Value of Analyzing Stakeholders: What is at Stake?

Stakeholder analysis is necessary because in bioethics sometimes the voice of the powerful (often Big Science, Tech, and Pharma, or doctors and hospitals) overpowers the voice of the vulnerable yet the vulnerable may be the ones a decision affects more deeply. In my work on parental refusals, I note that the parents live with after-effects of coerced or compelled care, making their stake in the decision more personal. Similarly, when industry promotes very long patents and high pharmaceutical prices, those trying to afford and access pharmaceutical products, including populations in countries with lower wealth and income per capita and, in the US, those without insurance, suffer a personal harm. The process of weighing stakeholders must account for vulnerabilities, personal effects, as well as incentive to innovate and role in providing care.

Stakeholders with a profit motive may be undeserving of some of the ethical heft attributed to them. Bioethics is peculiar in that institutional and corporate self-regulation are a current cornerstone of the field. Hospital ethics committees, corporate governance committees and even patient advocates employed by pharmaceutical companies and hospitals have built-in conflicts of interest. Law differs in that it is an outside check on corporate or physician behavior when the behavior breaks the law. In some cases, the law may reflect the ethical position. In others, an ethics violation very well may be legal. Looking into behaviors that are legal but seem unethical is difficult for those outside the system. In hospital settings, patients are directed to hospital ethics committees. Those committees should weigh what is at stake for the patient objectively. Yet their ties to the doctors and hospitals could interfere with the objectivity.

The frameworks here were developed with an eye to stakeholder analysis.

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