Since the recorded history of mankind there has been ethical conflict. Hippocrates (460 BC) addresses ethics in the care of patients. Known as the Father of Medicine, Hippocrates established the Hippocratic Oath as guiding principles "to do no harm." Plato (428 BC) in The Republic expressed human virtues and the soul of man seeking justice.

Today, we face the rising tide of ethical conflict. Both the clinical staff and non-clinical staff are confronted with ethical conflicts.

William Nelson, Ph.D., Associate Professor at Dartmouth College and international ethics expert, discusses this rising tide of ethical conflict as more demands by the public are placed on the staff in hospitals today. All ethical conflicts are characterized by a number of common components. Ethics is about doing what is right in the right way for the well-being of everyone. An ethical conflict occurs when an uncertainty, a question, or a controversy arises regarding competency, ethical principles, personal values, or organizational and professional ethical standards of practice.

The opportunities today for ethical conflicts are rising. For example, in order to improve HCAHPS (patient satisfaction scores), do we make what we know is the best clinical decision for the safety and health of the patient, even if that means a lower patient satisfaction score because the patient or family wanted the care team to act differently? Of course the ethical response is "Yes, we must do what is best for the patient, no matter what the ramifications on the HCAHPS.”

An ethical conflict might arise if a patient demands an unsafe level of narcotics. If we do as the patient wants, we might receive a high patient satisfaction score. However, if we address the issue in the clinically appropriate manner, and do what is best for the patient's health, we might receive a low patient satisfaction score.

Likewise, if we talk to a patient about their unhealthy lifestyle with the intention of guiding them toward better health, we may potentially anger the patient-and later receive a low satisfaction score. But haven't we done the right thing? Unequivocally, the answer is "yes"-but at what cost to HCAHPS?

Ethical conflicts are best addressed when all the people who are involved have an opportunity to discuss their values, perceptions, and concerns in an open and respectful environment. I encourage everyone to be mindful of ethical conflicts and work toward creating an ethical culture of 'to do no harm' as we ensure justice for all.