Ethical dilemmas concerning decision-making within health care leadership: a systematic literature review

Vilma Žydžiūnaitė^{1, 2}, Tarja Suominen¹, Päivi Åstedt-Kurki¹, Daiva Lepaitė³

¹Department of Nursing Science, Faculty of Medicine, University of Tampere, Finland, ²Department of Education, Faculty of Social Sciences, Vytautas Magnus University, Lithuania, ³Examination Center, Vilnius University, Lithuania

Key words: decision-making; ethical dilemma; health care leadership/management/administration; systematic literature review.

Summary. The objective was to describe the research methods and research focuses on ethical dilemmas concerning decision-making within health care leadership.

Material and methods. The search was conducted on Medline and PubMed databases (1998–2008). The systematic review included 21 selected articles.

Results. The ethical dilemmas concerning decision-making within health care leadership are related to three levels: institutional (particular organization), political and local interface (local governmental structure), and national (professional expertise and system). The terms that are used as adequate to the term of “ethical dilemma” are the following: “continuous balancing,” “result of resource allocation,” “gap between professional obligations and possibilities,” “ethically controversial situation,” “concern about interactions,” “ethical difficulty,” “outcome of medical choices,” “concern about society access to health care resources,” “ethically difficult/challenging situation,” “(the consequence of) ethical concern/ethical issue.” In qualitative studies, a semi-structured interview and qualitative content analysis are the most commonly applied methods; in quantitative studies, questionnaire surveys are employed. In the research literature, there is a lack of specification according to professional qualification of health care professionals concerning ethical dilemmas by decision-making within health care management/administration.

Conclusions. The research on ethical dilemmas in health care leadership, management, and administration should integrate data about levels at which ethical dilemmas occur and investigate ethical dilemmas as complex phenomena because those are attached to decision-making and specific nuances of health care management/administration. In this article, the presented scientific problem requires extensive scientific discussions and research on ethical dilemmas concerning decision-making within health care leadership at various levels.

Correspondence to V. Žydžiūnaitė, Department of Nursing Science, Faculty of Medicine, University of Tampere, 33014 Tampere, Finland. E-mail: vilma.vilma@ymail.com

Received 15 July 2009 , accepted 9 September 2010