CLINICAL ETHICS

The ethics of policy writing: how should hospitals deal with moral disagreement about controversial medical practices?

E C Winkler

Correspondence to:
Correspondence to:
Dr Eva C Winkler
MD, Harvard University Center for Ethics and the Professions, 79 John F Kennedy St, Cambridge MA 02138 and Division of Medical Ethics, Harvard Medical School, USA; and Department of Medicine III, University Hospital Munich Grosshadern, Germany; eva.winkler{at}med.uni-muenchen.de

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it.

Using, as an example, the controversy about patient’s refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency.

Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO’s obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy.

Abbreviations: HCO, healthcare organisation; OE, organisational ethics

Keywords: organisational policy; institutional ethics; professional ethics; professional autonomy; administrative personnel

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