The Virtuous Hospital: A Catholic Organizational Healthcare Ethics

This paper addresses a perennial problem in Catholic organizational healthcare ethics. Catholic and secular ethicists have acknowledged that organizational healthcare ethics is underdeveloped. Scholars have traditionally focused on the “micro” issues arising in the clinical setting or the “macro” issues of national healthcare policy and health insurance. The “meso” or healthcare organizational level, involving both healthcare systems and hospitals has received far less attention. As a result, contemporary organizational healthcare ethics lacks a developed conceptual framework with which to analyze and guide the decision-making of HCOs. The paper responds to two specific deficiencies in the field. First, organizational ethics undertheorizes sociological realities. Second, the field employs exceedingly thin and incoherent ethical frameworks. Although scholars have introduced the term "organizational virtue," they have yet to develop a robust account of the concept leaving healthcare leaders incapable of assessing organizational character or guiding moral decision-making. In sum, because neither "organization" nor "ethics" is well articulated, the entire project of organizational healthcare ethics loses its capacity to explain, guide, and assess human action and social outcomes. The paper directly addresses these deficiencies. First, it offers greater precision in the use of sociological terminologies, such as "structure," "institution," "organization," and "culture." Using critical realist social theory, the paper distinguishes between a social structure in the general sense, which is a “web of relations among social positions,” and an organization, which is a highly complex social structure containing positions of authority. Next, it synthesizes organizational theory with virtue theory to develop an account of organizational virtue ethics capable of aiding in organizational moral decision-making and assessment. It then articulates cardinal organizational virtues, including organizational prudence, justice, beneficence, and solidarity. The paper then applies the cardinal organizational virtues to a composite case.