NHS Ethical Dilemmas: Gifts, Hospitality, Leadership & Management

This report explores ethical leadership within the NHS, focusing on the acceptance of gifts and hospitality from pharmaceutical companies and the resulting conflicts of interest. It examines the ethical implications of such practices, highlighting the potential compromise of patient care and the integrity of the healthcare system. Key stakeholders, including the general public, NHS members, and pharmaceutical companies, are analyzed in terms of how they are affected by these ethical dilemmas. Relevant research on the impact of pharmaceutical influence on healthcare is presented, alongside recommendations for stricter regulations and increased transparency. The report also applies Utilitarian and Deontological ethical theories to evaluate the morality of accepting gifts, considering the consequences and duties involved. Furthermore, it discusses the qualities and values required for an ethical leader in managing a business to high ethical standards, emphasizing the importance of prioritizing patient well-being and maintaining public trust. The document is contributed by a student and available on Desklib, a platform offering study tools and resources for students.

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Executive Summary
The following looks at the NHS gifts and hospitality: The case of conflicts of interest topic
that was given for the first part. It looks at how the NHS accepting gifts from the
pharmaceutical companies would be considered a conflict of interest, and why this is
unethical. The following paper looks at the issue, why it would be considered an ethical
question, and the stakeholders as well. It also looks at relevant research and two theories, the
Utilitarian Theory and the Deontological Theory to explain the ethics of the case. The second
part looks at the values that are required for an ethical manager, and how the individual
would lead the business in an ethically high standard.

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Contents
Contents......................................................................................................................................3
Part 1: NHS gifts and hospitality: The case of conflicts of interest...........................................4
Introduction............................................................................................................................4
Why should this be explored?................................................................................................4
Role of the business in society...............................................................................................5
Key Stakeholders and How the issue affect them..................................................................6
Relevant Research..................................................................................................................7
Conclusion and Recommendations........................................................................................8
Utilitarian or Consequence-based Theory..............................................................................8
Deontological or Duty-based Theory.....................................................................................9
Part 2: Ethical Leader...............................................................................................................10
Introduction..........................................................................................................................10
Qualities and Values required..............................................................................................10
Managing Business to High Standard..................................................................................11
Conclusion............................................................................................................................12
References................................................................................................................................13

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Part 1: NHS gifts and hospitality: The case of conflicts of interest
Introduction
The NHS or the National Health Services, is a government, publicly funded healthcare
system in the United Kingdom. They are the main providers of healthcare and services to a
majority of the population in the United Kingdom, and have to as such, register all gifts that
are provided to local services by private drug companies. The NHS is a very prestigious
organization within the United Kingdom, and it is also one of the biggest employers within
the country as well, employing around 1,400,000 employees (Civaner, 2012). A conflict of
Interest can happen when the organization takes a large number of gifts from drug
companies, such as expensive items, in order to recommend the drugs to the patient. This
would be deemed unethical, and would be a conflict of interest, since the main duty of the
workers in NHS is the service of the patients, and not personal ambition or interest (Elliot,
2015). The NHS covers all the public health in England, and is one of the main reasons why
the Healthcare system in the United Kingdom works in an efficient, and cost-effective
manner.
When drugs companies or pharmaceuticals come up with a new and effective drug, they try
to sell the drug to the doctors or members of the NHS (Witten, et al, 2008). In order to get the
drug approved, they often given elaborate and expensive gifts to the doctors or members.
This is seen as a conflict of interest, since many of the drugs could have potentially harmful
effects that are not given attention to. Hence, there is a registry that all hospitals must keep,
that lists the gifts that are provided to the doctors and NHS members.
Why should this be explored?
Most drugs have side-effects, many of which are extremely harmful to the patient. A doctor is
supposed to recommend a medication or drug that works best for the patient and has

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minimum side-effects (Donaldson, 2016). The main idea is that the side-effects be reduced to
a minimum, since it is essential to keep in mind that the NHS exists mainly for the sake of the
common people, who cannot afford private doctors and health practices. Since the NHS is
funded by the government, and by the taxes of the people, a doctor has to recommend
something that is best according to the patient, and their interest should lie in the health, well-
being and fast recovery of the patient, which is why it is essential to keep in mind that getting
elaborate gifts, such as VIP Beyoncé concert tickets, would be a violation of their morality
(Fugh-Berman, and Homedes, 2018). Accepting gifts such as these would be putting personal
interest above the health of the many patients to whom they would recommend the drug,
without proper procedure in place to check the side-effects (Villalba, 2018). It would also
reduce the faith that people have in the healthcare system in the United Kingdom, which
could also cause a decrease in the patients, causing the entire system to collapse.
It would be important to look at this from an ethical perspective, since the question of ethics
is valid in the scenario. By getting and accepting elaborate gifts from the pharmaceutical
companies, they might have breached the trust that patients put in the doctors to provide them
with the best medication. This case brings to question the interest of the individual doctor. Is
it for their personal benefit, or the benefit of the sick patients who have their faith in the
doctor to treat them to the best of their abilities.
Role of the business in society
The company, NHS, would need to question the role it has in society. The role that the
business has in society is one of a public service. They are funded by the taxes and the
government, and are as such, government employees (Avraham and Silver, 2018). Their main
role in society is to care for the people, which is why it is essential for them to keep that as
their primary interest. The conflict of interest in accepting gifts is one that should be strictly
monitored, since it means that many doctors might be providing patients with medications

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that can have adverse impacts on the health of the individual (Pardo, 2017). This is done in
order to make the pharmaceutical company, which might be one of the most profitable
industries and companies in the country, more profit, and to keep a particular brand of drug
on the market. Since the government, and thus, taxpayer money, pays for subsidizing most of
the medications that are given to patients, this would also be unethical as well, and a large
waste of the money of the taxpayers (Salvioni, Gennari and Astori, 2015).
Key Stakeholders and How the issue affect them
The key stakeholders in the issue would be:
1. The general public: The general public, through their taxes, are the ones that are
paying for the medications that are recommended by most doctors, and they are also
paying for the NHS. They are also the ones who would have the most to lose if a
medication that is prescribed gives out very adverse side-effects, or harms that patient
in any way. A majority of the people who pay for the NHS and those who use the
health services are middle-class citizens (Rafique, Hameed and Agha, 2018). Thus, a
majority of the shareholders would be the general public, since they have the most to
gain or lose from the issue.
2. Doctors and NHS Members: There are many NHS members who have been bribed
through the extravagant gifts. They are also stakeholders in this issue, since it is their
ethics and morality that is being questioned. It is the doctors and members who have
been going against the rules, and laws and accepting gifts that are extremely
extravagant without noting them down in the registry that is provided to them
(Richmond and Stevenson, 2017). This means that for many of the doctors, most of
their prescription recommendations can come into question, which could ruin their
reputation as well.

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3. Pharmaceutical companies: Most pharmaceutical companies are obligated to submit
the drug, and potential benefits and side-effects for research and approval. Only then
can they be allowed to sell the drug to many of their doctors. However, by bribing
doctors with gifts, they can ensure that their brand is being used instead of the other.
This is true even in cases of common medications, such as that which is used to treat
colds or a fever. The new rule has a large impact on pharmaceutical companies, since
it would largely reduce the effect that they have on the medications recommended by
doctors (Saks, 2017).
Relevant Research
There has been a lot of relevant research that has been done that looks at the impact of the
pharmaceutical companies, and the gifts they provide, on public healthcare. According to
Gøtzsche, 2013, there has been research that indicates that in the United States, United
Kingdom and Europe, drugs are the 3rd leading cause of heart disease and cancer. A majority
of the drugs are prescription drugs, and this has been encouraged by pharmaceutical
companies, so that they can have a larger profit from the drugs (Gotzsche, 2013). Many of the
doctors have very little knowledge of the drugs that they are prescribing to the patients, since
the impact is carefully kept under-wraps by the companies. They also are involved in
lobbying politicians so that the testing of the companies is not disclosed to the public, and the
laws that are necessary for ensuring that the pharmaceutical companies are kept under limits
are not passed (Jackson, 2015).
According to Moynihan, 2013, in Britain, most of the pharmaceutical companies have been
peddling medications whose side-effects, and level of addiction are carefully covered up, and
are generally unknown to both doctors and the public. This can have a significant impact on
the health of the public, and lead to addiction, which, though unethical, is highly profitable to
the company (Moynihan, 2013).

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Conclusion and Recommendations
It is absolutely essential that the NHS investigate the issue thoroughly, and fine any doctor,
agency and pharmaceutical representative that has been bribing the government and the
doctors, be fined or imprisoned. It is essential to look into the adequate amount that can be
accepted by the doctor or the hospital as gifts, and set a cap into what can be given as a “gift”.
For example, the amount that can be given as a gift can include cash. This can be used to
fund the services in the hospital, or improve any of the medical equipment, as required. It
would also be recommended that there be legal provisions, to ensure that the doctor not be
required to talk to medical representatives if they do not wish to talk. From the above report,
it is clear that pharmaceutical companies, using doctors and members of the NHS, have been
harming the health of the individuals. This can be seen as something that should be
investigated further.
Utilitarian or Consequence-based Theory
This theory looks at the consequence that an action can have on the individual. This theory
states that the action that has the greatest utility, happiness and good to the greatest amount of
people is the most appropriate action that should be taken. In the following case study, it
would mean taking into account the effect that the medication shave had on the people, and
talking surveys into whether people are actually happy or satisfied with the medications that
have been prescribed to them on a regular basis (Kahane, et al, 2015). This looks at the
consequences of the action, and not the action itself. According to this theory, if the
consequence of the bribe gives the people a medication that is better than the one that has
been given to them before, and if there are no new side-effects, then the bribe cannot be
considered a bad act. This theory has been used in bio medics for the longest time, since it
can validate a lot of actions, such as amputation, or assisted suicide as well (Brunon-Ernst,
2015). The consequences of the action, while being extremely important to some people, are

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also extremely harmful to others. For example, if a medication to cure high fever included a
few nuts, then there would only be benefits for those who are not allergic to nuts. However,
for someone who is allergic to nuts, it would have very drastic consequences. Thus, the
benefit of one might not be the benefit of another.
Consequence-Based Theory looks at the overall good of the action, and the behaviour of the
doctors and the NHS members would be excused if the medication was found to be helpful or
beneficial to the general public. However, whether or not the action is good is only found out
after the action is done. For example, only after the side-effects are seen in patients can it be
possible to identify if the medication had a positive or negative effect on the people (Mill,
2016). Thus, there are a few flaws in the theory. However, the theory is flexible, as it gives
the people time to think whether the consequence was beneficial or not. Consequences of the
action are generally not considered when making a judgement about the action, but they
should be, since they are equally important.
Deontological or Duty-based Theory
This theory looks at some of the fundamental duties that people have. In this theory, the
action matters more than the consequences of the action. If the action is right, and is
according to the duty of the individual, and it follows the law of the land, then it should be
considered ethical. There are many moral rules in a society, and many moral rules that are
universal. According to this theory, whether the consequence of the bribe is good or bad,
whether or not people benefit from the drug, the action of giving a bribe in itself, is against
the moral rules of the society, and is not a duty of the doctor, which is why it is an unethical
or morally wrong action. The theory states that people have the obligation to do the right
thing, even if it meant that the consequences would be bad (Lazar, 2017). This theory is
applicable in this scenario, since it is the theory that is used by the media and the people to

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look at, and judge the actions of the doctors, NHS professionals and the pharmaceutical
executives as well.
Even if the intended drugs have positive consequences, and there are no side-effects, the
action would be viewed as something that is extremely unethical, since the act of bribing or
corrupting someone to do the wrong thing this is an unethical act in itself. One of the aspects
that is provided is that the consequence of the action is good or beneficial this time, but it
need not always be so (Zamir and Medina, 2017). The drug that was approved was beneficial
to the patients this time, but the next drug that could be given could lead to debilitating side-
effects. Hence, it is important to note that the action is as important as the consequence in
most cases, and most of the time, it is the action and not the consequence that is questioned.
This theory provides certainty, since it implies that some actions are always going to be right,
such as helping the poor, and some actions are always going to be wrong, such as the murder
of innocent people. Bribing and corruption are seen as something that is harmful or unethical
to the people, which is why it would be always wrong (Baron, 2017).
Part 2: Ethical Leader
Introduction
Ethical leadership is one of the most important aspects of the leadership process. In order to
become an ethical leader, there are many qualities that are required. Some of the qualities,
and how to manage a business to a high ethical standard is mentioned in the following.
Qualities and Values required
There are many qualities and values that are required from a leader in order to make them an
ethical leader. Some of them that are important, according to me, are:
1. Justice and Honesty: An ethical leader is always just and fair. They are not corrupted
to treat someone as unequal. To them everyone is equal. They are also honest. Most

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ethical leaders, depending on which ethical theory they believe in, will not tell a lie.
They would however, tell a white lie in order to save their employees from the
consequences of bad actions. Most followers and employees will respect someone
who does not care about the gender, sexual identity, race or ethnicity of the
individual. Most employees will trust someone who is honest and does not lie to them,
which is why these are important qualities or values that an ethical leader should
possess (Fehr, Yam and Dang, 2015). Ethical leaders are always transparent, even
though they might be unpopular because they are honest.
2. Respectful and Humane: I feel that a leader who is respectful and humane will always
be an ethical leader. Respect for others, even those who are at a basic level and would
be considered inferior to the manager, would make a manager greatly popular as well.
Being humane and understanding is also one of the main reasons behind an ethical
manager’s success, which is why it is necessary to for every manager who is aiming
to be an ethical manager to be humane and respectful (Yang, Ding and Lo, 2016).
This means being kind and understanding, and not putting too much pressure on the
employees.
3. Value-driver decision making and leading by example: An ethical leader, according to
me is one who is able to lead by example, and whose decisions are made by using the
values that they have. Decisions that meet the value, which are also in line with the
values of the organization, are taken into consideration and implemented. An ethical
leader is also one that is able to lead by example, so that the employees are able to
understand the leader from the values that have been portrayed.
Managing Business to High Standard
I would make sure that I am capable of listening to all my employees and being
understanding. It is not ethical to expect an employee to overwork, or to have unreasonable

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work put on them. Sometimes, due to various reasons, an employee happens to become sick
or is unable to finish the task. I would be understanding, and unless there were obvious signs
of laziness, I would not punish the employee for work that is not done on time. It is important
for employees to know that I am ethical, and the best way to do this would be to lead by
example, which is why as a leader, I would do my best to encourage them in any way. I
would not tolerate any forms of discrimination in the workplace, which is why I would do my
best to ensure that the organizational policies against discrimination are very strict. I would
also try to make the employee feel as comfortable as possible, so that the employee knows
that they are valued by the organization. If the employees are also encouraged to act ethically,
then the organization would be one of the few organizations where ethical behaviour would
be encouraged (Xing, et al, 2018). Ethical behaviour is important for any organization, and
even more so for an organization that wishes to distinguish itself from the rest. This means
that every employee is given a chance, and treated fairly in the organization. This would
create an atmosphere of positivity, which is how the organization would be able to survive in
the high-standards that are created within the organization (Esmaelzadeh, et al, 2017). Being
an ethical manager is hard, especially if the industry is known for being unethical. However,
to me, being ethical seems to be a good choice to make, which is why I want to be an ethical
manager.
Conclusion
Being an ethical manager is one of the most difficult things to do. However, it is important,
since ethical managers can improve the reputation of the organization. From the above case
study, it is important to understand that in order to manage business to a high standard, an
ethical leader is extremely important in the organization. Some of the values that are
important for an ethical leader are justice, honesty, respectfulness, humanity and being a

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value-driver decision maker and leading by example as well. In order for the leadership to be
successful, it is essential that they have these values.

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