Firms possessing a unique competency to rescue the victims of a human catastrophe have a minimum moral obligation to devote substantial resources toward best efforts to aid victims. The minimum amount that firms should devote to rescue is the largest sum of their most recent year's investment in social initiatives, their five-year trend, their industry's average, or the national average. Financial exigency may justify a lower level of investment. Alternative social investments may be continued if they have an equally compelling rationale. These duties apply to the global pharmaceutical companies in the context of the AIDS pandemic in sub-Saharan Africa.

The pharmaceutical industry has in recent years come under attack from an ethical point of view concerning its patents and the non-accessibility of life-saving drugs for many of the poor in both less developed countries and in the United States. The industry has replied with economic and legal justifications for its actions. The result has been a communication gap between the industry on the one hand and poor nations and American critics on the other. This paper attempts to present and evaluate the arguments on all sides and suggests a possible way out of the current impasse. It attempts to determine the ethical responsibility of the drug industry in making drugs available to the needy, while at the same time developing the parallel responsibilities of individuals, governments, and NGOs. It concludes with the suggestion that the industry develop an international code for its self-regulation.

In recent years society has come to expect more from the "socially-responsible" company and the global HIV/AIDS pandemic in particular has resulted in some critics saying that the "Big Pharma" companies have not been living up to their social responsibilities. Corporate social responsibility can be understood as the socio-economic product of the organizational division of labor in complex modern society. Global poverty and poor health conditions are in the main the responsibilities of the world's national governments and international governmental organizations, which possess society's mandate and appropriate organizational capabilities. Private enterprises have neither the societal mandate nor the organizational capabilities to feed the poor or provide health care to the sick in their home countries or in the developing world. Nevertheless, private enterprises do have responsibilities to society that can be categorized as what they must do, what they ought do, and what they can do.

Although the idea of intellectual property (IP) rights--proprietary rights to what one invents, writes, paints, composes or creates--is firmly embedded in Western thinking, these rights are now being challenged across the globe in a number of areas. This paper will focus on one of those challenges: government-sanctioned copying of patented drugs without permission or license of the patent owner in the name of national security, in health emergencies, or life-threatening epidemics. After discussing standard rights-based and utilitarian arguments defending intellectual property we will present another model. IP is almost always a result of a long history of of scientific or technological development and numbers of networks of creativity, not the act of a single person or a group of people at one moment in time. Thus thinking about and evaluating IP requires a traditional model of IP. It follows that the owner of those rights has some obligations to share that information or its outcomes. If that conclusion is applied to the distribution of antiretroviral drugs, what pharmaceutical companies are ethically required to do to increase access to these medicines in the developing world will have to be reanalyzed from a more systemic perspective.

This paper utilizes a qualitative case study of the health care industry and a recent legal case to demonstrate that stakeholder theory's focus on ethics, without recognition of the effects of incentives, severely limits the theory's ability to provide managerial direction and explain managerial behavior. While ethics provide a basis for stakeholder prioritization, incentives influence whether managerial action is consistent with that prioritization. Our health care examples highlight this and other limitations of stakeholder theory and demonstrate the explanatory and directive power added by the inclusion of the interactive effects of ethics and incentives in stakeholder ordering.

In this paper we highlight the emergence of organizational ethics issues in health care as an important outcome of the changing structure of health care delivery. We emphasize three core themes related to business ethics and health care ethics: integrity, responsibility, and choice. These themes are brought together in a discussion of the process of Mission Discernment as it has been developed and implemented within an integrated health care system. Through this discussion we highlight how processes of institutional reflection, such as Mission Discernment, can help health care organizations, as well as corporations, make critical choices in turbulent environments that further the core mission and values and fulfill institutional responsibilities to a broad range of stakeholders.

This article examines the ethical issues raised by the pricing of priceless goods. Priceless goods are defined as ones that are widely held to have some special non-market value that makes them unsuited for buying and selling. One subset of priceless goods is prescription drugs--particularly life-saving and life-enhancing ones. Drug makers are under pressure to price their medicines responsibly, which means to restrain their prices (and profits). However, this article argues that it is precisely because life-saving and life-enhancing medicines are priceless that it is especially urgent to leave companies free to charge market prices for them.

This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.

It is not too early to suggest that the attempts to place medical cae in private hands (through group insurance arrangements) has not fulfilled its promise--or better, the promises that were made for it. Yet history has not been kind to plans to make government the single payer, and the laudable progress in medical technology has placed high-technology medical care beyond the reach of most private budgets. In this paper I suggest that the major problem of the U.S. health care system as presently conceived is a failure of legitimacy, and I put forward a proposal that purports to solve that problem. The proposal is to localize health care, on the model of a public school system, on the argument that such localization will answer most of the questions of legitimacy at the core of the private insurance imbroglio, provide a brake for medical costs, while preserving our ability to take advantage of the most advanced medical interventions. I present some initial arguments for the proposal, but await its proof in the dialogue emerging as the present insurance system collapses.