Navigating the Pitfalls of Principlism in Healthcare Organizations’ Mission Statements and Moral Decision-Making

Abstract: Organizational ethics (OE) in healthcare is frequently defined as the practice of aligning a healthcare organization (HCO)’s policies, procedures, and leadership decisions with the HCO’s espoused values, which are articulated in its mission, vision, and/or values statement. Scholars have published a number of decision-making frameworks to facilitate HCO activities’ alignment to their stated mission and confer legitimacy to OE expertise and practice. In this paper, I argue that these decision-making frameworks employ a methodology carried over from clinical ethics, namely, Beauchamp and Childress’s principlist approach. This methodological analogy renders OE frameworks subject to H.T. Engelhardt’s critiques of principlism: that the mission statements used to guide HCO decision making fail to generate action-guiding content acceptable to those with divergent moral viewpoints. I support this claim by conducting a content analysis of prominent HCO mission statements. The important practical implication of my critique of OE decision making frameworks is that leadership decisions are vulnerable to the same biases and implicit values that contribute to health disparities in the United States. To address these problems, I propose that HCO mission statements should specify substantive moral content in three key areas—services offered, employee protections, and communities served—in order to (1) provide determinate moral guidance in HCO leadership’s decision-making and (2) engender HCOs’ transparency and public accountability. I conclude by responding to two objections: the theoretical objection that specifying moral content in HCO mission statements unjustifiably excludes some moral viewpoints, and the practical objection that specifying moral content hobbles HCOs’ decision-making flexibility.

Keywords: healthcare mission statements, organizational ethics, principlism