Administrative ethics: Good intentions, bad decisions

The Canadian healthcare system is costly. Each day, health leaders must make decisions about what healthcare services will be offered, how they will be funded, to whom they will be made available, and within what administrative and clinical structure they will be managed and delivered. These decisions, their justification, and the ethics framework employed can vary greatly across the Canadian landscape. These high-stakes decisions must not only draw upon healthcare science but the science of business finance, risk management, and organizational design. However, in equal measure and often overlooked, these decisions must draw upon our values, upon our ethics. Sometimes we get it right, and other times, decidedly less so. When timely and fair access to effective and efficient healthcare services is not rendered, matters of justice, fairness, rights, and a host of other constructs are often cited. However, these important constructs are commonly misunderstood, contributing, in part, to well-intentioned but ultimately unethical decisions.