What Can We Ask of Hospitals? Conceptual Foundations for an Ethics of Healthcare Organizations

From aggressive billing practices to neglectful or discriminatory care, news stories about the misconduct of healthcare organizations abound. Yet there has been limited ethical scrutiny of hospitals and other healthcare organizations in the bioethics literature. In this paper, we explore what philosophy and organizational theory can offer in terms of concepts for articulating the obligations of healthcare organizations, specifically hospitals. We highlight how the concepts of institutional agency and responsibility, administrative harms and burdens, and communicative blame provide theoretical resources that can help bioethics get closer to a more robust organizational ethics. We advance two claims: first, these concepts help us make sense of how hospitals or healthcare organizations—not just individuals and the broader systems they operate within—can be morally responsible or blameworthy. Second, critical reflection on these concepts as they apply to several historical examples suggest some prima facie obligations of organizations that provide patient care.