ETHICAL ISSUES FACED BY CLINICIAN MANAGERS IN RESOURCE-ALLOCATION DECISIONS

This article explores the ethical issues faced by clinicians with mana gement responsibilities (clinician/managers) when making decisions rel ated to resource allocation and utilization at a Canadian teaching hos pital. Using a focus group method, 28 individuals participated in four homogeneous groups that included nurse managers, managers from other professional groups, and physician managers. Ethical issues that recur red throughout the discussions included fairness, concern with prevent ing harm, consumer/patient choice, balancing needs of different groups of patients, conflict between financial incentives and patient needs, and professional autonomy. The particular issue of conflict is analyz ed from two perspectives-a theory of professional-bureaucratic roles a nd of obligation-that illustrate how both management and philosophical issues are related. The findings suggest that decentralizing resource allocation and utilization decisions does raise ethical issues for cl inician/managers and that a better understanding of these issues can b e obtained using an interdisciplinary perspective.