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

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.

First principles: substantive ethics for healthcare organizations.

Healthcare organizations (HCOs) often face ethical dilemmas, but ethical principles analogous to those of clinical ethics have not been established to guide resolution of such dilemmas. To date, most progress in business and organizational ethics has been made in developing processes that promote responsible behavior in complex organizations. In this article we offer a normative framework to guide value-laden decision making of HCOs.