Book Review: Safety Ethics Cases From Aviation, Healthcare & Occupational & Environmental Health

By Manoj S. Patankar, Jeffrey P. Brown and Melinda D. Treadwell, 2005, Boca Raton, FL: CRC Press

A review by EKU Asst. Professor David Stumbo, Ed.D., OHST

The following review was featured in the December 2019 edition of Professional Safety Journal

Books about safety ethics are rare compared to those about subjects such as safety management systems, behavior-based safety, and technical standards or codes. Indeed, a quick Internet search of book titles that include the terms safety and ethics delivers few results. Although this book may not be recent (written in 2005), ethics is a nearly ageless field, even as applied to safety. Readers will find that the book presents ethics as being distinct from the technical and professional issues specific to any particular field, and essentially universal in application. Structurally, the text is uniformly organized, with an introductory chapter that explains the system of ethical decision-making underpinning the subsequent chapters.

The authors then consider safety ethics through three lenses: aviation safety, patient safety, and occupational and environmental health (what I’d refer to as industrial hygiene). Within each subject, examples of ethical challenges are presented along with the various perspectives of those affected. These three sections also discuss the role and influence that groups such as government and academia have on ethical decision-making at the individual level. The appendix provides tailored scenarios with discussion questions, allowing the text to be readily utilized in classroom and workshop applications. I was easily able to adapt two of them for a workshop delivered to an audience of organized labor and management representatives. The authors reveal that they were prompted to write this book after noticing that safety-related technical issues did not present the same challenges as the demands of daily decision- making, and that ethics appeared to guide only a small portion of critical decisions. Unfortunately, most decisions were found to be made based on “lower-level” decisions and associated with a cyclical process of character degradation. A framework of ethical decision-making is presented by first laying groundwork regarding moral principles and corresponding ethical duties, such as the principle of nonmaleficence and from it the duty to inflict no harm upon others. The principle of respect is held in the highest regard above other ethical principles and the controlling factor of all decisions. Upon these ethical principles, Kohlberg’s theory of moral development, which organizes all decisions into a three-level structure, is applied.

  • Level 1 decisions, the lowest level, are decisions made out of self-interest.
  • Level 2 decisions are made in the pursuit of conformity with one’s group.
  • Level 3 decisions are made in keeping with the principle of respect.

Interestingly, the suggestion is made that as an individual’s decision-making transitions from Level 1 upward to consistently Level 3, the higher that person’s level of professionalism also becomes.

To ensure that decisions are made in accordance with Level 3’s principle of respect, each situation must be analyzed regarding aspects such as intent, motive, circumstance and outcomes to consider whether the decision’s intent is morally good (as defined by keeping with the principle of respect), whether the motivation of the decision is also good (not self-serving), whether the circumstances dictate that a given action is truly necessary, and whether the outcomes are also ethically acceptable. Granted, these concepts may seem vague in this brief review, but the text provides several case scenarios to clarify them and offer a practical basis for their application.

Perhaps the most difficult circumstance for ethical decision-making is one in which there is a high degree of uncertainty regarding the information about a potential outcome, such as the likelihood of a negative result. The authors recommend the application of precaution and conservative decision-making as a general rule, but also suggest a methodology called the concept alignment process (CAP). CAP is described as a group-based approach that is primarily associated with airplane maintenance issues but also can be used for risk-based decision-making.

In summary, this book addresses an important, although rare, approach to safety. I found that the chapters on occupational and environmental health offered technically astute and engaging discussions on topics such as how to expand the number of morally competent decision-makers involved in standards-setting, accreditation of collegiate educational programs, and the role of professional societies toward influencing professional codes of conduct. While some aspects of the authors’ system of ethical decision- making are complex and may be difficult to access by some readers, the book does an excellent job of conveying how ethical decision-making can (and should) be applied in a practical fashion and provides much fuel for thought for the safety professional who seeks a deeper but systematic basis of motivation.