Exploring the Ethical Dimensions of Public Service

Interest in ethical issues faced by government officials dates back at least to Plato’s “Republic,” and ethics can be considered so salient that some public administration scholars have gone as far as to define it as “the most important public policy” (Maletz and Herbel 2000). The three chapters of my dissertation have the overall aim of contributing to our understanding of ethics in public administration and, more specifically, within complex public organizations. To do so, after an exercise of stocktaking and systematization of what we know (Chapter 1), my work investigates critical questions on ethics in the empirical context of healthcare organizations (Chapters 2 and 3). In Chapter 1, I systematically review 160 articles from six top-ranked journals discussing ethics in public administration scholarship, thus illuminating ethical issues and dynamics emerging at different levels of public administration life. Furthermore, I offer a three-pronged classification of ethics in public administration that allows organizing ethical issues at the institutional, managerial, and individual levels. Results suggest that dilemmas and challenges arise from conflicting interests and values inside and between levels. Moreover, this chapter highlights the importance of including a level that has remained fairly overlooked by previous studies, i.e., the managerial level. I posit that recognizing and addressing the ethical dilemmas experienced at the managerial level may have positive spillovers on individuals and communities. Therefore, in the second and third chapters, I explore ethical issues characterizing the decision-making processes of public managers, as well as the strategies through which public managers pursue their core mandate in contexts replete with dilemmas. In Chapter 2, I explore the ethical dilemmas experienced in decision-making processes by public health managers when confronted with trade-offs between individual patients’ interests and the community interest in public health. Through a sequential mixed methods design, the chapter aims at understanding how healthcare managers perceive such ethical dilemmas and the relative importance of different factors influencing their preferences. Findings show that health managers’ experience of a health emergency is characterized by negative emotions and difficulty balancing their responsibilities as clinicians and their duties as managers. Chapter 3 explores the implementation of the contentious policy issue of voluntary termination of pregnancy in Italy, characterized by conflicting although legitimate interests. On the one hand, the woman has the legitimate interest to request the interruption of her pregnancy; on the other hand, the legitimate right to conscientiously object to providing this service is granted to gynecologists and other health professionals. Conscientious objection has divisive consequences on the workplace collective. Owing to societal developments such as value pluralism and professionalism, as well as to advancements in biotechnology, this provision is likely to spread across policy domains and countries. Yet, little is known about the role of managers in orchestrating the delivery of public services that trigger an ethical division in the workplace, such as elective abortion. This is exactly the focus of this chapter, which builds on studies on conflicting values and ethical dilemmas in public services, as well as on the notion of ‘dirty work.’ Through a qualitative research design based on semi-structured interviews, our findings illuminate strategies through which managers ensure service delivery with a divided workforce by attending to the ethical dilemmas in their discursive, structural, and organizational strategies.