About my book “Moral Leadership in Medicine”

Moral Leadership in Medicine discusses the moral challenges that confront senior doctors in leadership roles. Based on research into the experiences of respected medical leaders in the UK National Health Service it offers both insight into their day to day activities, and a framework for understanding the ethical dilemmas they encounter.

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Drawing on findings from a three year long study of NHS medical directors, I explore the issues that leaders find morally troubling, describe how they orchestrate solutions, and report the impact that clinical leadership has upon them personally. Later in the book, I suggest a new framework for conceptualising ethical action, discuss ways of understanding the ethics of healthcare organisation, and consider approaches to developing ethical leadership.

Terabytes of data have been consumed in arguing for better leadership of our care institutions. But there has been relatively scant analysis of the moral dimensions of leading care organisations. Mountains of paper have been consumed analysing the moral duties of medical professionals. But the moral duties associated with organisations are rarely discussed in the medical ethics literature.

This is an odd state of affairs. Organisations are where patients and professionals meet. Organisations are where unintended harm, controversial decisions, opaque policies, clashing priorities, complex regulation, and conflicting loyalties all create moral trouble.

The moral work that makes health and social care organisations trustworthy gets overlooked in accounts of leadership. And the organisational life that makes medicine possible is missing from medical ethics.

But within all our care organisations there are leaders striving to do the right thing by patients, their loved ones, colleagues, and their professions.  Sometimes, they feel it is impossible to satisfy conflicting moral demands.  This book is about the decisions medical leaders make, how they see them through, and how they feel about what they have done.


Dr Shale's book is an outstanding contribution to medical ethics. Its combination of theoretical reflection and empirical research is robust and insightful. I believe that her examination of the ways personal, organizational and situational ethics interact is profound and important for understanding real world healthcare. She writes with wit and grace. This is a superb book, which should be on the desk of anyone who thinks seriously about medical ethics and about the organisation of healthcare.

Richard Ashcroft, Professor of Bioethics, City University of London

This unique study will be of great value to those who have a leadership role at all levels in healthcare organisations. Dr Shale has drawn on the real experience of medical leaders to produce a genuinely useful framework for understanding the moral challenges that are regularly faced by both clinicians and managers. In doing so, she has opened the way for discussion about how we manage the value tensions at the heart of the business of healthcare, how we meet the moral needs of the patients and families we serve, and what it means to lead with integrity.

Dr Adrian Bull, NHS Chief Executive

Suzanne Shale has achieved a rare and impressive feat, combining theoretical rigour with empirical analysis in a way that makes her book uniquely valuable and insightful. This is a work that skillfully bridges the gap between the abstract and its application. It is an account that illustrates how moral questions and experiences are multi-layered and nuanced encompassing the systemic, organisational and personal. Dr Shale casts analytical light on areas of clinical management and leadership that have been overlooked within bioethics. This book is an original, scholarly and engaging work in which the author's thoughtful and wise perspective shines through on every page.

Deborah Bowman MBE, Emeritus Professor of Bioethics, Clinical Ethics and Medical Law at St George’s University of London

I found the book thought provoking and fascinating…The book bridges the gap between fundamental principles and the fine detail of individual moral and ethical issues and how they change and evolve…[T]he effort of reading it is well worthwhile and quite enthralling and I commend it.

Dr Paul Lambden, General Practitioner

I would recommend this book to clinicians and managers interested in exploring the moral framework around healthcare leadership and perhaps most importantly those of us who worry about maintaining a balance at times of financial uncertainty.

Simon Carley, Professor of Emergency Medicine (on Amazon)

For me, the book's real strength lies in a very authentic understanding of the complexities of modern healthcare. Undoubtedly, this work offers a great deal for medical leaders but its central thesis is highly relevant for all senior healthcare leaders.

Professor Murray Anderson Wallace (on Amazon)