Nathan Boucher

Teaching Health Care Organizational Ethics: Engaging Structural Inequity and Artistic Expression

Nathan Boucher

Duke University

nathan.boucher@duke.edu

Structural inequity is recognized as an ethical challenge as many organizations today turn an eye inward and engage difficult and important conversations concerning embedded inequity related to race, gender, ethnicity, social status, or income level. I designed a required graduate level organizational ethics course in an accredited public policy school that encounters structural inequity as a unifying theme and engages artistic expression as a way of learning about a complex topic. A good deal of the course is spent on organizational ethics in health care organizations. I will briefly illustrate my approach using selected examples from the course. In these examples, structural inequity plays a stark role: biomedical ethics principles (autonomy, justice, beneficence, nonmaleficence) applied across sectors; business principles (quality, competition, management, inclusion/exclusion, profit v. revenue) and their decidedly uncomfortable role outside of the for-profit sector; and ethics of stewardship (public trust in organizations, duty, fiscal responsibility, treatment of employees and customers) situated in the hands of organizational leaders. I include Joan Tronto’s interpretation of the ethics of care – attentiveness, responsibility, competence, and responsiveness – in an organizational ethics framework, weaving the principles throughout this presentation’s content as it is in the course itself. Essential to this successful course are professional reflexivity exercises where students are given rich opportunities individually and in small groups to examine their own beliefs, judgments, privileges, and practices. For example, students draw pictures depicting meaningful risks taken as organizational employees and display these in an anonymous gallery for discussion. In another, students work in teams to produce an “artistic masterpiece” incorporating principles learned in the course and perform this work for the class. In addition to students learning how to recognize and respond to structural inequity, this pedagogical approach allows the learner to acknowledge their own discomfort and develop a universal understanding of ethics, avoiding what can be a narrow organizational lens in available ethics teaching today.

BIOGRAPHY

I am a Research Health Scientist at the Durham VA Health System's Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) and Associate Professor at Duke University, with appointments at the Sanford School of Public Policy, Medical School, and Nursing School. I am also a Senior Fellow at the Duke Center for the Study of Aging & Human Development and Core Faculty at the Duke-Margolis Center for Health Policy. Additionally, I serve as Director of Undergraduate Studies in the School of Public Policy. With extensive experience in clinical medicine, healthcare administration, education, hospice/palliative care, and community-based research, my work focuses on the intersection of social care and healthcare. I collaborate across VA, Duke, and community organizations to understand the challenges faced by community members and caregivers. My research has been funded by the VA, NIH, CMS, foundations, and Duke University. Recent projects include: 1) assessing care partners' needs for older adults re-entering the community from prison, 2) developing community health worker programs for older adults, 3) investigating dementia care quality and emerging technologies, 4) addressing homelessness among Veterans, and 5) improving training and employment for direct care workers in home- and community-based services.