Ethical dilemmas in the assessment of clinical outcomes

Ethical dilemmas and concerns abound in healthcare today, particularly in managed behavioral healthcare. The traditional perspectives that clinicians and managers typically use in considering and dealing with such ethical dilemmas are the personal-ethics and professional-ethics perspectives. It is becoming increasingly evident, however, that a third perspective merits consideration. Because of the powerful and pervasive influence of organizational dynamics, it is necessary to consider the organizational-ethics perspectives. When it comes to the ethics of clinical outcomes, it has been suggested that three particular organizational dynamics - financial considerations, efficiency and expediency, and personal versus organizational values and ethical conflicts - exert considerable undue and often unrecognized influence on MBHO personnel. Accordingly, such organizational influence can and does pressure otherwise good and ethical clinicians and managers to engage in morally questionable or outright illegal behavior. While it is beyond the scope of this article to offer strategies for both resolving and preventing such ethical dilemmas, articles on the subject have been published elsewhere.10.