Within the healthcare system, it is important for healthcare professionals to maintain ethical standards, including those that govern respect for persons, a primary component of which is autonomy, and beneficence.

According to R.G. Rodriguez, Ph.D. (2009), autonomy is an element within the professional code of healthcare ethics that allows for a patient to govern themselves in the event that they are rational, competent, conscious and not coerced. This definition is significant because it provides indications both for the patient’s autonomy as well as situations where the requirements for autonomy have not been met and autonomy should therefore not be fully granted. Spicer (2005) qualifies autonomy by adding that patients must be informed in order to make an appropriate decision; must have the capacity to decide; and must be free from coercion. These definitions differ slightly in the emphasis of information required to be autonomous; however, capacity as defined by Spicer (2005) encompasses rationality, competency and consciousness. In effect, both definitions are mutually supportive and establish complementary guidelines in determining autonomy.

The definition offered by Fremgen (2009) is limited as it describes autonomy as “independence for their beliefs” (pg. 176). The definition provided fails because it addresses only religious considerations, as well as a person’s right to decision-making based solely on competence: “As long as a person is competent, he or she has the right to make his or her own decision” (pg. 176). This does not address matters of relevance involved with determining autonomy, including consciousness or freedom from coercion. “Bioethical and legal issues arise when a person is called upon to make this decision, based upon his or her own religious beliefs, for another person such as a child or an elderly or incompetent adult” (Fremgen, 2009, pg. 176). The assumption that religious considerations are the main contributing factor for dilemmas of autonomy is myopic and impractical as many social, cultural, familial, personal and financial components may contribute to a person’s decision making with regards to healthcare treatments and options. The aforementioned definition given by Fremgen also implies that people without religious considerations would not have ethical dilemmas when making healthcare decisions for themselves or others. However, one would conclude that the complexity of the human condition is still relevant even in the absence of religious belief. Therefore, in consideration of the inefficiency and of the definition provided by Fremgen, the definitions given by Rodriguez and Spicer will be used to analyze the following dilemmas.

Within the ethical guidelines of the healthcare profession, therapeutic privilege offers an option for nondisclosure under certain guidelines. “Physicians may withhold information about a patient’s diagnosis or treatment when disclosing it would pose a serious psychological threat, so serious a threat as to be medically contraindicated” (Wynia, 2004, p. 14). Following the guideline of therapeutic privilege, the provider may not disclose information simply because the information would cause the patient to choose a different course of action, but only in the event that the information would cause significant unnecessary harm if disclosed and is therefore determined to be medically contraindicated (Wynia, 2004). In this way, providers partially disregard the first ethical principle, selectively disclosing information and therefore not being fully truthful and allowing for the necessary information for complete autonomy, in lieu of the second and third principles, beneficence and non-malfeasance. However, beneficence is not sufficient; the judgment must be subjective to preventing actual harm.

The second principle within healthcare ethics is beneficence (Fremgen, 2009; Rodriguez, 2009; Gauthier, 2005). Beneficence means to “act with charity and kindness” (Rodriguez, 2009); it means to use one’s skills and professional authority to care for, comfort, and if possible, cure a patient. Beneficence implies that one will fairly and justly provide services with the intention of another’s improving the patient’s wellbeing. Rodriguez’s definition is valid because it indicates the primary values of beneficence.

When deciding ethical dilemmas, it is important to not only consider the ethical obligations; respecting a person and acting with beneficence, but it is also necessary to consider the legal implications of actions within the context of the healthcare setting. The following scenarios are presented with both ethical and legal considerations:

In the intensive care unit, you are working on a patient in a very unstable state. The woman and her children (who were all killed) had been in an accident. It is clear that further emotional trauma would be disastrous to the patient and may cause her death. In a lucid moment, she looks at you and asks, “How are my children?” Is this an instance when therapeutic privilege seems reasonable? Whether you decide yes or no to the therapeutic privilege question, write a sentence that you think would be the most appropriate answer for the patient.

The primary principle of healthcare ethics being respect for persons, it is important to reflect on the components of respect, mainly: autonomy, truthfulness, confidentiality and fidelity (Rodriguez, 2009). It is necessary to carefully consider the provider’s responsibility to the patient as well as the ethical duty expected by the profession. Beyond justice, the provider has a duty to respect the person, therefore allowing for autonomy as well as being truthful; beneficence, acting in a way that lends comfort, care and possible cure to the patient; and non-malfeasance, meaning that there is no harm caused.

The above mentioned scenario offers an ethical dilemma that may appear to be conflicting. It is the provider’s duty to be truthful, but also to cause no harm. In the event that the provider is truthful, harm, even death, is possible.

If the provider tells the patient that her children are dead, given the current situation, the patient may die due to the additional emotional trauma. In this manner, by telling the patient that the children have died, the provider would be causing harm; risking the patient’s death due to this additional emotional trauma would be medically contraindicated.

However, if the provider does not inform the patient of the news, then the provider is not being fully truthful and respectful of the patient. Under absolutely no circumstances should the provider lie to the patient; saying that the children are fine or any other statement simply to offer comfort. Such a lie would constitute a breach of ethical standards as it is not truthful and may cause greater long-term damage when the woman learns of their death. Lying to the patient is inadvisable and may lead to civil litigation since it would be outside of the professional ethical norms.

Under the guidelines of therapeutic privilege, a provider may not disclose information if such knowledge is dangerous, causing such significant emotional trauma as to be medically contraindicated. In this scenario, one may consider the immediate disclosure to be a matter of therapeutic privilege because the emotional trauma resulting from the information would cause significant emotional trauma possibly resulting in death. Given the likelihood of significant danger at the current time, the provider should not answer the question, but also not offer any false hope or lies. Additionally, autonomy is contingent on rationality; in the patient’s current condition of shock and significant physical trauma, she does not qualify for complete autonomy.

One appropriate response may be to redirect the patient’s focus to her own injuries and treatment, for example: “Ms. Doe, we are doing everything possible to help you right now. We need to ask you some questions about your medical history.” As the patient is not consistently lucid, this redirection would offer additional time to stabilize her condition before adding the additional emotional burden of her children’s death.

You are working late and you enter the patient’s room to find that she has climbed out on the window ledge. She appears to be crying and tells you to leave her alone.

In the abovementioned scenario, the woman on the ledge offers another ethical consideration, contrasting the autonomy of the patient’s wishes to be left alone against the provider’s responsibility for offering care. The patient exhibits clear signs of lacking the necessary components of autonomy. Her actions are clearly not rational and arguably not competent as they are likely indications of mental illness, risk of self harm or even suicide. In this matter, the clear decision is to not fulfill her wishes to be left alone. However, staying in the room or climbing out on the ledge is not a sufficient answer to this situation. This situation needs immediate response: security and police/EMS services need to be notified. Any and all possible means to prevent harm need to be taken.

Beyond the ethical considerations, it is necessary to consider the legal impact of inaction. Had the provider observed the patient’s wishes, he or she would have been liable for any harm that came to the patient (Jenner & Welch, 2001). When a patient is under professional care, it is important for the provider to protect them from harm, even if the harm is caused by themselves as in the case of psychiatric disorders. If the provider fails to reasonably safeguard against actions of self-harm or suicide, he or she will likely be civilly liable for malpractice and negligence (Jenner & Welch, 2001).

Your elderly patient hates to have the bed rails up and tells you to leave them down.

Ethically, this scenario does not offer enough information to conclude if there is a legitimate dilemma: whether or not the patient is autonomous is unclear. The indication of age does not necessarily indicate any potential harm. There is no mention as to whether there are physician orders regarding the matter of the bed rails. The setting of the situation is unclear. More information needs to be obtained before any actual ethical determinations may be made.

However, while this scenario could offer an ethical dilemma given additional information, the more significant consideration is that of the legality of the action. Bed rails qualify as restraints; restraints must be used under the order and direction of a physician (Greenwich Hospital, 2005). Restraints are used only when absolutely necessary; to use them in any other fashion or without proper indications or medical direction could constitute unlawful confinement and may open the provider and healthcare site up to civil or criminal ramifications.

Considering all aspects of a dilemma is important, however it is necessary to consider not only the ethical factors but also the legal responsibilities within the healthcare setting.

References

Fremgen, B. (2009). Medical law and ethics (3^rd ed.). Upper Saddle River, NJ: Prentice Hall Health.

Gauthier, CC, PhD. (2005). The virtue of moral responsibility and the obligations of patients. Retrieved 21 November 2009 from  http://wf2dnvr6.webfeat.org/qxkBN12932/url= http://content.ebscohost.com/pdf9/pdf/2005/MPS/01Apr05/16999952.pdf?T=P&P=AN&K=16999952&S=R&D=aph&EbscoContent=dGJyMNHX8kSeqK84zOX0OLCmrlGep7RSsqq4TbeWxWXS&ContentCustomer=dGJyMPGvtEyvrbVLuePfgeyx44Hy7fEA.

Greenwich Hospital. (2005). Restraint/bed rail entrapment information guide. Retrieved 21 November 2009 from http://www.greenhosp.org/pe_pdf/genmed_restraint.pdf.

Jenner, R. & Welch, B. (2001). Suicide watch: liability for negligent psychiatric care. Retrieved 21 November 2009 from http://www.medlawlegalteam.com/article_jenner_suicide_watch.html.

Rodriguez, R., Ph.D. (2009, November 19). Chat posting. Retrieved from AIU Online Virtual Campus. Chat 1 week 2. The ethical and legal aspects of healthcare: HCM410-0904B-02 website.

Spicer, J. (2005). Consent autonomy and the new practice nurse. Retrieved 21 November 2009 from http://wf2dnvr6.webfeat.org/qxkBN12924/url=http://web.ebscohost.com/ehost/ detail?vid=2&hid=11&sid=8ddc3e69-4ea1-4d2c-b570-228fdecf7b81@ sessionmgr110&bdata=JmxvZ2lucGFnZT1Mb2dpbi5hc3Amc2l0ZT1laG9zdC1saXZl#db=buh&AN=18776068.

You are a paramedic arriving at an emergency scene. A group of scouts has entered a cave that is now filling with water. They were led into the cave by a rather large scoutmaster. Unfortunately, while leading them out of the cave, the scoutmaster somehow managed to get stuck in a narrow opening with only his head and shoulders protruding out. With his upper torso stuck outside the cave, it appears the scoutmaster will survive, but all the boys below will drown if they cannot escape.

After you have checked all possible escape routes and have attempted to extricate the scoutmaster, it becomes clear that the only way to save the boys is to sacrifice the scoutmaster, so he can be removed. This is, unfortunately, not the Winnie the Pooh story where Rabbit has the option of waiting until Pooh loses weight. What is the correct action for this case?

Duty-oriented reasoning, otherwise known as deontology, deals with Immanuel Kant’s influential moral theory regarding what a person is obligated to do (Rosenstand, 2003). The reasoning behind deontology is the intention, and is based on universal principles that guide actions (Fremgen, 2009; Rosenstand, 2003). Duty-oriented reasoning concludes that the consequences of the action are not as important as the principle moral law that dictates the action; that the presence of one’s duty is the determining factor as to an action’s morality (Kant, 1785). For example, a person has a moral obligation to be honest, even if that honesty has negative outcomes. To lie, even to save one’s life, would be morally objectionable because there is a duty to be honest.

As applied to the scenario above, it is important to determine the moral obligation. As a paramedic, the implied duties and obligations are to aid those in need. The primary duty is balanced by both parties in the above scenario and does not further the decision process. A second obligation is a sociopolitical obligation to protect the most vulnerable of society.

Given the exigency of the situation, it is reasonable to prioritize. In this scenario, the greater duty would be to protect the innocent and vulnerable: to save the lives of the children. Children are considered to be some of the most vulnerable members of society; therefore assisting them holds a higher obligation in order to fulfill the duty. While this necessitates the sacrifice of the scoutmaster, the greater duty is the protection of the most vulnerable members of society. By following the moral law of protecting the innocent, the sacrifice of the scoutmaster would be a morally sound action given the circumstances.

Consequence-oriented reasoning, or consequentialism, uses a cost/benefit analysis to benefit as many people as possible (Fremgen, 2009; Rosenstand, 2003). The results are regarded as having a greater significance than the actions taken. In other words, consequentialism signifies that the ends justify the means. For example, if one would have to lie in order to save someone’s life, the act of saving the life would be morally sound while the act of lying would be justified through of the final results. “Utilitarians see as their moral guideline a rule that encourages them to make life bearable for as many people as possible” (Rosenstand, 2003, p. 175). This is an important quotation because it clearly states the guiding factor that the needs of the many outweigh the needs of the single person. The greater return for the least amount of effort, in essence an economic consideration, is of primary significance.

As applied to the scenario above, the lives of the scout troop would carry greater significance than the life of the single scout master. As a consequentialist, it would be necessary on moral grounds to assist the most people possible, even at the expense of a singular unit. Following this reasoning, it would be morally necessary to sacrifice the scout master and save the children. In this way, the greatest number of people is served while the least suffer.

Virtue-ethics reasoning is based on what a virtuous person would do; it deals with the character of a person and the responsibilities derived from such a character (Rosenstand, 2003). One concern of virtue-based reasoning is justice (Fremgen, 2009). According to R. G. Rodriguez, “Aristotle defined justice as being treated equally” (2009). Following virtue-reasoning, a virtuous person would act justly, therefore treating all equally. There would be no added value to one party or another.

As applied to the aforementioned scenario, using value-based reasoning would lead a person to the same conclusion as the other methods of reasoning, however for different reasons. The scout master holds ultimate responsibility for the lives and well-being of the troop that he leads. A responsible and virtuous scout master would have allowed the boys to exit first, therefore ensuring their exit before his own. Had he acted courageously, the boys would have been safely outside even had he then become lodged in the entrance; which would not have otherwise been fatal. However, justice would dictate that, as the responsible party, he would be sacrificed to save those for which his selfishness and lack of virtue harmed.

While all three methods lead to the same conclusion, the biggest dilemma with ethics is its subjectivity. There is no absolute right or wrong answer in many difficult situations; the morality is drawn from those involved and the examiners of the situation. This is especially important when considering healthcare ethics, often involving dramatic circumstances and choices. When applying different standards to healthcare practice, different conclusions may be achieved. It is important to understand all parties’ view points, to clarify the ethical issues, and to compromise in resolving the dilemma (Fremgen, 2003).

When determining who is right, it is important to consider the legal and sociopolitical context, including the professional codes of ethics. In this manner, the societal and professional obligations and expectations supersede the expression of the personal morality of an individual. For example, if a nurse feels that the morally obligatory course of action is to euthanize any cancer patient as a way to ease the financial drain on the economy (hence, utilitarianism as the societal needs serve a greater importance than a single person’s life), it would still be legally objectionable due to the standards of care, ethical code of conduct within the profession, and societal laws.

While all of the moral theories examined above result in the same conclusion, it is logical to consider some additional points that are relative due to the nature of the healthcare setting. The first thing to consider is the legality of the action: the paramedic would be operating outside of his or her scope of practice since they have no training on sacrificing a patient. Considering that the scout master is alive and yet unable to be extricated, it is reasonable to conclude that, even following the sacrifice, the paramedic would not be equipped to dismember the body in order to remove the scout master’s remains. In either case, this would be operating outside of the scope of practice, as well as violating the ethical principle of nonmaleficence (Fremgen, 2009). The paramedic would likely be sued in civil court, and may even be charged with murder.

Alternatives to executing the scout master may include dismemberment; losing a limb would be preferential to losing the life. Depending on the logistics of the scout master’s predicament, there may be time to find another way of extraction before the water rises high enough that the boys are mortally endangered. While ethics dictate one’s actions, it is also necessary to use all options available, to think independently and remain conscious of ethical and legal issues within the field (Fremgen, 2009).

References

Fremgen, B. (2009). Medical law and ethics (3^rd ed.). Upper Saddle River, NJ: Prentice Hall Health.

Kant, I. (1785). Grounding for the metaphysics of morals (Abbott, T. K., trans.). Retrieved http://philosophy.eserver.org/kant/metaphys-of-morals.txt

Rodriguez, R., Ph.D. (2009, November 9). Chat posting. Retrieved from AIU Online Virtual Campus. Chat 1 week 1.The ethical and legal aspects of healthcare: HCM410-0904B-02 website.

Rosenstand, N. (2003). The moral of the story: an introduction to ethics (4^th ed.). New York: NY: McGraw-Hill.

Physicians and caretakers are often faced with difficult dilemmas that require assisting patients and families to choose a specific course of action. Few environments are as demanding on the professional relationship as within medicine; treatment plans, end-of-life decisions and day-to-day recommendations balance risks with the patient’s best interests. Especially in the medical field, providers’ recommendations must maintain ethical standards. Ethical is defined at Dictionary.com (n.d.) as: “being in accordance with the rules or standards for right conduct or practice, esp. the standards of a profession”.

While persuasion is often used for beneficial or malefic purposes, as a method in itself it is amoral. However, given the responsibility of the vulnerable patient-doctor relationship, it is necessary to remain ethical and to avoid manipulation. Willingness to keep the patient’s best interests at heart helps create persuasive reasoning that is not only effective but also ethical. The key to ethical persuasion is motivation. Someone may persuade people to vote, knowing that citizens that are active in the selection of their representation will be happier than those who passively tolerate the rules and laws placed upon them. This persuasion has the audience’s well-being at heart, and would therefore be considered ethical. However, if the same person used strong-arm tactics, deception or manipulation to force people to vote for the persuader’s candidate, it would be unethical.

Persuasion can be ethical if all the facts, the pros and cons, are honestly presented. Persuasion is imperative, potentially leading to many beneficial ends, when it is done ethically. Ethical practitioners inform patients of the benefits of a treatment, prescription, surgery, or an action so that the patient can recognize just how well the idea, option or action will satisfy their need. Through ethical persuasion, patients should be able to face their fears and uncertainty in order to consent to the best options while staying fully informed of possible negative aspects of the course of action. By appealing to both the logical and emotional factors, the patient may be reasonably motivated to make the best choice.

For example: a pediatrician may persuade a parent to have their child receive a new vaccination. If the doctor maintains an audience-centered approach, keeping in mind the benefits to the child, this would be ethical conduct, following the standards of the profession. However, if the doctor did not fully disclose the risks of an elective procedure or vaccination, instead pressuring the parent with the intention of boosting their own treatment statistics, this would be unethical (and potentially illegal) behavior that is not within the standard of the profession. “To maintain the highest standards of business ethics, make every attempt to persuade without manipulating (Thill & Bovée, 2007, p. 308).”

References:

Ethical. (n.d.). Dictionary.com Unabridged (v 1.1). Retrieved September 14, 2008, from Dictionary.com website: http://dictionary.reference.com/browse/ethical

Thill, J. V. & Bovée, C. L. (2007). Excellence in Business Communication (7^th Edition). Upper Saddle River, New Jersey: Prentice Hall.

Over a period of many years, concluding with the bankruptcy of Enron in 2001, corporate and individual corruption and fraud cost shareholders millions of dollars (paraphrased, Einstein Law, 2008). “All of this debt was concealed from shareholders through partnerships with other companies, fraudulent accounting, and illegal loans” (Einstein Law, 2008). Because of the fraudulent business deals and special ghost companies that were created to hide the company’s debt, investors kept pouring more and more money into the stock. The artificial inflation of the stock price kept the executives rich, fed with outlandish bonuses. “Enron trussed up its corporate structure with hidden debt instruments, supported by the belief that reward could be divorced from risk (Steffy, 2008).”

Decision Making – Halo Effect

Enron was ranked as one of the top companies in the world. The corporate culture was both fun and challenging, and was viewed as the business model of the future (paraphrased, Ivanovich, 2004). Everything that Enron did appeared to be the best. “Fortune magazine named Enron the nation’s most innovative company five years running and, a year before Skilling’s resignation, ranked Enron among its ‘10 Stocks to Last the Decade’” (Ivanovich, 2004). The business was associated with its people, all of whom were top-notch. “The company also was obsessed with recruiting brilliant, aggressive people” (Ivanovich, 2004). In almost a hero-worship fashion, the brilliance of the executives carried over to the brilliance of the company. Everything looked perfect from the outside. The books looked great, and no one challenged the incredible profits that were being reported.

In retrospect, it is likely that stockholders and analysts should have been more cautious, scrutinizing the reports and actions of the company. I think that the primary reason that people did not investigate deeper into Enron was because of the halo effect. The people reacted to Enron because of the context-dependant stimulus (paraphrased, Plous, 1993). By seeing the executives as highly intelligent, brilliant and successful, fun and creative, the halo effect lead stakeholders to believe that they were also fair and ethical people, and that the business was run in a moral and ethical manner. Because of the halo effect, assumptions were made, based on the context of all the wonderfully positive things being said about the management; these assumptions eventually left employees and stockholders taking a major loss, facing long-term suffering.

Descriptive Models – Satisficing

Enron executives did not make the best decisions for the long-term good of the company or the collective. They did not even make the best long-term decisions for themselves, especially considering the lasting effects of their law-breaking on themselves and their families. However, I think that they chose their course of action by using the satisficing decision making model. “To satisfice is to choose a path that satisfies your most important needs, even though the choice may not be ideal or optimal” (Plous, 1993, p. 95). The executives committed fraud to fulfill their immediate need (or greed, in this case) for money. By fraudulently producing deceiving reports, they were able to keep a continuous flow of money into their own pockets. I imagine that the millions that they illegally gained helped to meet all their immediate needs, and to give the illusion of security. By choosing to address only their most primitive and narrow needs, without considering other all the other options that would be ideal or even optimal, the fraud committed is an example of satisficing.

Heuristics and Fallacy

Using the representativeness heuristic, people often judge probabilities by how much one thing appears to resemble another thing (paraphrased, Plous, 1993). However, this heuristic can cause problems when people fall into the “conjunction fallacy”, meaning that they assume that because there are more details, something is more likely to happen (paraphrased, Plous, 1993). In the case of Enron, I think that the executives used the conjunction fallacy of the representativeness heuristic to deceive the investors. With each additional factor, the probability is reduced (paraphrased, Plous, 1993); however many people feel that the more details the more likely something is. In the example of Enron, it created false companies to help hide its losses and substantial debt. By providing highly specific scenarios and ghost companies, many people did not question, but fell into the conjunction fallacy; assuming that, since there were so many details regarding the false companies, the lies must be truth. Fake companies, such as Chewco, JEDI, and Southampton (Einstein Law, 2008), helped to hide the billions of dollars of debt. By falsifying details such as the company names, stakeholders fell into the conjunction fallacy, and the executives were free to act as unethically as they wanted.

Another reason that I think Enron executives were able to execute such a grandiose fraud was because of their advantage using the availability heuristic. “People often use heuristics (or shortcuts) that reduce complex problem solving to more simple judgmental operations” (Schwarz, 1997). Using the availability heuristic, people judge probability on the frequency or prevalence of memory associated with a similar event (paraphrased, Plous, 1993). “The Enron mystique is due, in part, to the fact it was first in the recent wave of corporate scandals” (Ivanovich, 2004). Since there was yet to be a precedence of corporate fraud on such a massive level, no one suspected it. In fact, the company established such a reputation that its crash from on high was of tragedy proportions. Investors and watchdogs using the availability heuristic would not have perceived that such a massive fraud could take place, since there was no previous and readily available example of such events.

Overconfidence and Behavioral Traps

“Enron seems to have achieved primacy because it has all the earmarks of classic tragic drama, in which hubris causes the fall of the mighty” (Ivanovich, 2004). The mighty Enron, powerhouse and a sort of prince among large companies, became overconfident. The executives assumed that they would not be caught, that their deceiving and fraudulent tactics would continue without recompense. “No problem in judgment and decision making is more prevalent and more potentially catastrophic than overconfidence” (Plous, 1993, p. 217). Because the executives became overconfident in their own brilliance, they took risks that reasonable people would never enter into, particularly the defrauding of their investors, employees, and the general public.

Another major behavioral trap that the Enron executives fell into was the time delay trap. “When Kinder left and Skilling took over the presidency,” Strong said, “I started feeling that people were not looking at the longer-term perspective” (Fowler, 2004). Similar to saticficing, time delay serves only the short term, most immediate needs, without searching out the most ideal long-term decision. In this scenario, they fulfilled their immediate greed, but destroyed their futures, some by serving jail terms, another through desperation, shame and suicide (Einstein Law, 2008).

I would argue that a third behavioral trap that played a major role in this fraud was the investment trap. After completing the first fraud, they had little additional to lose to complete the second, the third, and so forth. Once the line was crossed into fraudulent and illegal behavior, it did not greatly affect the situation if they continued to behave in this way. Essentially, they had already invested too much, and could not withdraw from their immoral actions without even greater loss. Hence, it was easier for them to continue on the path than to withdraw and return to ethical business practices.

Yet another trap would be the collective trap. This small group of people benefitted greatly, but at a huge loss to the collective; costing not only the business entity, but the persons involved to suffer extensively. Lost jobs, lost wages, lost investments; stakeholders of all sorts were impacted by the selfish greed of this élite group. This trap seems to be especially cruel, since it shows a premeditated choice to injure so many other individuals. The evidence of the collective trap shows that the group of executives felt themselves above the rest, with a morally and ethically superior value.

The Social Side – Groupthink

I think that it is obvious that this group of executives fell victim to groupthink (Plous, 1993). Some of the most common symptoms that were demonstrated by the Enron group were: the illusion of vulnerability, collective efforts to rationalize warnings, and unquestioned morality (paraphrased, Plous, 1993).

Conclusions

There is no doubt that the Enron executives were brilliant, and that they used many theories and fallacies of common decision makers to extort and defraud millions of dollars from stakeholders. By utilizing their knowledge of the processes of decision making, they were able to mislead and manipulate the situation. They took advantage of the halo effect to make themselves look better than they were. They were satisficing; serving only their immediate needs. By exploiting the heuristics used by stockholders, they were able to continue to increase stock prices while the actual business portfolio plummeted. Their eventual downfall was a direct result of their overconfidence.

While it is embarrassing that such an event happened, it is important to understand how and why so that there is not a repeated scenario. Investors and the general public need to be aware of how immoral people can manipulate the situations, thereby controlling the cash flow. Awareness and knowledge are the best defense against such fraudulent behavior. These same concepts need to be applied to all aspects of healthcare; no department or field is beyond the possibility of flawed decision making.

References

Einstein Law. (2008). Enron fraud, the history of Enron, the Enron investigation. Retrieved 8 March 2009 from: http://www.lawyershop.com/practice-areas/criminal-law/white-collar-crimes/securities-fraud/lawsuits/enron/

Fowler, T. (2004). Enron’s implosion was anything but sudden. Retrieved 8 March 2009 from: http://www.chron.com/disp/story.mpl/special/enron/2655409.html

Ivanovich, D. (2004). Everybody knows Enron’s name. Retrieved 8 March 2009 from: http://www.chron.com/disp/story.mpl/special/enron/2655424.html

Plous, S. (1993). The psychology of judgment & decision making. New York, McGraw Hill.

Schwarz, S. (1997). SFB 504 glossary: heuristics. Retrieved 28 February 2009 from: http://www.sfb504.uni-mannheim.de/glossary/heurist.htm

Steffy, L. (2008). Meltdown highlights our own failings. Retrieved 8 March 2009 from: http://www.chron.com/disp/story.mpl/business/steffy/6038997.html

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