Session 3
Ethical Decision-Making
In this session, we explored ethical decision-making and responsible leadership, and analysing a case study on stakeholder management. We developed a framework emphasising stakeholder considerations and ethical principles, identifying leadership challenges, proposing solutions, and learning the importance of prioritising stakeholders in ethical decision-making.
Simon Sinek on Ethical Fading
A "Third Way" through Moral Imagination
In "Responsible Leadership and the Reflective CEO: Resolving Stakeholder Conflict by Imagining What Could be Done," Pleass et al., (2022) explore how CEOs can address complex stakeholder conflicts by introducing the concept of moral imagination as a tool to navigating ethical dilemmas. It encourages leaders to move beyond conventional solutions and consider innovative approaches that benefit all stakeholders. By shifting from a "what should be done" to a "what could be done" mindset, the article offers a strategic framework for decision-making that aligns business goals with ethical responsibility.
Amid escalating societal challenges and the increasing influence of multinational corporations (MNCs), there is a growing demand for responsible leadership. Business leaders are expected to address these issues by fostering solutions that generate value for all stakeholders. Despite a broad consensus on the necessity of such leadership, a persistent "knowing-doing gap" remains - a disconnect between understanding the need for responsible leadership and effectively implementing it in practice.
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In non-Western and emerging economies, MNCs often operate in environments plagued by weak institutional frameworks, such as poor rule of law, political instability, and widespread corruption. Leaders in these settings wield significant influence over both local and global ecosystems, making their role crucial in tackling large-scale societal challenges. The call for responsible leadership in these contexts stems from the hope that business leaders will drive positive and sustainable change.
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However, the adoption of responsible leadership does not automatically translate into local-level improvements. Business leaders in these regions may be tempted to conform to existing local practices or mirror lower standards prevalent in their own countries, leading to ethical fading - where unethical practices become normalised because they are widely accepted. This issue becomes even more pronounced during crises, particularly in stakeholder conflicts, as illustrated by the failure of Netcare’s project in Lesotho, which was hindered by disputes over project ownership.
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Drawing from a case study in India, research has explored how leaders of MNCs in these challenging contexts can navigate crises involving ethical dilemmas to achieve the best outcomes for all legitimate stakeholders. To devise responsible solutions, leaders must engage in moral imagination - a creative approach to resolving complex, "wicked" problems that cannot be easily fixed. Such conflicts often revolve around value-based dilemmas, presenting a choice between two competing "rights" rather than a clear-cut right versus wrong. In these scenarios, moral imagination allows leaders to step back, gain perspective, and identify a "third way" - a balanced solution that navigates between opposing extremes.
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Moral imagination encourages leaders to look beyond the binary choices typically framed by deontological (duty-based) and utilitarian (outcome-based) ethics, prompting them to ask, "What could be done?" rather than "What should be done?" This mindset helps avoid false dichotomies that can lead to decision paralysis, opening up new possibilities that might not be immediately apparent.
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Moreover, ethical conflicts may arise from clashes between global and local norms or even between differing local standards and values. The framework for responsible leadership presented here is grounded in normative stakeholder theory, which prioritises underlying moral and philosophical principles. A leader’s values, intentions, and attitudes shape their decision-making processes - such as value judgements, legitimacy considerations, and stakeholder preferences -ultimately influencing how they engage with corporate social responsibility (CSR). This approach is particularly pertinent in crisis situations that require rapid, yet thoughtful, decision-making, underscoring the importance of a well-developed ethical framework for responsible leadership.
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Ethical Decision-Making Framework
Activity 2.3.2: Identify ethical challenges in the case study and apply your framework
Ethical Dilemmas in Case Study:
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Resource Allocation: The hospital faced critical shortages of essential resources, including medical supplies and personnel. This raised ethical questions about how to allocate scarce resources fairly and effectively among patients, balancing immediate needs with longer-term sustainability.
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Equity vs. Efficiency: Leaders had to choose between maximising efficiency (treating as many patients as possible within the given constraints) and ensuring equitable care (prioritising vulnerable patients who might require more intensive resources).
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Staff Well-being vs. Patient Care: Overworked and under-resourced staff faced moral distress, having to decide between prioritising their own well-being (by adhering to standard working hours) or extending their shifts to meet patient needs, risking burnout and potential errors in care.
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Adherence to Policy vs. Flexibility: The hospital leadership faced pressure to strictly follow existing healthcare policies and protocols. However, given the unique challenges of their local context, there was an ethical dilemma about whether to adapt or bypass certain regulations to provide better immediate care, risking potential conflicts with governing bodies.​
Applying the Ethical Decision-Making Framework
To navigate these dilemmas, the ethical decision-making framework based on moral imagination can be applied as follows:
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1. Heightened Awareness
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The first step involves developing a deep understanding of the operational environment. Leaders must assess the broader context, recognising the interplay between systemic limitations, stakeholder expectations (patients, staff, government bodies), and the ethical dilemmas at hand. For example, the resource allocation issue is not simply a logistical challenge but involves deeper ethical considerations about fairness and justice in patient care.
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2. Engaging in Productive Imagination
Challenging Dominant Scripts: Leaders need to question traditional decision-making processes that prioritise efficiency over equity or rigid policy adherence over context-sensitive solutions. For instance, instead of following a 'first-come, first-served' policy, the leadership could consider prioritising patients based on urgency and vulnerability, recognising the unique demands of the context.
Exploring New Perspectives: By engaging with a range of stakeholders, including frontline staff, patients, and community representatives, the hospital leadership can gain diverse insights into the ethical and practical implications of various decisions, opening the door to more innovative and context-appropriate solutions.
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3. Creativity in Finding a Third Way
Reframing the Dilemma: Using moral imagination, the hospital leadership can look beyond the binary choices of either adhering strictly to policy or disregarding it entirely. For example, instead of making a rigid choice between staff well-being and patient care, the leadership might implement flexible shifts or introduce a rotational support system. This 'third way' balances the immediate need for patient care with the long-term sustainability of staff well-being.
Safe-to-Fail Experiments: The hospital could trial small-scale initiatives such as task-shifting, where certain medical duties are redistributed to trained support staff, thereby easing the burden on professional nurses and doctors. This allows the leadership to test whether this approach improves patient care without breaching regulatory standards, providing a practical solution to operational constraints.
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4. Utilising Normative Ethical Orientations
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Humane Orientation: Leaders should ensure that decisions respect the dignity and humanity of both patients and staff. For example, when allocating scarce resources, a humane orientation would consider the needs of the most vulnerable patients, ensuring that their rights to healthcare are respected.
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Justice Orientation: Equity must be a guiding principle in decision-making, especially in a public healthcare setting. Leaders should strive for fairness in how resources and attention are distributed, avoiding discriminatory practices that could marginalise certain patient groups.
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Responsibility and Sustainability Orientation: Decisions should account for long-term implications on the hospital’s operational capacity and community health. Leaders must consider the sustainability of resource usage, balancing immediate demands with the hospital’s ongoing ability to provide care.
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Moderation Orientation: Given the constraints, moderation requires leaders to avoid extreme actions—such as overextending staff to the point of burnout or severely rationing resources in ways that could jeopardise patient outcomes. A balanced approach ensures that neither staff nor patients bear the undue burden of the hospital’s limitations.
Finding the "Third Way"
By applying this ethical decision-making framework, the leadership at the KZN public hospital could avoid conventional binary choices and instead explore a 'third way'. This approach could include:
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Implementing a Triage System: A context-specific triage system prioritising patients based on medical urgency and vulnerability rather than order of arrival. This would address both equity and efficiency concerns.
Engaging Stakeholders in Dialogue: Establishing a regular feedback mechanism with staff and community members to understand their needs and perspectives better, fostering a collaborative approach to resolving ethical dilemmas.
Task Redistribution: Introducing task-shifting initiatives, where specific non-critical duties are assigned to support staff or volunteers, freeing up skilled medical professionals to focus on complex cases.
