Joint ventures: a risk to the ministry's moral capital?

When Catholic health care providers become involved in a joint venture, they put at risk not only their financial and legal resources but also their "moral capital," that is, their tradition of healing in Jesus Christ's name. Since collaborative arrangements may offer the only way to respond to persons in need, organizations that are contemplating joint ventures must assess in moral terms the "return" on such arrangements. The joint ventures fraught with the greatest moral risk are those between hospitals and physicians. In such arrangements, the patient's best interests may be compromised by the economic interests of both the physicians and the provider. Although both the law and the American Medical Association seem reluctant to prohibit entrepreneurial activity that places physicians in conflict-of-interest situations, they have established disclosure requirements to help safeguard patient interests. Moral tensions also are inherent in managed care plans such as health maintenance organizations and preferred provider organizations. The emphasis on gatekeeping to avoid unnecessary medical procedures and the potential for excluding persons in need who cannot afford to participate in such plans are two serious concerns. The patient's right to confidentiality also may be threatened in capitated systems, which rely on complex utilization review procedures that expose the patient's records to a wide circle of people. Each ethical issue will not arise in every potential joint venture. The sooner an organization can name the key values it wants to protect, however, the easier it will be for potential partners to work together and to build into the joint venture safeguards for these values.