Values Are Legal Constraints on Practice

Guidelines for ethical practices have been in place since the beginning of nursing. An ethical promise for nurses – a modified version of the Hippocratic Oath called the Nightingale Pledge – was developed by Lystra Gretter in 1893. The first code of ethics for nurses was proposed by the American Nurses Association in 1926 and adopted in 1950 (Lyons, 2011). As patient safety is multidimensional and based on ethical and legal imperatives, ethical and legal challenges should be considered. In this context, during the monthly ethics session at the Children`s Medical Center of Tehran University of Medical Sciences, Iran, a declining case of a 12-day-old newborn was discussed and the ethical and legal dimensions of patient safety were discussed by experts from various fields. The language of biomedical ethics is applied in all practice settings, and four basic principles are generally accepted by bioethicists. These principles include (1) autonomy, (2) charity, (3) non-malevolence, and (4) justice. In the field of health, truthfulness and fidelity are also called ethical principles, but they are not part of the basic ethical principles identified by bioethicists. Legal standards are useful because they help people know what they cannot do. Legal standards allow authorities to apply rules when people do something illegal.

For example, if someone steals, the legal standard «you can`t steal» is used to discipline that person, perhaps by putting them in jail. Respect for differences is a crucial ethical practice. Research shows that management ethics differ from culture to culture. Respecting these differences means recognizing that some cultures have obvious weaknesses – and hidden strengths. Managers in Hong Kong, for example, have a higher tolerance for certain forms of corruption than their Western counterparts, but they have a much lower tolerance for not recognizing the work of a subordinate. In some parts of the Far East, stealing a subordinate`s credit is almost an unforgivable sin. Despite increased attention to the quality of health services, patient safety in healthcare facilities still faces many threats. As patient safety is multidimensional and based on ethical and legal imperatives, ethical and legal challenges should be considered. Healthcare professionals are constantly confronted with ethical and legal issues in the workplace, putting them at risk of burnout. Efforts on collection costs increase the pressure on employees to do more with less.

Limited resources force difficult decisions about quality of care. Patient safety can be compromised, resulting in injuries and lawsuits. Bioethicists suggest that when health professionals practice the ethical principles of autonomy, do justice, do good and do no harm, health professionals can help resolve difficult situations. A cultural relativist would have no problem with this result, but I would. A country has the right to set its own health and safety rules, but in the case described above, the standards and contractual conditions could not have protected workers in Sevastopol from known health risks. Even if the contract met Ukrainian standards, ethical businessmen must oppose it. Cultural relativism is morally blind. There are fundamental intercultural values that companies must uphold. (For an economic argument against cultural relativism, see the supplement «The Culture and Ethics of Software Piracy.») Individual managers will not be able to root out corruption in a host country, no matter how many bribes they refuse. When a host country`s tax system, import and export procedures, and procurement practices encourage unethical actors, companies must take action. Companies need to help managers distinguish between practices that are simply different and those that are bad.

For relativists, nothing is sacred and nothing is false. For absolutists, many things that are different are false. Neither extreme illuminates the real world of business decision-making. The answer lies somewhere in between. Ethical dilemmas arise when there are equally compelling reasons for and against a certain course of action and a decision must be made. It is a dilemma because there is a conflict between decisions. Usually, an action, while morally right, violates another ethical norm. A classic example is stealing to feed your family. Theft is legally and ethically reprehensible, but if your family starves, it may be morally justified (Noel-Weiss et al., 2012). Consider these principles in action.

In Japan, people who do business together often exchange gifts – sometimes expensive – in accordance with Japan`s long tradition. When American and European companies started doing business in Japan, many Western businessmen thought that the practice of gifts might be bad rather than just different. For them, accepting a gift was like accepting a bribe. However, as Western companies have become familiar with Japanese traditions, most tolerate this practice and set different limits on gifts in Japan than elsewhere. The core company values I`ve listed can help companies exercise ethical judgment and think about how to act ethically in foreign cultures, but they aren`t specific enough to guide managers through actual ethical dilemmas. Levi Strauss relied on a written code of conduct to understand how to deal with the Tan family. The company`s global sourcing and operating guidelines, formerly known as the Business Partner Terms of Engagement, state that Levi Strauss «will seek to identify and use business partners who, as individuals and in the conduct of all their business, pursue a set of ethical standards that are not inconsistent with ours.» Whenever unbearable business situations arise, managers must be guided by accurate statements that describe the behavior and operational practices that the company needs. What factors led to this incident? How can this incident be prevented? What is the responsibility of staff in managing this incident? What is the duty of medical and nursing staff during such events? If so, what are the ethical issues of patient safety? What are the legal obligations and consequences of this case? Comparative justice determines how health care is delivered at the individual level. It deals with the differential treatment of patients based on age, disability, gender, race, ethnicity and religion. Age-related differences are particularly interesting at the moment. In 1975, Singer linked age bias to discrimination based on sex and race, calling the practice age discrimination (Gabard and Martin, 2003).

In a society where there is no equal access to health care, concerns remain about the distribution of resources, particularly in view of the ageing population and the growing demand for services. Finding the right balance between clear direction and individual judgment makes creating corporate values and codes of ethics one of the most challenging tasks facing leaders. Words are just the beginning. The leaders of a company must often refer to the credo and code of their organization and be themselves credible, committed and consistent. If executives claim that ethics don`t matter, the rest of the company`s employees won`t think they do. Despite the obvious tension between nepotism and the principles of equal opportunity, I cannot condemn this practice for Indians. In a country like India, which emphasizes clan and family relations and experiences catastrophic unemployment, the practice must be considered in a morally free space. The decision to give a special benefit to employees and their children is not necessarily a bad one, at least for members of this country. Few ethical questions are easy for managers to answer. But there are hard truths that must guide managers` actions, a set of what I call core human values that set minimum ethical standards for all businesses.1 The right to health and the right to economic progress and improved living standards are two fundamental human values. Another is what Westerners call the Golden Rule, which is evident in all the world`s great religious and ethical traditions. In book 15 of his Analects, for example, Confucius advises people to maintain reciprocity or not to do to others what they do not want.

Core values form a moral compass for doing business. They can help companies identify acceptable and intolerable practices – even if those practices comply with the standards and laws of a host country. The removal of pollutants near homes and the acceptance of inadequate standards for the handling of hazardous substances are two examples of measures that violate fundamental values. Ninety percent of Fortune 500 companies have codes of conduct and 70% have vision and values. In Europe and the Far East, the percentages are lower but increasing rapidly. Does this mean that most businesses have what they need? Barely.