ETHICAL CONSIDERATION IN LEADERSHIP AND MANAGEMENT

A. Moral Decision Making

1. Principle of Moral Discernment

Many people just use discernment as a synonym for “decide.” But discernment is a richer
and deeper concept that, while related and antecedent to “deciding” is distinct from it. The
goal of discernment is to see beyond the mere external dimensions of something, and to
probe to its deeper significance.

The word discern comes from the Latin dis- “off, or away” + cernere – “to distinguish,
separate, sift, set apart, divide, or distinguish.

Thus, to discern is to distinguish or sort out what is of God, and what is of the flesh, the
world or even the devil. As such, discernment, in its root meaning is something that ought
to precede decision and aid it.

Thus as we discern, either a course of action or simply whether what we think or “hear” is
of God or not, we must often admit that, while some things are purely from God, it is also
the case that there may be other things admixed, things not of God, which must be sifted or
separated out. Discernment regards these sorts of things.

BASIC NORMS OR PRINCIPLES:

These principles are most often applicable to discern about a course of action, but many of
them can also apply to discerning the promptings and urges that the faithful often sense in
their walk with God, and which cause them to wonder, is this of God or just me?

Disclaimers. – None of these principles should be read in an absolute sense. They all
admit of limits and distinctions. They are merely principles that guide further reflection. In a
brief blog, not everything can be said about them, and you may wish to use the comments
to elaborate some of your own thoughts and distinctions. Secondly, while not every
principle applies to every situation, as a general rule, these principles ought to be used
together and in tandem. It would be wrong merely to use one principle, and think
discernment is complete. Generally these are all part of a process and their evidence
should be considered collectively.

Principle 1 – State of life. There are many different states in life, some permanent, some
long-lasting, some only temporary. We may be single, married, a priest, a religious, young,
old, healthy, or fragile in health. We may be a student, a parent, rich or poor. Being clear
about our state in life can help us discern if a call is from God or not.

For example, a young woman may sense a call to spend extended hours before the
Blessed Sacrament. Of itself this is surely a good and fine thing. But what if she is the
mother of four young children? Would God ask this of her? Probably not. Perhaps one hour
will be more in keeping with her state in life. On the other hand a single woman, may be
free to do this, and it may even be a part of her learning of her vocation to the religious life.
Other things being equal it is more likely we can be open to this call being of God in her
case.
Principle 2  – Gifts and talents – It is a clear fact that people have different combinations
of virtues and talents, gifts and skills. In discerning the will of God, regarding a course of
action, or of accepting an offer or opportunity, we ought to carefully ponder if it will make
good sense based on our skills and talents.

God has surely equipped us for some things and not others. I am a reasonably good
teacher of adults, I am not a good teacher of young children. Thus, in being offered
opportunities to teach or preach, I am much more open to the possibility that God wants it,
if it is for adults. If I am asked to address young children for more than 5 minutes, I am quite
clear God is not asking.

Age is something of a factor here too. Young people are often still in a process of
discovery as to their gifts and talents, and should try more new and challenging things.
Older adults are more likely to discern God’s will a little closer to their current skill set.

Principle 3 – Desire – Desire as a principle of discernment surprises some people. We are

often suspicious of our desires, and not without reason. When it comes to most things
regarding the Moral Law and Doctrine, our feelings and desires are largely irrelevant, and
should not be determinative of understanding God’s will. For example that we should not
commit adultery remains the clear will of God, no matter how we feel about. That Jesus is
God is true, no matter our feelings.

But when it comes to discerning between various courses of action that are both
good (e.g. marriage and priesthood), feelings and desires do matter and may help indicate
the will of God for us. For when God wants us to move in a direction of something good, he
most often inspires some level of desire for it. He leads us to appreciate that it is good,
attractive and desirable.

Learning to listen to our heart therefore is an important way of discernment. There

may, for example, be a good thing proposed for us to do, yet we feel no joy or desire to do
it. Such feelings should not be wholly dismissed as mere selfishness or laziness. It is
possible that our lack of desire is a sign of a “no” from God. On the other hand, we may
experience a joy and zeal to do, even things that are challenging, and these desires too
may help us to discern that God has prepared and wills for us to do that very thing. Hence
desire is an important indicator, among others, in deciding between courses of action that
are both, or all, good.  Ultimately God’s will for us gives joy.

Principle 4 – Organic development – This principle simply articulates that God most often
moves us in stages rather than in sudden and dramatic ways. While it is true, in most lives,
there are times of dramatic change, loss, and gain, it is more usual for God to lead us
gently and in stages toward what he wills for us.

Hence, in discernment, it is valuable to ask, “Does this change…, does this course of
action, seem to build on what God has generally been doing in my life? Is there some
continuity at work if I move in this direction? Does moving into the future in this particular
way make sense based on how and where God has led me thus far?”

It is generally a good idea to exercise great caution about “biggie-wow” projects and “out of
the blue” rapid changes. It is better to ask, “What is the next best step in my life?”

Principle 5 – Serenity – When God leads us, the usual result is serenity (peace) and joy.
In my own priestly life I have at times,  been asked to move from one assignment to
another. At such moments there is great sadness, since I had to say goodbye to people I
greatly love. And yet, when it is God’s will that the time has come for moving on, in spite of
the sadness, I also feel an inner peace, a serenity.
 Serenity should not be underestimated as a tool for discernment. For it often happens
that to ponder change is stressful, even fearful. But beneath the turmoil of difficult
decisions, we must listen carefully for a deeper serenity that signals God’s will.

Sometimes we must wait a while to sense serenity’s still, small voice. And when it is
present we have an important indicator that this is God’s will.

Principle 6 – Conformity to Scripture and Tradition. – Some may think that this principle
should be at the top of the list, and you are free to put it there. But I prefer to say that the
Word of God and the teachings of the Church has the last word in any decision.

If a person were to strangely think God was telling her of a fourth person in the Godhead,
and that she should build an altar, and spread devotion to this fourth person, we will rightly
and surely conclude she is dead wrong.

On the other hand, it may be one hears a call from God to be more faithful in prayer, and
more generous to the poor and has gone through the discernments above. And, while
Scripture and Church teaching may have little to say on the exact way of prayer, or the
precise amount of money, surely, as a general principle, such notions are in keeping with
God’s revelation and would not be overruled by it.  One can confidently proceed to discern
how, and when to pray, or what amount and to whom alms should best be directed.

Just a few principles for discernment. Remember the disclaimers above. They are to be
considered together and held in balance. They are also not understood in an absolute
sense, (except perhaps the last one) and may admit of exceptions and distinctions. Take
what you like and leave the rest. Add to them if you like. 

2. Principle of Well-Formed Conscience

The Church equips its members to address political questions by helping them develop
well-formed consciences. “Conscience is a judgment of reason whereby the human person
recognizes the moral quality of a concrete act. Every person is obliged to follow faithfully
what he [or she] knows to be just and right. We Catholics have a lifelong obligation to form
our consciences in accord with human reason, enlightened by the teaching of Christ as it
comes to us through the Church.

A well-formed conscience is an ongoing exercise

The Church offers the following process in forming one’s conscience:

 When examining any issue or situation, we must begin by being open to the truth
and what is right.
 We must study Sacred Scripture and the teachings of the Church.
 We must examine the facts and background information about various choices.
 We must prayerfully reflect to discern the will of God.

 The formation of a good conscience is another fundamental element of Christian
moral teaching. “Conscience is a judgment of reason by which the human person
recognizes the moral quality of a concrete act.” “Man has in his heart a law inscribed
by God. His conscience is man’s most secret core, and his sanctuary.”
 Conscience represents both the more general ability we have as human beings to
know what is good and right and the concrete judgments, we make in particular
situations concerning what we should do or about what we have already done.
 Because our conscience is that inner sanctuary in which we listen to the voice of
God, we must remember to distinguish between our subjective self and what is
 objectively true outside ourselves. We can be subjectively in error about something
that is objectively true. On the objective level, if our conscience is “correct,” then
there is no error between what is internally perceived to be true and truth itself. If
there is an incorrect conscience, that means that the conscience is erroneous in its
view of truth.
 On the subjective level we can have a “certain” conscience, which means we believe
that our conscience is in conformity with what is objectively true. A person can have
a “certain” conscience on the subjective level but an “incorrect” one on the objective
level

 There are some rules to follow in obeying one’s conscience.

o First, always follow a certain conscience.
o Second, an incorrect conscience must be changed if possible.
o Third, do not act with a doubtful conscience.
 We must always obey the certain judgments of our conscience, realizing that our
conscience can be incorrect, that it can make a mistake about what is truly the good
or the right thing to do. This can be due to ignorance in which, through no fault of our
own, we did not have all we needed to make a correct judgment.

3. Strategies of Moral Decision-Making Process

Expanded definitions of cognitive reasoning strategies relevant for ethical decision-making

Strategy Operational Definition

1 Recognizing your
circumstances
2 Seeking outside help
3 Questioning your own
and others’ judgment
4 Dealing with emotions
5 Anticipating
consequences of
actions
6 Analyzing personal
motivations
7 Considering the
effects of actions on
others
Note: Adapted with permission from Mumford, Connelly, Brown, Murphy, Hill, Antes, Waples, & Devenport, 2007
Thinking about origins of problem, individuals involved, and
relevant principles, goals & values; considering one’s own role
in causing and/or resoling the problem
Talking with a supervisor, peer, or institutional resource, or
learning from others’ behaviors in similar situations
Considering problems that people often have with making
ethical decisions, remembering that decisions are seldom
perfect
Assessing and regulating emotional reactions to the situation
Thinking about many possible outcomes such as
consequences for others, short & long term outcomes based
upon possible decision alternatives
Considering one’s own biases, effects of one’s values and
goals, how to explain/justify one’s actions to others, &
questioning ability to make ethical decisions
Being mindful of others’ perceptions, concerns, and the impact
of your actions on others, socially and professionally

A. Meaning and Service Value of Medical Care

1. Allocation of Health Resources

The allocation of healthcare resources involves distributing health-related materials
and services among various uses and people. The concept of allocation can imply
that a designated individual or group is responsible for each level of decision making
within a system that is designed to distribute fixed amounts of resources.
Nevertheless, the degree to which such a system exists and such explicit allocation
decisions occur varies widely. 
 The allocation of healthcare resources involves distributing health-related
materials and services among various uses and people. ... It often involves "patient
selection": determining which patients among those who need a particular
scarce resource, such as a heart transplant, should receive treatment. Nov 23,
2019

Healthcare allocations are commonly classified in terms of two levels of decision

making: microallocation and macroallocation.

Microallocation focuses on decisions regarding particular persons. It often involves

"patient selection": determining which patients among those who need a particular
scarce resource, such as a heart transplant, should receive treatment. Sometimes,
however, microallocation entails deciding for an individual patient which of several
potentially beneficial treatments to provide, particularly when only a limited time is
available for treatment.

Macroallocation, on the other hand, entails decisions that determine the amount of
resources available for particular kinds of healthcare services. Macroallocation
decisions include how particular health-related institutions such as hospitals or
government agencies. Macroallocation also encompasses the decisions a nation
makes concerning what resources to devote to particular institutions or, more
broadly, to high-technology curative medicine as opposed to, for example, research
or primary and preventive care.

2. Issues Involving Access to Care

Goal
Improve access to comprehensive, quality health care services.

Why Is Access to Health Services Important?

Access to health services means "the timely use of personal health services to achieve the
best health outcomes." It requires 3 distinct steps:
 Gaining entry into the health care system (usually through insurance coverage)
 Accessing a location where needed health care services are provided (geographic
availability)
 Finding a health care provider whom the patient trusts and can communicate with
(personal relationship)

Access to health care impacts one's overall physical, social, and mental health status and
quality of life.

Barriers to health services include:

 High cost of care

 Inadequate or no insurance coverage
 Lack of availability of services
 Lack of culturally competent care

These barriers to accessing health services lead to:

 Unmet health needs
 Delays in receiving appropriate care
 Inability to get preventive services
 Financial burdens
 Preventable hospitalizations

Access to care often varies based on race, ethnicity, socioeconomic status, age, sex,
disability status, sexual orientation, gender identity, and residential location.

Understanding Access to Health Services

The Access to Health Services topic area encompasses 3 components: coverage, services,
and timeliness.

Coverage
Health insurance coverage helps patients gain entry into the health care system. Lack of
adequate coverage makes it difficult for people to get the health care they need and, when
they do get care, burdens them with large medical bills. Uninsured people are:

 More likely to have poor health status

 Less likely to receive medical care
 More likely to be diagnosed later
 More likely to die prematurely

Emerging Issues in Access to Health Services

Specific issues that should be monitored over the next decade include:

 Increasing and measuring insurance coverage and access to the entire care
continuum (from clinical preventive services to oral health care to long-term and palliative
care)
 Addressing disparities that affect access to health care (e.g., race, ethnicity,
socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and
residential location)
 Assessing the capacity of the health care system to provide services for newly
insured individuals
 Determining changes in health care workforce needs as new models for the delivery
of primary care become more prevalent, such as the patient-centered medical home and
team-based care
 Monitoring the increasing use of telehealth as an emerging method of delivering
health care