whatever society says one should do.  Yet religion, law and social custom very often inform an individual's notion of what is ethical.  These same sources also have led to serious ethical problems. The US has seen a lot of unjust law on the books and a number of atrocities have been committed in the name of what religion or society says is the right thing to do.  Ethical behavior can also be situational. That is, one can have the best of intentions but be forced by much bigger circumstances than one can control to behave in a manner that compromises one's ethics. Clearly an individual can only do the best they can. 

If ethics is reduced to such virtues as honesty, compassion, and loyalty then indeed the answer to the question posed in the previous paragraph is yes.  Human beings are social beings and must live their lives in accordance with proper ethical principle because this is the strongest foundation on which to build a well-functioning social order. It is unlikely we could maintain a cohesive social order without a strong commitment to ethics. 

The value of ethics in my life

When assessing the response to the question: what is the value of ethics in your life?  As noted above ethics is important to building a strong social order.  A society in which all individuals help and share with one another is far happier life than one where each individual is consumed entirely with their own self-gain.  But each individual is responsible for contributing what they can to make this social system function and the way to do this is with strong ethical behavior. Also, immoral behavior has consequences and does not contribute to happiness either generally or personally. 

Part B. Case Study Application of Ethics

The following case concerns an issue of whistle-blowing at a local medical office.  It is adapted from a case provided by the Accounting Professional and Ethical Standards Board (2012). The case is as follows: Rita returned to work after a period off for maternity leave and is now employed at a neighborhood medical office part-time as an accountant. She reports to a practice manager who supervises other physicians employed at the practice. Sometime during her second week on the job, Rita observed that one of the physicians seemed to have treated more patients than had checked in at the waiting room. For the sake of improved accuracy, the office uses an electronic waiting room program to record and track patient attendance.  It's also used to document how many patients the practice's doctors are seeing over a given period.  This method is partially used to help determine a physician's income.  When Rita discussed the discrepancy with the doctor, he indicated it was a mistake on his part.  He told Rita that the practice manager would be informed of the error and that it would be corrected by the end of the week. 

When Rita reviewed the patient records at the end of the week, she noticed that the mistake had not been corrected.  So, she decided to make the necessary corrections to the record herself. When Rita checked the waiting room program the next week she discovered her entries had been removed from the system. Rita was upset by this, so she confronted the doctor about it.  The doctor took exception to Rita and told her that her job was only to record payments and expenses nothing more.  He told Rita to leave any business matters to him and others at the practice who understand how a business functions. Notwithstanding this Rita remains concerned about the doctor's deliberately falsifying of patient attendance records. 

ABCD guide to ethical decision making

Awareness. Do we know the facts in this case?  Some questions embodied in this case study include does Rita have all the information to make a decision that the doctor's behavior was unethical?  Is it not known whether this is a one-time only event or something this doctor's does as a matter of course. In light of these additional questions, the safe course would be to say all the facts are not known. Is this an ethical problem or a legal one?  It is both.  Falsifying medical records is not only an ethical problem (it is dishonest and indicates lack of good character).  But it can also be considered fraud if Medicare claims are submitted to the Federal government based on incorrect patient data.  Can the problem be resolved by way of the law or organizational policy?  It is difficult to say from the information available whether a small medical practice would even have a procedure for reporting staff misdeeds. Who are the people involved in this case and who would be affected by any decision or action taken?  The people or stakeholders involved include Rita herself, the doctor in question, other doctors at the practice, the patients who visit the office for medical care, and government agencies, such as Medicare, that may reimburse expenses based on false data reported by the practice. 

Beliefs. Would I want what I'm about to do be done to me or to a member of my family?  From a purely subjective standpoint no one who engages in ethical malpractice wants to have the whistle blown on them. However, we are always instructed to maintain strong ethical conduct, both in life and in the workplace.  That is, unethical conduct does have its consequences and one must look beyond sentimentality when assessing that.  So, Rita's answer would be yes and the doctor's no.  Would it be responsible of me if I thought everyone should act this way in my situation?  The answer would be yes, from Rita's standpoint and no if we are considering this from the doctor's perspective. Will my decision affect the greatest good for the greatest number?  As the unethical conduct noted above extracts a cost to the taxpayers, correcting it would fulfill a utilitarian ideal.  The doctor appears mainly interested in his own personal utility to the exclusion of all others. 

Consequences.  What type of ripple effects will my action have?  As mentioned above the affected parties include Rita, the doctor in question, other doctors at the practice, the patients whose records were falsified, and government agencies involved in taxation and Medicare reimbursement. These violations exact a significant cost in terms of trust that makes the provision of good medical care at the office more suspect. Rita's actions would at least restore that trust, recompense the proper parties and hopefully will not lead to the discovery of a much more systemic pattern of abuse at the office. Rita would be setting a great example if she comes forward with what she knows. This is because so many individuals in her situation would not have taken any action for fear of losing their own jobs. But the doctor is setting a poor example.  Can I respect myself given the probable consequences of my actions?  In Rita's case I think that answer would be yes.  In the doctor's case that would be no. 

Decision. Rita should consider the doctor's abrupt response when she approached him a second time to discuss this matter. It may be that these parties now have an antagonistic relationship.  Further actions taken by Rita should likely include consulting with a lawyer to become aware of her own rights.  She might also take a more patient course: document the doctor's record keeping over a much longer period of time.  If the deceit continues at least a lot more evidence is available than an incident from one week that can still be argued as a mistake.  Rita should not be ashamed of her actions.  In fact, Rita is an exemplar of behavior for all staff in who becomes aware of unethical and illegal conduct.  The doctor would likely experience serious damage to his reputation if his actions were broadcast on the evening news. Such a moral actor would likely not counsel anyone else to repeat his own conduct considering the consequences. 

The final decision is based on utilitarian theory.  The classic formulation of which is based on the greatest happiness principle (Brink, 2008) and morality is defined as that which does the greatest good for the greatest number.  Rita's choice maximizes this greatest good because of its benefits to a wide array of stakeholders.  Whereas if nothing is done at all the reverse happens: harm is spread around to a greater number and a benefit is available to only one person.  

References

"APES  GN 40 Ethical conflicts in the workplace  - considerations for members in business." (2012, March). Pesb.org.au. Retrieved from http://www.apesb.org.au. 

Brink, David. "Mill's Moral and Political Philosophy. “The Stanford Encyclopedia of Philosophy. Ed. Edward N. Zalta.  Fall 2008. Web. May 2013. <http://plato.stanford.edu/archives/fall2008/entries/mill-moral-political>.

Velasquez, Manuel, Claire Andre, Thomas Shanks & Michael Meyer. (1987, May). What is Ethics? Issues in Ethics, vol. 1, no. 1. Revised 2010. Retrieved from http://www.scu.edu/ethics/practicing/decision/whatisethics.html.