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


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


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.


  • epublished Author Accepted Version: March 6, 2022
  • epublished Final Version: March 12, 2022
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Volume 11, Issue 10
October 2022
Pages 2349-2351
  • Receive Date: 14 September 2021
  • Revise Date: 02 March 2022
  • Accept Date: 05 March 2022
  • First Publish Date: 06 March 2022