Administrators encounter problems in the ethical sphere substantially different from those encountered by personnel involved mainly in the diadic therapeutic relationship. Although they can never neglect their ultimate responsibility for the individual patient's welfare, it is in the broader reaches of that responsibility that they become involved in local and regional economics, politics, and health policy.
Many of the administrator's problems center around lack of resources for maintenance of quality care, progressive erosion of that level of care over time, increasing threats to humanitarian standards and ideals, and the ethical and moral obligations related to their numerous constituencies.
Thus, inequitable access to health care, the favoring of clients with good insurance coverage, discriminations in direct service due to crowded facilities, undue physical and mental risks borne by service staff, unavoidable flouting of legal or regulatory standards, the compromising of professional integrity and ideals—all burden the ethical and judicial consciousness of the administrator.
In addition, pursuit of one's duty to the public versus one's own institution is worrisome, particularly when untoward events occur in one's institution for which one may take blame. There is also the decision if and when the administrator should take social/political action after other measures have failed and the situation has deteriorated to unacceptable levels.