First principles: substantive ethics for healthcare organizations.

Healthcare organizations (HCOs) often face ethical dilemmas, but ethical principles analogous to those of clinical ethics have not been established to guide resolution of such dilemmas. To date, most progress in business and organizational ethics has been made in developing processes that promote responsible behavior in complex organizations. In this article we offer a normative framework to guide value-laden decision making of HCOs. We propose four substantive principles--provide care with compassion, treat employees with respect, act in a public spirit, and spend resources reasonably--that are derived from the roles that HCOs are expected to play as caregivers, employers, citizens, and managers, respectively. We anticipate that these principles can clarify and resolve tensions between different spheres of HCOs' responsibility, help to promote organizational values and trust in HCOs, and aid discussions about the appropriate roles of HCOs in our society.