Moral Leadership in Medicine

photo of book jacket coverMoral Leadership in Medicine is a book about the moral challenges that confront medical leaders running large healthcare institutions.

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 conveyed urgent calls for better clinical leadership. But there has been 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 of 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 people striving to do the right thing.  Sometimes, they feel it is impossible to satisfy conflicting moral demands.  That is why I want to tell their stories.


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.
Professor Richard Ashcroft, Queen Mary, 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, Managing Director at Imperial College Health Partners

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 skilfully 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.
Professor Deborah Bowman, St George’s, University of London