How should our public hospitals respond to increasing ethical challenges?
OBJECTIVE
To explore the considerations and influences on decision making of doctors and managers when faced with ethical dilemmas.


METHODS
Two hundred and eighty-four doctors and managers responded to a mailed survey. The questionnaire probed the types of considerations that were salient in the ethical dilemmas faced by doctors and by managers, the support these groups received for reflection on these difficult decisions, the specific influences on their decision making and their perception of future ethical issues in the health sector.


RESULTS
The study found that doctors and managers report encountering a similar frequency of ethical dilemmas in their work but apply significantly different considerations and influences in their decision making. They reported similar levels of support from their colleagues but differing levels of support from their managers and the Crown Health Enterprise overall.


CONCLUSIONS
This study highlights various areas of dissonance between different stakeholders in the public health sector, in particular, between the manager representing the organisation's interest and the doctor representing the patients' interests. Policy makers, purchasers and providers need to consider the infrastructure required to support doctors and managers in their work. Above all, with more ethically challenging decisions ahead, there needs to be clarity over the decision-making role of the government, the health manager and the doctor.
Bryson
J
J
School of Business and Public Management, Victoria University of Wellington, New Zealand.
D015510:Clinical Medicine; D003657:Decision Making; D004992:Ethics, Medical; D006295:Health Resources; D006296:Health Services; D006740:Hospital Administrators / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D009520:New Zealand; D010820:Physicians / Q000706:statistics & numerical data*; D011057:Politics; D012941:Social Responsibility; D011795:Surveys and Questionnaires