The world is full of contradiction, and so it is among the pages of the BJGP! Take the article from Andrew Moscrop on clinical leadership1 and set it alongside the paper from Andrew Lee et al on commissioning.2 Both impact directly on the need for a moral compass in clinical commissioning. Lee et al have no doubts about their morality. For them (as with NICE) utilitarianism is the moral philosophy to apply in clinical commissioning: ‘the greatest benefit for the greatest number’, but without specifying what constitutes ‘benefit’. At least Bentham (founder of utilitarianism) was more specific with ‘happiness’ as the magnetic North of the moral compass. If only life were so simple! In what reads like special pleading on behalf of public health specialists Lee et al argue both for the pre-eminence of population over the individual and, curiously, the balancing of competing voices. In contrast, Moscrop embraces complexity in his impassioned plea for a ‘moral compass’ in leadership. He makes a strong case for the central role of values but advocates ‘uncovering and perhaps challenging well-established assumptions, behaviours, values, and beliefs’ (perhaps including utilitarianism?). Crucially, he proposes a ‘shared morality’ though he leaves this idea hanging in the air.
I suggest Moscrop’s argument could be developed using the notion of distributed leadership originating from education.3 Here both the determination of what is good and the bearing of responsibility are shared among a wide community of stakeholders, though accountability usually remains with a designated leader. The moral compass consists in a few high-order shared values pertaining to what it takes for humans and the environment to flourish. This is best understood through the conceptual framework of complexity science3 which tells us that what is crucial is the coherence of the community of stakeholders in terms of these high-order values as ‘rules’ for action. That is where our efforts should be focused.
- © British Journal of General Practice 2012
