Book contents
- Frontmatter
- Contents
- Preface
- Acknowledgements
- Chapter 1 Why medicine needs moral leaders
- Chapter 2 Creating an organizational narrative
- Chapter 3 Understanding normative expectations in medical moral leadership
- Prologue to Chapters 4 and 5
- Chapter 4 Expressing fiduciary, bureaucratic and collegial propriety
- Chapter 5 Expressing inquisitorial and restorative propriety
- Epilogue to Chapters 4 and 5
- Chapter 6 Understanding organizational moral narrative
- Chapter 7 Moral leadership for ethical organizations
- Appendix 1 How the research was done
- Appendix 2 Accountability for clinical performance: individuals and organizations
- Appendix 3 A brief guide to commonly used ethical frameworks
- Index
Preface
Published online by Cambridge University Press: 05 January 2012
- Frontmatter
- Contents
- Preface
- Acknowledgements
- Chapter 1 Why medicine needs moral leaders
- Chapter 2 Creating an organizational narrative
- Chapter 3 Understanding normative expectations in medical moral leadership
- Prologue to Chapters 4 and 5
- Chapter 4 Expressing fiduciary, bureaucratic and collegial propriety
- Chapter 5 Expressing inquisitorial and restorative propriety
- Epilogue to Chapters 4 and 5
- Chapter 6 Understanding organizational moral narrative
- Chapter 7 Moral leadership for ethical organizations
- Appendix 1 How the research was done
- Appendix 2 Accountability for clinical performance: individuals and organizations
- Appendix 3 A brief guide to commonly used ethical frameworks
- Index
Summary
Preface
This book has been gestating a long time; almost exactly thirty years in fact. I can trace its beginnings to 1981, the year that racial tension erupted into riots in the Brixton area of London. I was a political activist at the time, heavily involved in campaigning against racism and for greater social equality. I was also working my way through law school, and I used to cycle off at 5 a.m. every weekday morning to an ill-paid job cleaning government offices. On the day in question I was half-way through emptying wastebaskets, scouring coffee cups and wiping ashtrays (they still smoked in offices back then) in a messy typing pool (they still had typing pools too) when my supervisor sidled over and announced that he had a new assignment for me. He was white, and I am white, and those facts have relevance to my story. He escorted me to a different office, evidently kept spankingly clean by its occupants, and explained that from now on my entire morning round would consist of this pristine domain alone. I appraised it with an office cleaner's eye and calculated that the new assignment would give me at least an extra hour in bed. Then he said – and this is the point – ‘we have to look after our own you know’. And what did I do? I did not upbraid him for his discriminatory attitude. I did not question his management decision. I did not reject his offer. But I did spend the rest of the week feeling guilty and uncomfortable, so much so that I went out and found myself another job. And I've spent a lot of time since then thinking about why I didn't live up to my deeply held convictions, and what gets in the way of other people living up to theirs.
Of course one of the reasons we don't always do what we think is right is that self-interest gets in the way. It would be ridiculously naive not to acknowledge that. But it's not the whole answer. In my case, I was already going out of my way – incurring personal disadvantage – to act in opposition to racial inequality. And I ended up walking away from the benefit that had been handed to me on a plate. I genuinely didn't want it. So why couldn't I do what I thought was right there and then, on the spot? It was partly because I was taken by surprise, and could not immediately make sense of what he said. I was pretty sure I'd got it right, but I was also worried that maybe I'd got it wrong and was making a horrible misjudgement. And my reaction was partly because when I was sure I knew what he was hinting at, I simply couldn't think of what to say that would actually alter his outlook. And finally, it was because although I loathed his attitude he hadn't hitherto done anything to make me loathe him; and I didn't want to offend him by spurning his gift.
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- Information
- Moral Leadership in MedicineBuilding Ethical Healthcare Organizations, pp. vii - viiiPublisher: Cambridge University PressPrint publication year: 2011