(ECO)Ethical Issues in Organizations Including Healthcare Facilities

Abstract

Ethics issues are present in the daily life of every human being. This paper presents an overview of difficult, yet everyday ethics dilemmas, and general rules and tools helping in making ethical choices. These tools are: distinguishing facts from values, reasoning from principles, defining terms and clarifying concepts, comparing cases, thought experiments, logic, and recognizing and avoiding errors in reasoning. But ethical issues also appear on a bigger scale in every social group, including organizations. The paper contains a literature review and an analysis of it applied to the present day. The analysis includes topics of medical ethics, business ethics and ecoethics, and was conducted according to the basic tools used in ethical problem solving. There are also discussions about a key condition for performing ethical analysis, that is, the distinction between ethics and morality. An ethical solution is dictated by logical principles and based on facts, while respecting the tools of ethical reasoning. In contrast, accepted values are also taken into account when interpreting events morally.

Full text

CIVIL AND ENVIR ONMENTAL ENGIN EERING REPORTS
E-ISSN 2450-8594 CEER 2022; 32 (3): 0240-0247
DOI: 10.2478/ceer-2022-0038
Original Research Article
(ECO)ETHICAL ISSUES IN ORGANIZATIONS INCLUDING
HEALTHCARE FACILITIES
Martyna MYSZOGRAJ1
University of Zielona Góra, Poland
A b s t r a c t
Ethics issues are present in the daily life of every human being. This paper presents an
overview of difficult, yet everyday ethics dilemmas, and general rules and tools helping
in making ethical choices. These tools are: distinguishing facts from values, reasoning
from principles, defining terms and clarifying concepts, comparing cases, thought
experiments, logic, and recognizing and avoiding errors in reasoning. But ethical issues
also appear on a bigger scale in every social group, including organizations. The paper
contains a literature review and an analysis of it applied to the present day. The analysis
includes topics of medical ethics, business ethics and ecoethics, and was conducted
according to the basic tools used in ethical problem solving. There are also discussions
about a key condition for performing ethical analysis, that is, the distinction between ethics
and morality. An ethical solution is dictated by logical principles and based on facts, while
respecting the tools of ethical reasoning. In contrast, accepted values are also taken into
account when interpreting events morally.
Keywords: ethics, medical ethics, healthcare, ecoethics
1 Corresponding author: 3th year Biomedical Engineering student, University of Zielona Góra,
Poland, myszograj.martyna@gmail.com

(ECO)ETHICAL ISSUES IN ORGANIZATIONS INCLUDING HEALTHCARE FACILITIES 241
1. INTRODUCTION
"There are no moral phenomena - there is only a moral interpretation of
phenomena".
These are universal and extremely apt words of Friedrich Nietzsche, which define
the importance of morality in the evaluation of events. Morality is a set of
principles that can be dictated by, for example, culture or religion, like the
Decalogue for Christians. Therefore, it is impossible to define a universally moral
phenomenon. The branch of philosophy that deals with the study of morality and
the analysis of the basis and consequences of moral precepts, as well as
determining the ethicality of phenomena is ethics.
Ethics should be the basis of all decisions made by humans. To determine
the ethical value of decisions made, eight tools of ethical reasoning are used.
These tools are: distinguishing facts from values, reasoning from principles,
defining terms and clarifying concepts, comparing cases, thought experiments,
logic, and recognizing and avoiding errors in reasoning. Ethical analysis requires
distinguishing facts from values because the facts, i.e., evidence of the actual state
of affairs, should be primarily evaluated. The values considered in the analysis
should be argued on the basis of facts and as objectively as possible. It is also
important to define key terms. In the case of a dispute between two or more parties,
it is important that each party use terms defined in the same way, while having a
general understanding of the definitions. The case comparison tool involves
presenting different situations involving the same ethical problem and basing the
argument on that. Thought experiments are a tool that uses imagined examples of
situations to verify an argument. One of the most famous thought experiments is
Robert Nozick's " The Experience Machine" [6,7]. It is an experiment designed to
answer the question of whether pleasant experiences alone can make a person's
life meaningful. According to R. Nozick, the answer is negative. The last tools
used in ethical analysis are logic and seeing and avoiding fallacies in reasoning.
That is, arguments should directly derive from facts and be consistent with the
principles of logic and evidence.
2. ETHICS IN ORGANIZATIONS
Ethics is concerned with the functioning of not only the individual, but also larger
groups of people. An organization is an intentional social group. Most often,
however, organizations are associated with business activities. A special section
of ethics, relating to behavior in such organizations is business ethics, which is a
set of standards for reliable and responsible business conduct towards people with
whom they work, including customers. Such actions should primarily comply

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with the principles of ethics, but also with the law. Ethics in the organization
includes not only the decisions made by the company, but also the norms of
behavior of those employed [1].
Organizations, striving to minimize costs and maximize profits, are often forced
to make controversial decisions concerning, among others, the choice of business
partners and actions towards competitors. The basis for the actions taken should
be business ethics. The basic values of business ethics in an organization include
accountability, transparency, ethical behavior and active presence in the
environment. Responsibility means that the company is prepared to take
responsibility for the impact it has on the environment (including taking
responsibility for any damage and withdrawal of actions that cause damage).
Transparency of an organization is the provision of information by an organization
about its decisions and activities that relate to or have an impact on society and
the environment [8]. Ethical behavior is behavior that is guided by ethical
principles and integrity. An organization's active presence in the environment
should be based on awareness of impact on the environment, interaction and local
activity. To maintain ethics among employees, organizations are increasingly
deciding to create a code of ethics. Such a code is a list of clearly formulated rules,
which is presented to all employees at every professional level. This makes it
possible to eliminate possible misunderstandings, or misunderstandings in the
field of behavior at work.
3. HEALTHCARE FACILITIES
A specific example of an organization where ethical issues are particularly
prominent are medical facilities. Employees, i.e., doctors, nurses, and other
medical professionals, are often forced to make difficult decisions on short notice.
Consideration of the ethicality of decisions made by this professional group is
dealt with by a special field - medical ethics. It is based on fundamental principles
of ethics, but also takes into account the unique conditions involved in the
problems under consideration. Philosophy and science also play an important role
in the ethical analysis of medical practice. Science deals with the validity of the
proposed treatment, whereas philosophy deals with the justification of specific
ethical choices.
3.1. Principles of medical ethics
There are four fundamental principles of medical ethics - respect for patient
autonomy, doing good, doing no evil, and justice [4,12].
Patient autonomy is defined as the ability to think and decide, and to act freely on
those decisions. Respecting patient autonomy requires health care providers and

(ECO)ETHICAL ISSUES IN ORGANIZATIONS INCLUDING HEALTHCARE FACILITIES 243
families to show support for decisions and to act accordingly (even when those
decisions are considered wrong). The principles of "doing good" and "doing no
evil" complement each other. The principle of doing good requires doing good to
the patient, for example, by offering appropriate treatment. However, it is
important to emphasize who decides what is good for the patient. Research
findings and diagnosis based on scientific knowledge and facts are of great
importance. However, the final decision about what is good should belong to the
patient - this follows from the principle of respect for his autonomy. Therefore,
the opinion based on moral principles of the medical personnel should not
influence the decision to undertake medical procedures, and even less should the
use of the so-called "conscience clause" be allowed, which permits refraining from
performing health services which are against the doctor's conscience. The
principle of doing no evil, on the other hand, emphasizes that decisions about
treatment should be dictated primarily by the good of the patient and should never
lead to harm, i.e. worsening of the state of health. The last principle of medical
ethics is justice. This principle states that all limited resources (e.g., money, time,
ICU beds, medications) should be equitably shared - people in the same medical
situation should have access to the same health services. However, this is difficult
to achieve. Especially in countries where healthcare is partially or fully paid for.
These rules also apply to undertaking CPR. By default, the initiation of
resuscitation is accepted, but in accordance with the patient's right to autonomy,
it is possible to refuse to perform this medical procedure by signing the
appropriate document in advance. The exception is suicide attempts, which could
be seen as a refusal to save a life. However, in such a situation, there is no way to
confirm consent and determine the capacity to make such a decision, unlike a
patient in the hospital, who is informed of the possible course of treatment and
consequences before signing the document on refusal of the medical procedure
[2].
3.2. Ecoethics in healthcare facilities
As healthcare facilities are a form of organization, therefore they also should stick
to the rules dictated by business ethics. The basic values of business ethics in an
organization include accountability, transparency, ethical behavior and active
presence in the environment. The three first-mentioned rules can be easily
interpreted while referring to healthcare facilities - an organization has to always
be prepared to take responsibility for the impact it has on the environment or
person (including taking responsibility for any damage and withdrawal of actions
that cause damage), all information about its decisions and activities that relate to
or have an impact on patients and the environment has to be provided, its behavior
should be guided by ethical principles and integrity. The last one - active presence

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in the environment should be based on awareness of impact on the environment,
interaction and local activity, which means that healthcare facilities should not
only take care of patients and its own revenues but also the environment and local
society [3,5].
Healthcare sector has an important environmental footprint due to, among
other things, the consumption of plastic. It is estimated that about 25% of the
hospital's waste is plastic [9]. It is necessary to say that elimination of whole
medical plastic usage is not possible. But as the role of healthcare facilities is to
treat and prevent diseases, and plastic waste is harmful to the environment and
thus to human health, usage of single-use plastic should be reduced. Also 15% of
waste is considered to be hazardous (toxic, infectious or radioactive) [3].
The production of plastic causes, among others, air pollution dangerous to
health [10,11]. The plastic waste, such as packaging or food containers, is harmful
for health not only by having a negative impact on the environment. Plastic waste
which enters the environment, especially the water areas, does not dissolve but
breaks down into even smaller particles. Those elements can be consumed by
small organisms and move higher up the food chain, and therefore be found in
food. Also plastic food containers can cause health issues, such as stomach ulcers,
diarrhea and vomiting in case of PET material. Those ailments can be caused by
toxic substances that leach into food or drink due to heat [11].
As the production, use and disposal of plastic can cause health issues it
should be one of healthcare facilities' priorities to minimize it by choosing other
relevant materials, such as glass, metal or composite materials.
WHO in its “Guidance for climate-resilient and environmentally
sustainable healthcare facilities” [14] states that healthcare facilities should be
encouraged to assess their environmental footprint. Thanks to that there could be
set a baseline upon which improvements would be monitored and measured. That
would also make it possible to propose an index based on which comparisons
between facilities could be made.
What was significantly highlighted was how important it is to state short-
and long-term interventions and evaluate improvements. The features that should
be monitored and be subject to improvements are health workforce, water,
sanitation and waste, energy and infrastructure, technology and products. Smart
use of water is particularly important in areas with a tendency to droughts or
floods. Excessive energy consumption leads to unjustified fuel waste which
involves costs and air pollution. The problem with unjustified consumption of
these resources can be solved by promotion of new technologies providing
enhanced health service delivery and climate resilience.
The main conclusion made in this guide was that healthcare facilities are
impacted by climate change and by their surrounding environments but also
accountributing to climate changes and environment degradation through their

(ECO)ETHICAL ISSUES IN ORGANIZATIONS INCLUDING HEALTHCARE FACILITIES 245
emissions and unsustainable practices. It is also important to remember that a
satisfying healthcare should contain a skilled and informed workforce; adequate
water, sanitation and waste services; energy services; safe, functional and
sustainable infrastructure including technologies and products. Reasonable use of
those resources would not only be ecological but also would provide access to
equal health care for more people.
4. MEDICAL RESEARCH
Today, the area that is subject to the most stringent medical ethics rules is medical
research. Ethics committees are set up to check whether the research is designed
in accordance with medical ethics. The principles are described, for example, by
the Nuremberg Code and the Declaration of Helsinki [15]. These documents were
formulated in response to unethical behavior committed by people in the past.
During World War II, there were horrific human experiments conducted by Nazi
doctors such as J. Mengele known as the Angel of Death from Auschwitz.
Therefore, in 1946 (according to some sources in 1947), the Nuremberg Code was
established, setting rules for medical research involving human subjects. In 1964,
the WMA (World Medical Association) published the Declaration of Helsinki,
which was later revised in 2013. Since then, a number of additional regulations
have been developed that clarify the principles outlined in the Nuremberg Code
and the Declaration of Helsinki. All are based on four fundamental principles of
medical ethics (respect for patient autonomy, doing good, doing no evil, and
justice). In Poland a Code of Ethics for Research Workers was created in 2012.
It was formed on the basis of The European Code of Conduct for Research
Integrity (2010). It states that researchers should be guided primarily by
conscientiousness, trustworthiness, objectivity, impartiality, independence,
reliability and transparency when conducting research and publishing results, and
the researcher himself should be characterized by an open approach to discussion
and concern for the future of science [13].
5. CONCLUSIONS
In summary, a key condition for making ethical decisions is the distinction
between ethics and morality. An ethical solution is dictated by logical principles
and based on facts, while respecting the tools of ethical reasoning. In contrast,
accepted values, such as those dictated by religion or culture, are also taken into
account when interpreting events morally.
Ethics issues take place in every social group, including organizations. It is
worth noting that the active presence in the environment also concerns whether
the activities of the organization are ecological or have a negative impact on the

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environment. An organization whose functioning results, for example, in the
poisoning of rivers or air, and which does not try to remove, minimize or
compensate for the negative impact on the environment, cannot consider its
activities ethical. In view of the contemporary struggle against the negative effects
of human activity, this is an issue that should be given more attention. Perhaps,
with increased criticism and radicalization of environmental laws, it would be
possible to get organizations to change their policies.
The issue of ethical conduct is particularly important in organizations with
a medical purpose, where human welfare depends on the decisions made. It is
essential that medical personnel make decisions according to medical ethics and
the principles it defines, rather than their own worldview and morality.
Given the free will and the ability of people to also make unethical
decisions, the principles of ethics should be regulated by the strictest possible
laws. Such documents should be clearly described and respected on a global scale.
Ethics also concerns inviolable human rights, which should not be subject to
discussion, nor should they be described only by national law, which can be
changed by current authorities with certain views.
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Editor received the manuscript: 11.06.2022