The idea of trying to reconnect values to the value produced for patients came from direct personal experience on the wards, in the clinic and in the ethics committee. Clinical ethics does not operate in a vacuum. In the past clinicians had the power to decide and were rightly held accountable for that. The present world is different. Clinicians are on a journey from independent professionals, to managed professionals and, some believe, are destined to become mere employees. But as power to control systems and available choices has drained, accountability remains.
One thought was that business ethics seemed to have invaded the decision space. Whilst grounded it seemed to define value in very different terms to a medical ethos. There was disconnection and conflict between this ethic and the previously prevailing medical value set. Interestingly the business ethic sought control not just through dedicated managers but also by imbuing clinicians with the business ethic. An evolution in medical professionalism seemed to be part of the response. Evolution and change are not bad things per se and medicine and money are long-standing bedfellows. But, unlike the past, the power balance was not in the hands of the clinicians. There were cases such as Bristol and now Shropshire where patients suffered from a disconnection somewhere. Then there was Bawa gaba. Accountability without power?
The idea in my recent JME paper is to uncover this structure, see that alloying duties without properly allying values creates risk. Then realising that the organisation is an entity that can act to balance values but only through independent and clear eyes. It proposes an overriding organisational duty to promote the welfare of patients and a Board Ethics Committee to better perceive and then to advise those who must decide. Transparency forces better decisions and better accountability. The little voice inside that warns, cajoles and sometimes enlightens can have great value. We shall see if the idea has any effect at all. There are many vested interests in play. But for now, best to live in hope and consider the arguments.