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P H I L O S O P H Y F O R B U S I N E S S ISSN 2043-0736
Issue number 9
13th June 2004
I. The Cardiff Centre for Ethics, Law and Society
II. 'Ethics and Advertising' by Geoffrey Klempner
III. 'Ethics is Political Economics. Moral behavior is Good Management'
by Liviu Drugus
In April, I received an invitation to write an article for the Cardiff Centre
for Ethics, Law and Society (CCELS) from Kate Reeves, the Resource Manager.
Below, you will find some information from the CCELS web site, including the
list of articles currently available online. This is an excellent resource
which is well worth a visit.
I am grateful to the CCELS for permission to reproduce here my article, 'Ethics
Also in this issue, a plea from a Romanian philosopher, Professor Liviu Drugus,
for a more holistic, 'post-modern' approach to the politics, economics and
ethics of health management.
I. THE CARDIFF CENTRE FOR ETHICS, LAW AND SOCIETY
Led by Cardiff Law School and based at Cardiff University, the CCELS is a
virtual learning centre with an interdisciplinary focus, connecting researchers
and practitioners in medicine, science, the social sciences and humanities.
Each month, the CCELS web site publishes original papers which are specially
commissioned or submitted for review to an editorial board.
The CCELS was launched in January 2003. In March 2004, Soren Holm joined CCELS
as its new director.
On the CCELS web site, its aims are stated as follows:
CCELS aims to:
* foster interdisciplinary collaboration under the three
themes of Bioethics, Ethics & Society and Business &
* provide a resource which is both useful and attractive to
academics, professionals, policy makers and citizens;
* provide a resource for researchers seeking partners to
address the ethical, social and legal aspects of their work;
* provide a resource for policy makers seeking expert
* provide a source of information and expertise for those
working in the professions and industry;
* provide an educational resource.
A welcome aspect of the the editorial policy of the CCELS is the emphasis on
new articles especially written for the virtual resource centre.
This makes the publications archive a particularly valuable resource both for
academic researchers and for business people interested in knowing what is
going on at the cutting edge of cross-disciplinary social and ethical research.
Here is what the CCELS say:
CCELS will invite regular papers on topics of ethical
interest - the aim will be to publish two papers per month.
These papers will not be peer reviewed.
Contributors will also be able to submit papers and these
papers will be selected by an editorial board.
A hard copy volume of these papers will be published
Taken from the CCELS web site, here is the current list of publications
available on the CCELS web site, with the month of posting:
'Ethics and Advertising'
Professor Matthias Kaiser
'Practical ethics in search of a toolbox: Ethics of science
and technology at the crossroads'
Dr Yulia Egorova
'The Meanings of Genetics'
Dr Maire Messenger Davies
'Do mention the war : children and media coverage of
'Self Regulation and the Market for Legal Services'
Professor Philip Fennell
'Reducing Rights in the Name of Convention Compliance:
Mental Health Law Reform and the New Human Rights Agenda'
Professor Ken Peattie
'In Search of Ethical Business Leadership: Time to Mix Our
Professor Bob Lee
'GM Foods - A Regulation History'
Professor Guy Lebeer
'Clinical Ethics Committees in Europe: Assistance in
Medical Decisions, Fora for Democratic Debates, or Bodies
to Monitor Basic Rights?'
Dr Roberto Andorno
'Human Dignity and the UNESCO Declaration on the Human
Dr Sam Salek
'Health Economics and Access to Treatment'
Professor Ian Hargreaves
'The ethics of journalism: a summing-up for Lord Hutton'
Dr Ian Kenway
'Only Connect - Broadband Provision and Social Inclusion'
'Why do research on human brains?'
'No profits - no need for Corporate Social Responsibility'
'In the company of spies: the ethics of industrial
'Rights and Reproductive Choice'
Professor Celia Wells
'Holding Multinational Corporations Accountable for
Breaches of Human Rights'
Professor Loane Skene
'Theft of DNA: do we need a new criminal offence?'
Professor Jules Pretty
'Agri-Culture: Some Principles and Lessons for
Professor Robin Attfield
'Environmental Ethics, Environmental Problems and the
Ethics of Science'
'Corporate Actors in Zones of Conflict: responsible
Professor Richard Gardner FRS
'Therapeutic and reproductive cloning - a scientific
Professor Bob Lee
'Ecological Modernisation and the Precautionary Principle'
Professor Ruud ter Meulen
'Ethical Issues of Evidence Based Medicine'
Professor Peter Whittaker
'Stem cells, patents and ethics'
CCELS web site: http://www.ccels.cardiff.ac.uk
Kate Reeves is the Resource Manager for the CCELS.
For further information email: email@example.com
II. 'ETHICS AND ADVERTISING' BY GEOFFREY KLEMPNER
Human beings are world creators. One of the worlds that human beings have
created is the world of money, commodities, trade, exchange. To me, it's a
world full of beauty and ugliness in equal proportions, messy, flashy, exotic,
scary. No-one who has made their home in this world would see this the way an
outsider - and being a philosopher makes me by definition an outsider - can see
I regard the business arena - the world of buyers and sellers, bosses and
workers, producers and consumers, the world of money - as nothing less than an
ontological category, a way of Being. It is not accidental to who we are. It
defines the way we relate to each other and to the world around us. But it is
not the only way of Being. There are other ways, and the most fundamental of
these is ethics.
Ethics, as understood here, is defined by the I-thou relationship:
When I engage another person in moral dialogue, there are
not two parallel processes of practical deliberation going
on, his and mine, but only one. (Contrast this with the
case of a 'dialogue' between politicians or traders, where
each is privately deliberating how to gain the upper hand.)
In opening myself up and addressing the other as a thou I am
already committed to the practical consequences of
agreement, of doing the action which, by the combined light
of his valuational perspective and mine is seen as the thing
to be done.
Geoffrey Klempner 'The Ethics of Dialogue' (1998) 
As a professional metaphysician, I am fascinated by the idea that human beings
can belong to more than one world, or move between worlds. Anthropologists who
'go native' in order to study their subjects more closely have an inkling of
what I am talking about. We live in the marketplace and also outside it. We can
play the various roles assigned to us in the game, or we can stand outside our
economic personae and observe ourselves from an ethical point of view. The only
difference between us and the anthropologist is that, most of the time, we don't
realize that we are doing this.
In my recent article, 'The Business Arena', I put forward three propositions,
as a 'prolegomenon to a philosophy for business':
Business and commerce take place in a frame, an arena
defined by unwritten rules.
Within the business arena, normal ethics is suspended.
The aim of a philosophy for business is to understand the
rules that define the business arena, in other words, to
grasp from an ethical perspective how business is possible.
Geoffrey Klempner 'The Business Arena' (2004) 
To claim that in the business world 'normal ethics is suspended' is not to deny
the validity of rules of conduct, such as fairness and honesty. Without these
universal rules, these values, the game could not be played. However, these
obligations fall far short of the demands of ethics, as I have defined it here.
Advertising: for good or evil?
But how fair is the business game, really? On the face of it, producers and
consumers have a very different view. The marketplace is not a level playing
field, and the chief culprit is advertising.
Here are three charges levelled against advertisers:
They sell us dreams, entice us into confusing dreams with
They pander to our desires for things that are bad for us.
They manipulate us into wanting things we don't really need.
All this can be summed up in the popular sentiment that advertisers cynically
use a world of fantasy and illusion in an attempt to control us.
Most people who express this sentiment, however, would add that the attempt
doesn't succeed. We see through the ruse. (Or, at least, it is always other
people who seem to have the wool pulled over their eyes, never ourselves.)
That's a claim to take with a big pinch of salt.
In recent times advertising has become increasingly regulated by codes of
practice. These codes may be adequate to curb the worst excesses of
advertising. It is much harder nowadays for advertisements to get away with
telling outright lies. But they still fall far short of answering these three
That suggests the following question: suppose that you were an advertiser who
wanted to be truly ethical and not just legal. What would you have to do? Let's
look at each of the indictments in turn.
Let me start with a personal example. What initially attracted me to philosophy
was the life of Socrates. In the same way that few, if any Christians could live
the way Christ lived, so few if any philosophy students are capable of emulating
the life of Socrates. I knew this. I was sold the dream of philosophy. And I am
glad for that. I don't feel I was cheated. Plato, the greatest of all salesmen
for philosophy, seduced me - along with countless thousands of students before
and since - with his brilliant dialogues depicting the life of his mentor.
Gilbert Ryle in his book Plato's Progress (1966)  argues that the dialogues
were performed live. You can see audiences of Plato's dialogue Phaedo sobbing,
or swooning as Socrates calmly drinks the hemlock, with words of reassurance
for his gathered friends, facing death with courage and dignity.
The dream is not extraneous to the product. It is part of the complete package.
The treasure that is the collected works of Plato has added to the value of
philosophy, not just through novel arguments or its addition to the storehouse
of human knowledge but through the sheer seductive power of Plato's
storytelling. Living and breathing the atmosphere of the dialogues we become
more, we become better, we are enhanced.
But is that also true out there in the commercial marketplace, where humans
barter their love of material goods, succumb to the dreams that advertisers
sell? It is very tempting to say no. It is so easy to take the moralistic high
ground. Yet, as I want to argue, that would be a serious error.
Anyone who is serious about deconstructing the dream world of advertising
should start by considering the meaning of fashion and style, not as illusions
that human beings fall helplessly victim to, but as part of the scaffolding of
human culture. A world without fashion or style would be obnoxious, alien,
brutal - in the true sense of being fit only for brutes.
Think of the clothes one wears as a kind of advertising. To say that the
appearance that clothes create is a mere illusion is to class a well cut or
well designed suit with cod pieces and false breasts.
A philosopher might object that my example of the 'dream of philosophy' is not
fair. Philosophy is an ideal. Advertisers try to sell us material things. The
two could not be more different. I totally disagree.
Philosophers, so quick to analyse, look at an object as a mere bearer of
physical properties, or as a tool with a function, or, possibly, one of those
rare objects that attains the status of a 'work of art', a bearer of sheer
disinterested aesthetic value. None of these ways of analysing an object
explain why we love things. All parents know how children lust for toys. We
grow up. We put away childish things. We do not lose that lust, we merely look
for different things to attach ourselves to, to project our emotions onto. This
is normal, not pathological behaviour.
Object-love is one of the most profound facts about our human relation to the
world. That is something Freud saw.
These are passing observations (as Wittgenstein would say) concerning the
'natural history of mankind'. It ought to be seen as surprising, worthy of
note, in the same way as we ought to be surprised at the capacity of the human
imagination to be captured by storytelling, by fiction. Maybe Martians are not
so lucky. Pity them.
In the commercial world, there are plenty of examples of manufacturers who
believe passionately in their product. Apple Macintosh is the best example I
can think of. Macs are good, not only because they function well, but because
they are beautiful, stylish, designed with loving attention to detail (most of
the time, anyway - there have been occasional, humorous exceptions when in the
face of competition cost-cutting was allowed to take precedence over quality).
I am happy to buy into a dream I can believe in. But not one that has been
cynically created with the sole aim of making me spend my money.
So is this true? - 'As an advertiser, it's OK to sell a dream if you believe in
it too.' When a consumer buys an Apple Mac, the value of the product is not just
its beauty and functionality, but the love that has been lavished on it. The
image that the advertisers have created is not only true, but also enhances the
pleasure of using the product.
But we're on risky ground here. Consider the religious cults who send their
followers on the streets seeking converts. They believe in the dream that they
are selling too. Even if the dream selling is not done cynically, it all-too
easily becomes an attempt to brainwash, to control.
A campaign which Apple ran a couple of years ago featured 'real people'
explaining why they switched to Macs and recounting the misery of badly
designed, unreliable PCs. The campaign backfired because PC users found it
offensive, while Mac users resented being patronised. They were rudely awakened
from the dream.
We tell a child, 'You'll feel sick if you eat that second chocolate bar.' Yet
advertisers are only too willing to sell us as many chocolate bars as we can
eat - or, whatever our particular vice may be.
In today's climate, as a would-be ethical advertiser, there's no way you could
accept a cigarette advertising account. With the current problem of binge
drinking in the UK amongst young people, one would have to be very careful in
accepting a drinks account. I have yet to see a drinks advert whose message
was, 'Enjoy our beer - but don't get drunk!'
Advertisements can set out with the laudable aim of educating people. 'Eat our
cereal because it's low in fat and high in fibre'. This is good advice,
offered, however, not in a spirit of social conscience but as part of the sales
pitch. If consumers were less sensitive to such appeals to improve their health
and life style, then advertisers would not waste time and money making them.
Ever-resourceful advertisers have even found ways to openly admit that their
product is bad for you. A recent advert for meat pies portrays impressively
overweight men - a construction worker, a welder, a tyre fitter, a fireman - as
everyday 'heroes'. A potentially damaging admission is turned round into
something positive with the clever use of humour. A real man likes his beer and
This illustrates the important point that advertisements can be very knowing -
showing an awareness of the ethical issues which marketing that particular
product raises, while at the same time deftly deflecting criticism. We are not
offended because we get the point, we smile at the irony - and we buy the
Suppose you are a deodorant manufacturer who has conceived the idea of an
ethical advertising campaign. It goes without saying that the deodorant has got
to work effectively, as claimed. It should not contain chemicals which are bad
for your health (when the product is used according to instructions). This is
more or less where we are now, in relation to current rules on advertising.
But what does it mean for a deodorant to be effective? On a hot day, you will
be more confident in the company of other people, because they will not be able
to detect your body odour. Critics of deodorant advertising have pointed out,
however, that although it is true that the deodorant has the power to prevent
odour, and this is a ground for extra confidence, the reason why it is a ground
for confidence is at least partly due to a belief or attitude which has itself
been inculcated by advertising.
'Body odour' is one of the classic phrases invented by advertisers, embodying
the concept that any natural human smell is, or ought to be regarded as
offensive. It is hard to question a belief when it has become part of language
itself. If you have B.O. that is something bad, by definition. B.O. is
unpleasant and offensive, because being offensive is part of its concept. But
that begs the question whether all bodily odours are unpleasant, or only some.
So let's take our imaginary scenario from here:
The ethical deodorant marketing team take the brave decision to question this
assumption. The design and advertising of the product will be based around the
idea that there are pleasant as well as unpleasant bodily odours. The chemists
are asked to come up with a product which gets rid of the unpleasant odours
while not masking the pleasant ones. After extensive research and testing, the
product is launched.
The campaign is a great success. The concept captures the public imagination,
better than anyone had dared hope.
However, a new trend emerges from the on-going market research. A significant
proportion of the people questioned express a willingness to try a product
which enhances their 'naturally pleasant' bodily smell. The chemists identify a
complex blend of chemicals, some of which are capable of synthesis in a
laboratory. The ethical marketing team now face a difficult dilemma.
How can it be wrong to market the chemically enhanced product, if this was what
people want? The argument for not doing so is that it was the success of the
first campaign that created the demand for an added 'natural bodily smell',
where none had existed before. This is the very thing that the ethical
advertising team had sought to avoid! Against competitors who show no such
scruples, however, the ethical advertisers face a losing battle in the
I raised the question whether it is possible to be an ethical advertiser - in
the true sense of 'ethical', and not merely in the minimalist, legal sense of
respecting the rules that govern play in the business arena, such as honesty
I have argued that reflection on what ethics demands makes the hurdles
impossibly high. The stark truth is that manufacturers and advertisers are as
much controlled by the fickle consumer as in control. Rules can be set down
concerning what is factually truthful, decent and fair. It is not the
advertiser's job to make people better than they are, or want better things
than they want. That is the work for politicians and preachers, or, possibly,
A defence of advertising against unjustified demands is bound to be less
spectacular than an attack. However, don't forget the point of all this. My aim
is to defend ethics against pressures that would weaken or dilute its
requirements in order to fit in with a so-called 'business ethic'. Ultimately,
we are all members of the moral world, whatever games we choose to play,
whatever other worlds we may inhabit. No-one escapes ethics.
1. 'The Ethics of Dialogue' (1998) Wood Paths web site
2. 'The Business Arena' (2004) Philosophy for Business Issue 5
3. Ryle, G. Plato's Progress Cambridge: Cambridge University Press 1966
4. This article was commissioned by the Cardiff Centre for Ethics, Law and
Society. I would like to express my thanks to the CCELS and to Kate Reeves,
CCELS Resource Manager for this opportunity, and also for permission to
reproduce the article here. The original version may be found on the CCELS web
site at http://www.ccels.cardiff.ac.uk/pubs/klempnerpaper.html.
(c) Geoffrey Klempner 2004
III. 'ETHICS IS POLITICAL ECONOMICS. MORAL BEHAVIOR IS GOOD MANAGEMENT'
BY LIVIU DRUGUS
Applying End-Means Methodology to Health (Care) Systems
and to their Management
This paper is the result of a happy conjunction of teaching Economics, Economic
Policies and Health Management and working practically in a Health Insurance
Fund. The amazing experience of confronting day by day the theoretical and
practical aspects of management generated a lot of new ideas, questions and
answers. Many innovations appeared as a solution to improve the effectiveness,
efficacy and efficiency of teaching and learning.
For example, I invited managers and medical doctors at the Health Management
lessons, and this was a good way to test the efficacy of my former teaching. At
the same time, it was an instrument of understanding what they really needed in
order to have a better knowledge of the health system and to apply it in daily
management. Conclusions are both theoretical and pragmatic: the almost ruined
health care system in 2003 Romania proved that there is a real need for true
educational, (economic, political and ethical) reform in this two vital
sectors: health and education.
1. Health, Health Care, Health System and Health Care Systems
Defining health is a quite conventional thing. The World Health Organization
(WHO) proposed such a definition and most of us are using it. In fact,
talking about health we are talking about our life and of its quality. Or, in a
most general way, we are talking about MAN (i.e. human being). Unfortunately,
health is primarily connected with medicine, although medical practice
contributes only 4-14 per cent to the good health of individuals. More than
that, medicine is about curing illness and not about preserving health. The
"imperialistic" medical vision of health generated a too narrow definition of
Bioethics as the morality of medical activities. I suggested, recently, a
different point of view by which Bioethics is defined as the morality of
preserving and assuring a decent life for all beings (human beings included)
and not only as the morality of medical practices.
I define MAN, i.e. human beings (in 1990, at the Paris ISINI Congress -
International Society for the Intercommunication of New Ideas) as a function of
three fundamental variables: ends, means and the end/ means ratio. That is why I
called this vision the End-Means Methodology (EMMY). Human action is measured in
function of the degree of fulfilling its ends (by using the concept of
efficacy). On the other hand, human action is measured in function of the real
results obtained from combining means (by using the concept of effectiveness).
Finally, human action is measured in function of the quantity of effects (ends)
obtained with a certain amount of efforts/ means (by using the concept of
efficiency). A certain action in obtaining a better/ improved health (i.e. a
health care action) should be at the same time effective, efficacious and
efficient. For a more precise understanding of the relationships among
Politics, Economics and Ethics I suggest to consider them as Better, Best and
Good. So, Politics aims all the time at better positions, better situations and
promises better living conditions. Economics precisely calculates the best
variant/ alternative from a long list of possibilities. Ethics is the final
appreciation of the degree of adequation between ends and means. If there exist
adequate ends to means or adequate means to the future ends, Ethics says: that's
Health system is a political dimension, health care is an economic dimension
and health is an ethical dimension, i.e. is the result (ratio) between the
inputs used in improving health and results obtained in pursuing a better
quality of life. Translated in accordance with the above suggestion we may say
Politics is concerned with better health systems, Economics is concerned with
best health care and Ethics is concerned with good health. Otherwise
formulated, the ethical concept of health has two clones: a political one, the
health system, and an economic clone - the health care. The first one (Politics
of implementing a certain health system) is about ends in function of means, the
second (Economics of combining health means) is about means used to attain ends.
Their synthesis is Ethics, which is about good adequation of means to ends and
of ends to means in a quite continuous and simultaneous way. So, the Ethics of
health (Bioethics) is about the Politics and Economics of getting health.
2. Methodological tools in Political Economics (i.e. in Ethics): clear defining
of ends (pure Politics), holistic combining of means (pure Economics), permanent
equilibrating of ends and means (pure Ethics)
As I have already shown, EMMY is an explanation of human beings and their
behavior. Economics, Politics and Ethics study human actions from the point of
view of human good. A high profit with low costs is good, an attainment of a
desired end is good, an attainment of a desired end with low costs (few means)
is good. Good attainment is the essence of Ethics. That is why, by using EMMY,
we find that Ethics is the most general discipline that is studying efficiency,
Politics is the derived discipline that is studying efficacy/ effectiveness and
Economics is another derived discipline from Ethics that is studying scarcity
and minimal/ optimal use of scarce means. All of them are studying nothing but
ends and means.
As Adam Smith, the ethicist philosopher indirectly demonstrated (in "The Theory
of Moral Sentiments" and "The Wealth of Nations") Ethics is about good policies
and good economies. Aristotle, in his apocryphal writing "Economics" described
the "political economy" as a special kind of economy, distinct from royal
economy and home economy. "Political economy" was a specific way of obtaining
happiness and wellbeing at a social/ community level. The scientific discipline
that is studying political economy is Political Economics, a true name
introduced by scholars from the American Radical Political Economics
The aim of this paper is to demonstrate that there is no pure Economics, no
pure Politics, and no pure Ethics but only specific combinations of ends and
means. From this reason it may be considered that the EMMY is a more general
view on human behavior, more general than Economics, than Politics or even than
Ethics. If we accept the definition of Ethics as the study of ends-means ratio,
then we can put an equal between Ethics and Political Economics.
Anyway, there is an asymptotic tendency to the absolute (and pure) values. We
hope to have defined the (political) ends in the clearest way, but it rarely
happens. So, it is quite impossible to have pure Politics if we do not have
most clear ends. Similarly, we do not may have pure Economics because it is
almost impossible to have a complete list with the existing (economic) means.
Finally, it is impossible to have a pure Ethics if we do not have most clear
ends and an exhaustive list with existing means. As a matter of fact there is
an infinity of possible (human) ends and an infinity of combinations of the
known existing means. To put all these in their real and relative position is
the very task of a thorough reform in education and in health (care) education.
3. End-Means Methodology: A Holistic, Triadic, Abductive (the logic of the
third included), Transdisciplinary and Postmodern Thinking
The Holistic Approach. Understanding (sub)systems means scanning entirely all
their surface (extensity and intensity) i.e. the WHOLE (greek. HOLON) list of
ends and means should be analysed together with the balance between ends and
means. This holistic approach is fundamental in our globalizing world. In
managerial language this means that when searching solutions for a certain
problem we need to enlist the WHOLE possible and quite impossible solutions,
i.e. the maximum amount of combinations among real and ideal solutions. This is
the true difference among a good manager and a bad one. The first is more rich
in possibilities and the second is selflimiting and selfdiminishing in its own
solutions. When it is impossible to enlist the whole set of combinations for
our existing or/ and future means, it is compulsory to have at least the first
three of them. Our tridimensional existence suggests that the Holy Trinity is
the archetype of any terrestrial life.
The Triadic Approach. EMMY is a method of improving the human action results,
i.e. the human action management. All principal things are, fundamentally
speaking, composed from three parts. This elementary observation is very useful
when we find only two components and do not understand why something is yet
unclear or not very clear. After revealing the triadic principle of all our
existence (natural and cultural) I find out that human action could not be
entirely perceived if we are not establishing the three fundamental parts of
it. Without falling in dogmatic Christianism I do consider that The Holy
Tri(u)nity is the very archetypal structure of our philosophic, religious and
scientific realities and beliefs. Life has an end, some means to perpetually
try to fulfill that end and a continuous adequating of ends to means and means
to ends. This is just an example of triadic approach. Another one is: health,
health system and health care. Policy, economy and morality are the three
faces/ dimensions (two faces and a weight) of the same coin. Etc.
The Abductive Approach. Induction is generalizing a characteristic of some
things to a lot of things. Deduction is getting a certain characteristic of a
lot of things as a true one for some things. Abduction is using simultaneously
and continuously the inductive and deductive method. Induction is like a
triangle with the vertex down. Deduction is like a triangle with the vertex up.
Abduction is like a six vertices/ ends star, i.e. like two superposed triangles
in the above mentioned position.
The Transdisciplinary Approach. Transdisciplinarity is a postmodern approach
that ignores the conventional frontiers among scientific disciplines that are
selflimiting the possibilities of combining means and techniques. This is done
in order to be able to obtain better results. Transdisciplinarity is more than
interdisciplinarity, it is just against disciplinarity and the sovereign feudal
domain of autonomous "sciences". Good Management (Ethical behaviour) is just the
result of transcending different disciplines and of considering them a continuum
of the knowledge field instead of segmenting it into disciplines, fields and so
called selfsustaining "sciences". EMMY does not consider Economics, Politics
and Ethics as different or autonomous fields of sciences, but as a
nondifferentiating continuum in which ends and means are permanently
equilibrating and adequating to each other. Analysis of health system, of
health care system and of health itself should need no disciplinary barriers,
as it now unfortunately happens. The transdisciplinary method is the
preliminary step towards the holistic approach.
The Postmodern Approach. Many analysts of the postmodern culture describe it as
"everyone is doing his own job in his own way" i.e. do not follow and do not
respect any rule or prerequisites. This means that there is a huge empty and
free space to innovate, to create and not to follow certain trends, schools or
magisters. In this way it was possible to combine liberalism and dirigism,
capitalism and socialism, Economics and Politics, finding again and again new
alliances between extremes. Postmodernity is to find all the time new ideas and
ISINI is, in my opinion a quite postmodern organization. Health (care) systems
are combining and borrowing specific elements from one to another. We have an
already a classical example in the new British NHS which is both social and
liberal and it is really difficult to say if it is more liberal or more social.
This postmodern approaches are most useful in choosing a specific health (care)
system, but also in choosing any political or economic system.
4. Health Economics, Health Care Economics, Health Management and Health Care
I demonstrated in a previous article the essential identity between ends and
means (i.e. means are future fulfilled ends and ends are past and combined
means), and here I apply that demonstration to the health and health sector. If
we consider only the means and their combination in order to obtain a certain
level of health (at micro, macro or mondo level) we are studying Health
Economics - a discipline launched in the seventies. If we are doing the same
thing (combining means) in order to optimize the health care activities, then
we are studying Health Care Economics (called by some scholars as Medical
Economics). If we are studying how people behave in order to preserve their or
others health we are constructing another discipline called Health Management.
But if we are referring strictly to the medical activities we are studying
Health care management (or Medical Management). Unfortunately, often all these
approaches are confusing or deliberately confused and considered altogether as
Although we are working only with means (did we?), as a matter of fact all the
time we have in our minds a final end, an aim or purpose more or less clear
defined. That is why it is impossible to have a pure Economics (Health
Economics and Health care Economics included).
5. Health Systems Politics, Health Care Politics, Health Politics and Health
Systems Management, Health Care Management and Health Management
If we are studying the health, health care and health systems from the
teleological point of view (i.e. considering their ends first of all) we obtain
specific disciplines as: Health Politics, Health Care Politics and Health
Systems Politics. But all these theoretical activities have their practical
counterpart and this is Management. So, we have Health Systems Management,
Health Care Management and Health Management. Of course, the transdisciplinary
and holistic approaches will attenuate all barriers and distinctions among
these temporary disciplines. One should have in mind all the time the
fundamental similarity relation among ends, means and ends-means ratio, or
theoretically speaking among Politics, Economics and Ethics. The very rationale
of these combinations is to suggest that we give up the modern parcelling out of
knowledge and science and to accept the new postmodern idea of keeping an open
eye - simultaneously and continuously - on all of them. This is a great source
of new ideas, of new truths and new solutions for practical management.
6. Health Ethics (Bioethics), Health Care Ethics (BioBizzEthics), Health
Systems Management, Health Care Management and Health Management
Health Ethics is about good behavior in preserving life - simultaneously and
continuously - at all three possible levels: micro (individual), macro
(societal) and mondo (social global). In other words this is Bioethics, the
ethical discipline concerned with the best combination of means (BioEconomics)
in order to attain the highest human end (BioPolitics): life and health
preservation. The founding father of BioEconomics (written as Bioeconomics) is
Nicholas Georgescu-Roegen, a special economist who built the bridge between
Economics and Ecology. There is some free space for another special builder
waited to found BioPolitics. In medical schools BioEconomics should be taught
(instead of "pure" Economics or even coupled with Health Economics).
The economic dimension of health is studied nowadays by Health economics but
with a notorious missing aspect: the ethical one. Only by accident the ethical
aspects are included in the Health Economics studies. For example, the
permanent scarcity of resources in health care sector generated an ethical
problem: who has the right to receive a bigger part of resources when in need?
Some argue that a political figure is more important than a simple citizen.
Others argue that resources should be distributed in function of the personal
financial contribution someone is paying. So, a rich person could use all
resources to the detriment of hundreds of human beings that may die from this
cause. As an example that contains political, economic and ethical aspects I
mention here what happened in Romania in 1987 at the time of Chernobyl when all
the people needed to receive some drugs (3 capsules) that could help against
radiation. Political people or those who distributed capsules received more and
some uninformed or poor people received nothing. This is a practical definition
of Ethics viewed as conjunction of political and economic power. When medical
people are involved in this equation it is about BioBizzEthics - a special
branch of Ethics I propose to found especially for health care specialists
implied in decision making. As a matter of fact, any physician is a distributor
of resources when deciding to whom and how much of scarce resources every people
deserves to receive.
When a decision is needed a Health care Management needs to be well founded. I
consider that all medical students have to learn more about BioBizzEthics,
Health Management, Health Care Management and Health Systems Management.
Unfortunately, in Romania, and as far as I know, also in many other countries
where the medical profession is deeply involved in health sector
administration, this knowledge is almost nil. It is not a simple coincidence
that Romania is the last country in Europe from the health care index point of
view. Bad (political) management is intimately correlated with a very bad
health care management. That is why I do consider that professional management
(done by professional managers and not by physicians) should be implemented as
a first solution to the actual depth financial and managerial crisis in the
Romanian health care sector. Although I have been advocating that for at least
seven years, only now there are some very small signs that professional
managers will be welcome in Romanian hospitals. It is a kind of compromise.
Medical doctors who administrate hospitals should have some managerial
competence, but they also perform medical work at the same time as their
managerial work. Universities of Medicine and Pharmacy are not yet prepared to
offer managerial skills to those who intend to learn that.
All countries in the world are highly preoccupied with improving the health
care sector performance but this perpetual reform shows that good managerial
solutions are yet to be adopted. That is why I do propose here to build this
bundle of disciplines that may be offered to special health care management
schools. It is a proposal for European decision makers to create this special
education for health by special managerial skills.
Managerial skills for the health care sector are part of the ethical behavior
of top decision makers. The lack of managerial education for future health care
managers is the best proof of a very low ethical behavior of the top political
decision makers. In my opinion, this is a sad consequence of a too deep
specialization of our education. Especially in social sciences disciplines this
fragmentation is highly unethical. For example, there are Faculties of Political
Sciences where no lessons of Economics or Ethics are offered! The same is true
for our Economics faculties where no lessons of Politics or Ethics are offered.
To cap this bad situation, none, or only few, hours of Management/ Ethics
lessons are offered to Economics or Political Sciences students. This is the
root evil of our education in social sciences and probably this situation is
common to more countries.
I consider that a beginning should be made by improving the methodological
tools of Management (Science). It is obvious that many objectives (ends) are
not clearly defined, or only presupposed to be well known. Some consider that
health is supplied by physicians, but their contribution to health is only 4
per cent. Health is a fundamental political, economic and ethical matter, but
only some hours (at most) about health system are taught in Economics,
Political Sciences or Ethical schools. Health care has some characteristics
that do not fit with general economic theory, but lots of decisions are taken
ignoring that truth. The huge number of factors that influence health requires
us to speak about a quasi-pure Economics in health care and of course about an
impure Ethics. We may speak about Good healthcare Management as an equivalent
to Ethics applied in healthcare. But Ethics is the conjunction of Politics with
Economics, so Political Economics is another name for Ethics. Q.E.D.
8. The academic confusionism in terms defined and in terms used: Management is,
in fact, applied Ethics or applied Political Economics to real life
As I have already shown, there is a great deal of confusion in Social/ Human
Sciences and some work should be done to decrease this. "Confusionism" is a
term I have coined some years ago in order to underlie that there is a tendency
to deliberately create confusion. Terminological confusion is a serious ill of
human sciences (Politics, Economics, Ethics, Political Economics, Management).
The plurality of denominations I used here is not confusionism. On the
contrary, the essential identity among Management, applied Ethics and Political
Economics helps us to better understand their objectives (ends) and the methods
(means) used. For sure, a special meeting on this issue may be organized,
especial now when we are witnessing a passage from modernity to postmodernity.
9. What kind of Health System? Good Health (Care) Systems - an ethical/
Finally, Political Economics (i.e. Ethics) and Good Management are applied to
systems, in our case to health (care) systems. So, the fundamental question is
"what kind of health system do we choose?". Of, course the answer is a very
differentiated one in function of cultural backgrounds, ideology, religious
beliefs or simply the level of knowledge. Romania has a sad experience in
health care system reform that comes from the incompetence of the political
class. Choosing one health care system or another is a political decision and
this one should be made by informed voters. Ill-informed voters and a corrupt
political class is a very good recipe for making any health care system sick.
No matter how well a health care system functions in a country it may be
destroyed in a few months by the above mentioned factors. So, the solution to
these two big illnesses is EDUCATION. As a result we may have better informed
voters and a less corrupt political class. Education is the solution to the
value crisis in Europe and not only in Europe.
10. Good (Health care) Management is ethical behavior in (health care)
organizations at the three levels: micro, macro, mondo.
I would like to put an accent to two specific aspects of EMMY: simultaneity and
continuity. These should be applied to all levels of human organization: micro,
macro or mondo/ global. We are living through historical processes:
globalization, the information society, continental integration and
transformation. All of them are influencing directly health care systems and
their performance. Some of us are studying them, but we have taken from
modernity certain habits and manners: deep specialization is one of them. Some
know very well the problems of the information society and others are
specialized in European integration. The reason is that these processes are so
huge that an individual says: it's too much for a single person to learn about
all these, not to speak about the possibility of fully knowing all of these
processes. However, we SHOULD study all of them, in their essences of course.
More than that, all of them are planetary problems. SIDA, SARS and other
epidemics oblige us to think in planetary terms. So a health care system is not
only a nation level issue, but a global one.
Human problems are local, continental and global ones and they happen
simultaneously and continuously, without (artificial) borders between
countries, between scientific disciplines or between cultures.
The most important fact at this moment is that Ethics is/ could be THE solution
to a lot of artificial problems created by people themselves. Bioethics is the
conjunction between BusinessEthics and PolicyEthics. These last two should be
ONE (i.e. Ethics) in order to achieve real and practical moral behavior with
better results for as big as possible number of human beings on the planet
1. "Health is a complete physical, psychical and social well being, and not
only the lack of illness or disability"
2. See L. Drugus, Ethics and Ethical Behavior in Education and Health Care. A
Postmodern View,(2), in The Romanian Journal of Bioethics, Vol 1, nr. 2,
april-june 2003, pp.27-33
3. L. Drugus, "The Scope of the economic, the politic and the ethic. What is,
at last, studying the Political Economics?", in: Economica, Vol 3, Nr 3-4,
1995, pp 35-51, Chisinau, Republic of Moldova
(c) Liviu Drugus 2004
Liviu Drugus , PhD.
Prof. of Health Management
Gr.T. Popa University of Medicine and Pharmacy