Their Unique Moral Responsibilities
Philip Boyle, Ph.D.
Vice President, Mission & Ethics
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•Goals for today’s conversation
What Trustees identify as “their ethical
Trustee’s role and how it creates unique
The responsibilities and what principles
should guide them.
The tools that are necessary to “navigate the
ship”; how will you know when you have
fulfilled the ethical obligations of trusteeship
ETHICS AND TRUSTEESHIP
• Reflection on ethics and the role and
responsibilities of trustees can be used to
facilitate, assist, and enable already virtuous
people in making hard choices
• The ethics of trusteeship is not about right
answers, but about striving to do the right
thing for the right reasons.
What tools in ethics can help me do
my job better?
• What trustees identify as “ethical
• Trustees’ role and unique ethical
• Guiding ethics principles for trustee
• Necessary tools to “navigate the ship”
Why is this an issue now?
• Shifts in governance
– Fewer religious and the shift to lay ministry
• Changing responsibilities
– In the Past: CEO selection and philanthropy
– Now: Asked to make critical decisions about
mission and values
• Changing external environment
• Scandal, and the question, “What is adequate
What is the ethics of trusteeship?
• Ethics provides standards and rules for
conduct; it interprets and clarifies
fundamental values, virtues, and principles
that have proven themselves over the
centuries to be reasonable and beneficial to
• Ethics is the study of how to make hard
choices in the face of conflicting values.
• Ethical arguments are grounded in
principles and foreseeable
consequences and aim at human
• The ethics of trusteeship involves the
study of people who have been placed
in significant power and responsibility.
• The ethics of trusteeship involves the study of
how such power is used, how human beings
should live together to mutual advantage, and
the boundaries that people should not
transgress in their relationships with one
• It focuses not on individual but collective
choices . . . It is not enough to appeal to the
ethical standards and consciences of
• Institutional autonomy
• Financial issues
• Positioning of the hospital
• Facility enhancement
• Physician relations
• Managerial issues
• Quality of services
• Community role
The role of the board
– Trustee as representative
– Trustee as mediator
– Assures for Community Benefit
– Delegates responsibility
– Social versus economic values
• Conflicts of interest:
– Trustee’s personal benefit from his or her
official actions and biased judgments
• Board composition and deliberation.
Periodically, the board should review
the hospital’s mission, composition of
the board, operating procedures, and
• This deliberation involves six questions
6 questions for deliberation
1. Do we have an open deliberative
2. Have we deliberated from a clear
understanding of our mission?
3. Have we made explicit the principles on
which our deliberations are made?
4. When principles come into conflict, do
we weigh the merits of each?
5. Do we have a clear justification for
balancing them in a particular way?
6. Do we have an appropriate procedure
for determining a consensus?
• Shared or federated trusteeship
• Trustees on subsidiary boards
• Relation to administration and staff: examine
policies and practices
– Quality of care: quality assurance, reduction of
– Clinical decision making and patient care:
– Human resource issues such as civil rights,
discrimination, and employee relations and
MAJOR ETHICAL PRINCIPLES
• Entrusted with mission and a set of
• Assets have been created by years of
charity, private donation, and public
• Entrusted to see that assets continue to
serve the public interest in accord with
FIDELITY TO MISSION
• Trustees should use their authority and
best efforts justly, to promote the
mission of the not-for-profit, and to keep
that mission alive by interpreting its
meaning over time in light of changing
SERVICE TO PATIENTS
• Trustees should ensure that high quality
health care is provided to patients in an
effective and ethical manner.
SERVICE TO COMMUNITY
• Trustees should govern hospital policy
and deploy hospital resources in ways
that enhance health and the quality of
life in the broader community that the
• Trustees should sustain and enhance
the integrity of the hospital as an
institution, as an effective organization
for the delivery of high quality health
care services, and as a moral
community of care giving.
• Trustees have been given substantial authority
and prerogatives, and therefore have a
substantial role and responsibility.
• These roles and responsibilities are just
beginning to be articulated, and are rarely
discussed among boards.
• “Good decisions” = values-based screens and
tools; four-point check