Moral Lacunae in the Management of Dual Agency Dilemmas; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?”

Document Type : Commentary

Author

Department of Philosophy, Macquarie University, Sydney, NSW, Australia

Abstract

Waitzberg and colleagues’ participants articulate a wide range of strategies to manage tensions between clinical and economic obligations. There are, however, three notable absences in the data. First, all strategies described by participants are underpinned by the assumption that clinical (and associated administrative) practices need to either align with economic considerations or be made more compatible with them. Second, the dual agency dilemma was framed exclusively as existing at the level of the health care institution, with little attention paid to obligations to broader health systems. Third, there was no evidence of critical questioning of the priorities of the hospitals in which participants work. These absences do not render the strategies used by Weitzberg and colleagues’ participants morally “wrong,” but they do suggest that people who are deeply embedded in a system might fail to recognise the full range of moral concerns and moral possibilities.

Keywords


  • epublished Author Accepted Version: March 6, 2022
  • epublished Final Version: March 12, 2022
  1. Waitzberg R, Gottlieb N, Quentin W, Busse R, Greenberg D. Dual agency in hospitals: what strategies do managers and physicians apply to reconcile dilemmas between clinical and economic considerations? Int J Health Policy Manag. doi:10.34172/ijhpm.2021.87
  2. Heritage J, Boyd E, Kleinman L. Subverting criteria: the role of precedent in decisions to finance surgery. Sociol Health Illn. 2001;23(5):701-728. doi:1111/1467-9566.00272
  3. Griffiths L. Categorising to exclude: the discursive construction of cases in community mental health teams. Sociol Health Illn. 2001;23(5):678-700. doi:1111/1467-9566.00271
  4. Bourgeault IL, Armstrong P, Armstrong H, et al. Everyday experiences of implicit rationing: comparing the voices of nurses in California and British Columbia. Sociol Health Illn. 2001;23(5):633-653. doi:1111/1467-9566.00269
  5. Tilburt JC. Addressing dual agency: getting specific about the expectations of professionalism. Am J Bioeth. 2014;14(9):29-36. doi:1080/15265161.2014.935878
  6. Ghinea N, Wiersma M, Kerridge I, et al. "Some sort of fantasy land": a qualitative investigation of appropriate prescribing in cancer care. J Eval Clin Pract. 2020;26(3):747-754. doi:1111/jep.13278
  7. Wiersma M, Ghinea N, Kerridge I, Lipworth W. 'Treat them into the grave': cancer physicians' attitudes towards the use of high-cost cancer medicines at the end of life. Sociol Health Illn. 2019;41(2):343-359. doi:1111/1467-9566.12830
  8. Gallagher S, Little M. Procedural justice and the individual participant in priority setting: Doctors' experiences. Soc Sci Med. 2019;228:75-84. doi:1016/j.socscimed.2019.03.012
  9. ABIM Foundation. Medical Professionalism in the New Millenium: A Physicians’ Charter. 2004. https://abimfoundation.org/what-we-do/physician-charter. Accessed September 10, 2021.
  10. Dawson A, Jennings B. The place of solidarity in public health ethics. Public Health Rev. 2012;34(1):4. doi:1007/BF03391656
  11. Davies B, Savulescu J. Solidarity and Responsibility in Health Care. Public Health Ethics. 2019;12(2):133-144. doi:1093/phe/phz008
  12. Schoot T, Proot I, Legius M, ter Meulen R, de Witte L. Client-centered home care: balancing between competing responsibilities. Clin Nurs Res. 2006;15(4):231-254. doi:1177/1054773806291845

Articles in Press, Corrected Proof
Available Online from 06 March 2022
  • Receive Date: 14 September 2021
  • Revise Date: 02 March 2022
  • Accept Date: 05 March 2022
  • First Publish Date: 06 March 2022