Reply by Fletcher, Sorrell, Silva to Tabone on "Organizational And Administrative Ethics In Health Care: An Ethics Gap"

James J. Fletcher, Jeanne M. Sorrell and Mary C. Silva's response:

We were pleased to learn of the reactions to our paper "Whistleblowing as a Failure of Organizational Ethics" which appeared in the December, 1998, edition of this journal. It seems clear to us that we are dealing with a subject that has been on the minds of many individuals in the nursing profession.

We agree with Amy Chan that the lack of adequate support, communication and value systems are major factors in issues leading to whistleblowing. The key question is how one can ensure that the requisite support will be present to safeguard patient health and safety. Certainly one aspect of support for nurses should be the state nursing associations as Carol Compton points out. We were pleased to learn from Stephanie Tabone that the Texas Nursing Association has had a whistleblowing clause in the Texas Nursing Practice Act since 1987 and has recently strengthened the right of nurses to make independent, professional judgments through the Patient Advocacy Act. We remain convinced that individual health care organizations (HCOs) lack sufficient motivation to ensure that conditions leading to whistleblowing responses are addressed. For this reason we urged that the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) use its considerable power as an accrediting association to ensure that HCOs are responsive.

James Bergstrom asks what can be done to influence change. We believe that this form of change will only come about if there is a true groundswell of individual health care workers who recognize the need for changes in this area and are willing to work actively to bring it about. State and national nursing associations can be powerful forces to lobby JCAHO especially if there is a coordinated effort.

Thank you for giving us the opportunity to respond.


James J. Fletcher
Jeanne M. Sorrell
Mary C. Silva

Dr. James J. Fletcher Phone: (703) 993-8774
Department of Philosophy & Fax: (703) 993-1297
Religious Studies email:
Robinson Hall B444
George Mason University
Fairfax, VA 22030