The ethics of ordering non-essential items online during the coronavirus lockdown

Laura Steele
MNAFM.com
Originally posted 3 April 20

In response to the Coronavirus crisis, the UK government announced that all retail outlets, except for those considered to provide essential goods and services, were to close with immediate effect. Online retail is, however, 'still open and encouraged'.

So, does that mean we can click with a clear conscience?

Business academics Andrew Crane and Dirk Matten argue that a decision has an ethical dimension to it if it has a significant effect on others it is characterised by choice, and it is perceived as ethically relevant to one or more parties.

Most of us would likely agree that ordering essential items, such as food or medicine, is ethically acceptable. Especially if there is no alternative, as is currently the case for millions of people who have been deemed at high risk due to underlying health conditions, are self-isolating as the result symptoms of COVID-19, or are otherwise unable to shop in person.

But what about goods that are not absolutely necessary, such as clothing that is wanted but not needed, home decor, toys and games, garden furniture and accessories, beauty products or even, depending on your view on the matter, the humble Easter egg?

The info is here.

Alleviating Burdensome Beliefs Through a Care Ethics Approach

Medical Bag
Originally posted May 29, 2019

Compared with a principles-based approach, taking a care ethics approach to patients who believe they are a burden may be more effective for addressing moral dilemmas related to treatment, according to research published in Bioethics.

Two clinical ethicists from the department of medical humanities at VU University Medical Center in Amsterdam, The Netherlands, shared the case of Mrs K, a 66-year-old patient with leukemia, and examined the ways in which physicians can approach treating a patient who feels like a burden.

Mrs K recently received a bone marrow transplant, but because of rejection symptoms, is now taking an antirejection treatment. Although a cure is possible, the treatment is both taxing and extensive and presents a host of physical and mental challenges. Although Mrs K had previously focused on survival, her mindset has shifted: She says that she is burdening her husband and feels that he deserves better. Mrs K feels that life is no longer worth living and has considered stopping her antirejection treatment, which will result in her death.

Noticing that Mrs K’s mood has been poor over a long period of time, the treating physician suggests antidepressant therapy; they believe that by treating the patient’s depression, the patient will be more optimistic about continuing the antirejection therapy. Mrs K’s husband — also a physician — strongly disagrees with this course of treatment. Mrs K’s care team contacts the clinical ethicist to address this moral dilemma.

The info is here.

Big Island considers adding honesty policy to ethics code

Associated Press
Originally posted September 14, 2018

Big Island officials are considering adding language to the county's ethics code requiring officers and employees to provide the public with information that is accurate and factual.

The county council voted last week in support of the measure, requiring county employees to provide honest information to "the best of each officer's or employee's abilities and knowledge," West Hawaii Today reported . It's set to go before council for final approval next week.

The current measure has changed from Puna Councilwoman Eileen O'Hara's original bill that simply stated "officers and employees should be truthful."

She introduced the measure in response to residents' concerns, but amended it to gain the support of her colleagues, she said.

The info is here.

How To Deliver Moral Leadership To Employees

John Baldoni
Forbes.com
Originally posted April 12, 2018

Here is an excerpt:

When it comes to moral authority there is a disconnect between what is expected and what is delivered. So what can managers do to fulfill their employees' expectations?

First, let’s cover what not to do – preach! Employees don’t want words; they want actions. They also do not expect to have to follow a particular religious creed at work. Just as with the separation of church and state, there is an implied separation in the workplace, especially now with employees of many different (or no) faiths. (There are exceptions within privately held, family-run businesses.)

LRN advocates doing two things: pause to reflect on the situation as a means of connecting with values and second act with humility. The former may be easier than the latter, but it is only with humility that leaders connect more realistically with others. If you act your title, you set up barriers to understanding. If you act as a leader, you open the door to greater understanding.

Dov Seidman, CEO of LRN, advises leaders to instill purpose, elevate and inspire individuals and live your values. Very importantly in this report, Seidman challenges leaders to embrace moral challenges as he says, by “constant wrestling with the questions of right and wrong, fairness and justice, and with ethical dilemmas.”

The information is here.

Will Tech Companies Ever Take Ethics Seriously?

Evan Selinger
www.medium.com
Originally published April 9, 2018

Here are two excerpts:

And let’s face it, tech companies are in a structural bind, because they simultaneously serve many masters who can have competing priorities: shareholders, regulators, and consumers. Indeed, while “conscientious capitalism” sounds nice, anyone who takes political economy seriously knows we should be wary of civics being conflated with keeping markets going and companies appealing to ethics as an end-run strategy to avoid robust regulation.

But what if there is reason — even if just a sliver of practical optimism — to be more hopeful? What if the responses to the Cambridge Analytica scandal have already set in motion a reckoning throughout the tech world that’s moving history to a tipping point? What would it take for tech companies to do some real soul searching and embrace Spider-Man’s maxim that great responsibility comes with great power?

(cut)

Responsibility has many dimensions. But as far as Hartzog is concerned — and the “values in design” literature supports this contention — the three key ideals that tech companies should be prioritizing are: promoting genuine trust (through greater transparency and less manipulation), respecting obscurity (the ability for people to be more selective when sharing personal information in public and semipublic spaces), and treating dignity as sacrosanct (by fostering genuine autonomy and not treating illusions of user control as the real deal). At the very least, embracing these goals means that companies will have to come up with better answers to two fundamental questions: What signals do their design choices send to users about how their products should be perceived and used? What socially significant consequences follow from their design choices lowering transaction costs and making it easier or harder to do things, such as communicate and be observed?

The information is here.

Vignette 37: The Fabricated Letter

Dr. Krista Gordon received an email from E Corp, the employer of a current patient Mr. Elliot Alderson (someone she provided psychotherapy for over a year, but has cancelled multiple appointments recently due to some family issues).  Dr. Gordon has not seen him for over a month, and he is not scheduled until the following month.

The email from E Corp was for the purposes of letting Dr. Gordon know that her patient had submitted documentation to E Corp (supposedly from Dr. Gordon), and they wanted to confirm that these documents were legitimate and unaltered.

To Dr. Gordon’s disappointment, she saw one legitimate letter (an older letter she wrote for Alderson to submit to his boss, confirming regular 4:30 pm appointment times, which allowed Alderson to leave 30 minutes early on those days), and one entirely questionable, clearly altered letter.

Apparently, Mr. Alderson copied Dr. Gordon’s letterhead and pasted it as an image for the false documentation.  The body of the letter is something Gordon never wrote (saying that Dr. Gordon assessed Alderson and determined he is unfit to return to work for an indefinite period).  Dr. Gordon’s signature is also copied and pasted on the fake letter.  The fake letter was shoddily done, the footer is cut-off, some of the text is cut-off, and most of the text appears to be slightly at an angle.  The letter clearly did not come from Dr. Gordon.

Of course, this a huge breach of trust and Dr. Gordon struggling to organize her thinking as she feels incredibly violated by Mr. Alderson.  Dr. Gordon calls you for a consultation.

What are the clinical issues involved in this situation?

What are the ethical issues involved in this scenario?

What are the ramifications about the therapeutic relationship?

How does Dr. Gordon respond or not respond to E Corp?

Are there any other legal issues that may be in play?

What course of action would you suggest to Dr. Gordon?

Unconscious Patient With 'Do Not Resuscitate' Tattoo Causes Ethical Conundrum at Hospital

George Dvorsky
Gizmodo
Originally published November 30, 2017

When an unresponsive patient arrived at a Florida hospital ER, the medical staff was taken aback upon discovering the words “DO NOT RESUSCITATE” tattooed onto the man’s chest—with the word “NOT” underlined and with his signature beneath it. Confused and alarmed, the medical staff chose to ignore the apparent DNR request—but not without alerting the hospital’s ethics team, who had a different take on the matter.

But with the “DO NOT RESUSCITATE” tattoo glaring back at them, the ICU team was suddenly confronted with a serious dilemma. The patient arrived at the hospital without ID, the medical staff was unable to contact next of kin, and efforts to revive or communicate with the patient were futile. The medical staff had no way of knowing if the tattoo was representative of the man’s true end-of-life wishes, so they decided to play it safe and ignore it.

The article is here.

Vignette 36: The Cancellation Conundrum

Dr. Wendy Malik operates an independent practice in a suburban area.  She receives a referral from a physician, with whom she has a positive working relationship.  Dr. Malik contacts the patient, completes a phone screening, and sets up an appointment with Mr. Larry David.

As is her practice, Dr. Malik sends a confirmation email, attaching her version of informed consent.  She instructs Mr. David that he does not have to print it out, only review it and they would discuss any questions at the initial appointment.

Several days later, Dr. Malik checks her email.  In it, Mr. David sent her an email with an attachment.  Mr. David asks Dr. Malik to review his edits on the informed consent document.

While Dr. Malik notes some suggested corrections on the document, Mr. David modified the cancellation policy.  Dr. Malik’s form (and standard policy) is appointments cancelled with less than 24-hour notice will be charged to the patient.  Mr. David added a sentence that if Dr. Malik cancels an appointment with less than 24 hours, Mr. David expects Dr. Malik to pay him an amount equal to her hourly rate.

Flustered by this edit, Dr. Malik contacts you for a consultation.

What are the ethical issues involved in this case?

What are the pertinent clinical issues in this case?

How would you help Dr. Malik work through these issues?

Would you recommend Dr. Malik call to address the issue ahead of the appointment or wait for the initial session?

At this point, must Dr. Malik keep Mr. David as a patient?

If not, does Dr. Malik need to contact her referral source about the issue?

Vignette 34: A Dreadful Voicemail

Dr. Vanessa Ives works in a solo private practice. She has been working with Mr. Dorian Gray for several months for signs and symptoms of depression. Mr. Gray comes to some sessions as emotionally intense, and high strung.  Dr. Ives has considered the possibility that Mr. Gray suffers with some type of cyclic mood disorder.

As part of treatment, Mr. Gray admitted to experiencing anger management problems, to the point where he described physically intimidating his wife and pushing her down. They worked on anger management skills. Mr. Gray reported progress in this area.

Dr. Ives receives a phone message from Mr. Gray’s wife.  In the voicemail, Mrs. Gray reports that Mr. Gray has become more physically intimidating and has starting to push her around.  The voicemail indicated he has not caused her any significant harm.  She requested a session to see Dr. Ives to explain what is happening between them.  Dr. Ives only met Mrs. Gray informally while she sat in the waiting room before and after several sessions.

Dr. Ives wants to be helpful, but she is struggling with whether she should even return Mrs. Gray’s phone call.  Dr. Ives has a personal history of being involved in a physically abusive relationship herself and is concerned about both the clinical and ethical issues involved regarding calling Mrs. Gray back.

Feeling uncomfortable about what is happening with this patient and his wife, Dr. Ives calls you for a professional consultation.  She wants to make an appointment to talk with you candidly about her history as well as the dynamics of the current case.

What are the ethical issues involved in this case?

What are the pertinent clinical issues in this case?

How would you help Dr. Ives deal with her emotions related to this situation, given how her history relates to this patient and his wife?

Would you recommend Dr. Ives return the call or not?

What are some possible options should Dr. Ives return the phone call?

How much transparency would you suggest to Dr. Ives with Mr. Gray about the phone message?

The Ethics of Killing Baby Hitler

By Matt Ford
The Atlantic
Originally published October 24, 2015

Here is an excerpt:

The strongest argument for removing Hitler from history is the Holocaust, since it can be directly tied to his existence. The exact mechanisms of the Holocaust—the Nuremburg laws, Kristallnacht, the death squads, the gas chambers, the forced marches, and more—are unquestionably the products of Hitler and his disciples, and they likely would not have existed without him. All other things being equal, a choice between Hitler and the Holocaust is an easy one.

But focusing on Hitler’s direct responsibility for the Holocaust blinds us to more disturbing truths about the early 20th century. His absence from history would not remove the underlying political ideologies or social movements that fueled his ascendancy. Before his rise to power, eugenic theories already held sway in Western countries. Anti-Semitism infected civic discourse and state policy, even in the United States. Concepts like ethnic hierarchies and racial supremacy influenced mainstream political thought in Germany and throughout the West. Focusing on Hitler’s central role in the Holocaust also risks ignoring the thousands of participants who helped carry it out, both within Germany and throughout occupied Europe, and on the social and political forces that preceded it. It’s not impossible that in a climate of economic depression and scientific racism, another German leader could also move towards a similar genocidal end, even if he deviated from Hitler’s exact worldview or methods.

The entire article is here.

Inside the Monkey Lab: The Ethics of Testing on Animals

By Miriam Wells
Vice News
July 7, 2015

"Of course it's pitiful for the monkeys. Everyone feels the same — you see it and you don't want it. But the point is if you want something different then you have to make something different. It doesn't happen overnight."

Speaking to VICE News, Jeffrey Bajramovic, a scientist from the Biomedical Primate Research Centre (BPRC) in Holland, was refreshingly honest. What happens to the monkeys tested on inside the center — a not for profit laboratory which is the largest facility of its kind in Europe, housing around 1,500 primates — is horrible. Those sent for experimentation suffer pain and distress, sometimes severe, in studies that sometimes last for months, before ending their lives on an autopsy table.

But the tests they undertake contribute to the understanding of and development of vaccines and treatments for some of the world's most deadly and prevalent diseases. And in a grim paradox, as Bajramovic pointed out, the captive primates are also contributing to the development of alternative research methods that scientists can use so that ultimately, they don't have to test on animals at all.

It's a messy and emotional ethical dilemma that VICE News came face to face with when we gained rare access to the BPRC to see just what happens inside.

The entire article is here.

WARNING: There is a graphic and disturbing (to me) video embedded within the article.

Twitter’s Great Porn Purge of 2015

By Aurora Snow
The Daily Beast
Originally posted May 16, 2015

Say it ain’t so! Don’t censor us Twitter, like all those other wildly profitable social media platforms.

According to SunTrust Robinson Humphrey tech analyst Robert Peck, Twitter is preparing to purge an estimated 10 million porn-posting users. Ditching such a large chunk of users sounds drastic until you do the math: Twitter claims to have 302 million monthly users, so getting rid of the explicit posters will only account for about 3 percent of its total—although that’s just counting the users and not their followers. Twitter is a one-stop shop for all your media needs, whether you want to catch up on news, message a celeb in real time, or browse explicit images posted by adult stars. Purging the porn will surely upset millions of users, and would certainly put a dent in Twitter’s hip freedom of speech reputation.

The entire article is here.

Proposed symbol for hidden disabilities taps into debate over disclosure

By Staff
Torstar News Service
Originally published March 1, 2015

Here is an excerpt:

Last week, a Torstar News Service story about Toronto mother Farida Peters, who carries a sign alerting strangers that her 5-year-old son has autism, generated discussion about the issue of disclosing invisible disabilities and public reaction.

Despite mixed feelings about labelling her son, Peters found the sign has made their daily commute on the TTC easier. Instead of the annoyance and tart comments she used to encounter, passengers have reacted with support and encouragement. If he becomes disruptive or upset on a crowded subway car, they are more understanding.

Brydges says while people can be intolerant when faced with behaviour they don’t understand, providing an explanation like Peters’ sign can shift the dynamic. That’s where her symbol comes in.
“Ultimately, I developed this for people who need help when they are least able to ask for it,” she says.

The entire article is here.

Parents who wish no further treatment for their child

By M.A. de Vos, A.A. Seeber, S.K.M. Gevers, A.P. Bos, F. Gevers, and D.L. Williams
J Med Ethics 2015;41:195-200 doi:10.1136/medethics-2013-101395

Abstract

Background

In the ethical and clinical literature, cases of parents who want treatment for their child to be withdrawn against the views of the medical team have not received much attention. Yet resolution of such conflicts demands much effort of both the medical team and parents.

Objective

To discuss who can best protect a child's interests, which often becomes a central issue, putting considerable pressure on mutual trust and partnership.

Methods

We describe the case of a 3-year-old boy with acquired brain damage due to autoimmune-mediated encephalitis whose parents wanted to stop treatment. By comparing this case with relevant literature, we systematically explored the pros and cons of sharing end-of-life decisions with parents in cases where treatment is considered futile by parents and not (yet) by physicians.

Conclusions

Sharing end-of-life decisions with parents is a more important duty for physicians than protecting parents from guilt or doubt. Moreover, a request from parents on behalf of their child to discontinue treatment is, and should be, hard to over-rule in cases with significant prognostic uncertainty and/or in cases with divergent opinions within the medical team.

The entire article is here.

Ethical trap: robot paralysed by choice of who to save

By Aviva Rutkin
The New Scientist
Originally published September 14, 2014

Here is an excerpt:

In an experiment, Winfield and his colleagues programmed a robot to prevent other automatons – acting as proxies for humans – from falling into a hole. This is a simplified version of Isaac Asimov's fictional First Law of Robotics – a robot must not allow a human being to come to harm.

At first, the robot was successful in its task. As a human proxy moved towards the hole, the robot rushed in to push it out of the path of danger. But when the team added a second human proxy rolling toward the hole at the same time, the robot was forced to choose. Sometimes, it managed to save one human while letting the other perish; a few times it even managed to save both. But in 14 out of 33 trials, the robot wasted so much time fretting over its decision that both humans fell into the hole. The work was presented on 2 September at the Towards Autonomous Robotic Systems meeting in Birmingham, UK.

The entire article, with video, is here.

Loving animals and eating meat: The Meat Paradox

By Brock Bastian

New Philosopher

Originally posted March 11, 2014

Here is an excerpt:

Of course consuming animals that are not considered food can create all kinds of squeamishness. Consider the recent horsemeat scandal. People created all kinds of reasons for their feeling of disgust at eating horsemeat, including health safety concerns, but of course horsemeat has been consumed safely for years.

I would argue that the issue was far more closely related to the fact that horses are seen as pets and not food. The idea of eating pets is indeed disgusting.

If people try to avoid the connection between meat and animals, what happens when they are forced to make this link? In other research we have shown that asking people to think about animals being killed for food leads them to attribute fewer mental qualities to that animal. Perhaps, however, this only happens for meat-eaters and not vegetarians, who on average attribute many more mental qualities to animals in the first place.

The entire article is here.

Opting to Blow the Whistle or Choosing to Walk Away

By ALINA TUGEND
The New York Times
Published: September 20, 2013

WHISTLE-BLOWERS have been big news lately — from Chelsea Manning, formerly known as Pfc. Bradley Manning, to Edward J. Snowden. Yet, for most people, the question of whether to expose unethical or illegal activities at work doesn’t make headlines or involve state secrets.

But that doesn’t make the problem less of a quandary. The question of when to remain quiet and when to speak out — and how to do it — can be extraordinarily difficult no matter what the situation.

And while many think of ethics violations as confined to obviously illegal acts, like financial fraud or safety violations, the line often can be much blurrier and, therefore, more difficult to navigate.

The entire story is here.

Physicians' Top Ethical Dilemmas: Medscape 2012 Survey Results

Physicians' Top Ethical Dilemmas

Would you fight with a family that wanted to withdraw care from a viable patient? Would you follow the family's directive to continue treatment if you thought it was futile? Would you date a patient? More than 24,000 physicians told us how they feel about this and other ethical dilemmas.

The entire survey is here.

Providence police, hospitals at odds in medical privacy debate

By Amanda Milkovitz
Rhode Island News

A judge in a murder trial in June wanted to see the medical records of a woman whose husband was charged with killing her.

Rhode Island Hospital’s records department rejected the court order –– and answered the subsequent subpoena by saying the law allowed 20 days to respond.

A Providence detective investigating an alleged murder requested the medical records of the victim, who died at Rhode Island Hospital. In his request for the records in March 2010 — nearly two years after the death –– the detective included a copy of the victim’s death certificate, plus two signed releases from the man’s father and adult son.

Rhode Island Hospital refused.

In March, the Providence police wanted to know if a man who’d been shot was still alive, before the suspect accused of shooting him was released on bail. If the victim was dead, the suspect would be held for murder.

Rhode Island Hospital wouldn’t say whether the wounded man existed.

Providence Detective Sgt. James Marsland sighs in frustration as he tells these stories.

“We call over to the hospital to find out his condition: Is he dead or alive? That’s the only medical information I want.

“They wouldn’t tell me he was there,” Marsland said. “I know he’s there –– we brought him there.”

The federal Health Insurance Portability and Accountability Act, known as HIPAA, was designed to protect the privacy of medical databases and imposes hefty fines against those who release patients’ protected information. Even so, the federal law allows the release of some information to law enforcement, such as when the police need to identify a suspect, fugitive or material witness, or when the police are investigating whether a patient is a victim of a crime.

States have their own versions of patient privacy laws, and Rhode Island’s Health Care Confidentiality Law, written in 1978 and adapted over the years, is even more restrictive than the federal law.

The state’s law requires health-care providers to release information to law enforcement about specific kinds of cases, including those involving gunshots and abuse of children — but otherwise, providers need the consent of the patient or family to release any information. Violators may be punished by a fine of up to $5,000 or six months in prison.

Dr. John B. Murphy, senior vice president for medical affairs at Rhode Island Hospital, said in an interview that the hospital wants to work with the police, but it also must follow the law. He’s participated in meetings with the Providence police about the issue, most recently with then-Chief Dean M. Esserman a few months ago, and said the hospital has been trying to accommodate investigators.

The hospital has recently stopped concealing the identities of all people brought in with violent injuries, Murphy said. The hospital also gave police contact information for the top on-call administrator.

But there is only so much the hospital can do within the law, he said.

“If you think the law needs to be changed, then change the law,” Murphy said. “Why does the law differentiate from a grazing gunshot that just needs a Band-Aid and a life-threatening stab to the liver?”

The rest of the story can be found here.

Vignette 4: A Psychologist in Turmoil

Vignette 4

A psychologist is treating a client who is involved in a legal proceeding.  The client presents the psychologist with information about a well-known, local psychologist who released confidential information to an attorney without a signed release or court order.  After the psychologist reviews the information presented, it is clear to the treating psychologist that other psychologist breached confidentiality.

The treating psychologist knows the local psychologist who released the information, but does not have a strong relationship with him.  The treating psychologist is questioning what to do.  The treating psychologist believes the options are:

1. Address the matter with the other psychologist directly.

2. Refer the matter to the State Board of Psychology.

3. Encourage the client to file a complaint with the State Board of Psychology.


Are there any other options?

What are the possible emotional reactions to this situation?  And, how would you, as the treating psychologist, deal with those emotions?

What is a likely course of action?