Sometimes administrators need to make difficult choices regarding the funding of various treatments that could be offered by one's facility. Regardless of the size or source of funding for our organizations, we make choices to fund certain initiatives over others. Rarely do we explicitly have to defend our choices. Even more rare is the need to declare which principles are guiding our choices. By saying that they are not explicitly expressed, I am not saying that we make our decisions in a fiscal or ethical vacuum. We have our own reasons as to why we make the choices we do. This exercise is an opportunity to step back and determine why we make the decisions that we do, especially as administrators are often held to high standards of transparency in organizational decision-making. Institutions, like individuals, must be held accountable for explaining why their decisions are ethically supportable even when they might make some members of the community unhappy.

You are a health care administrator at a community hospital who has been appointed to a committee that must decide how to spend a recent donation. Your hospital is being given $1,000,000 to be able to offer through your organization any of the prevention programs listed below. (Do not become bogged down in the logistics of the management of the funds. They are yours, and you must decide which programs to fund.) Even though you are not being told how to allocate the funds, you are being told that you can only use the funds toward these programs. Once funded, the programs will be offered to the patients at no cost.

• Immunizations for infants through the first five years of life.
• Mammograms for women over the age of 50.
• Back injury prevention education for your staff and any community members who may wish to attend.
• HPV vaccinations for all individuals aged 9 to 26 years of age. (Note: The FDA has cleared the use of the HPV vaccine for young boys and men, as well as young girls and women.)

You can choose to fund all of the programs, some of the programs, or only one of the programs. You must spend all of the $1,000,000. Again, you can decide to divide your monies equally, allocate the funds in varying amounts, or give all of the funds to one program.

1. Determine which of the programs you will fund and how much money you will give to each of the programs you wish to fund.
2. Then, for each of the programs you choose to fund, describe how a specific ethical principle or theory supports that choice. You might refer back to Week 1 for a refresher on ethical theories.
3. If you choose not to fund a program, state your ethical rationale for doing so.
4. Briefly consider the ramifications that your decisions might have for patients, the community, and hospital employees