The Ethicist

[Libre]

Anybody read this column, by Randy Cohen? It is in the Sunday New York Times Magazine, every week. It is kind of an Ann Landers sort of advice column, that deals exclusively with moral dilemmas. Each week Randy prints 2 or 3 questions from people in ethical straights, and prints his replies.
My wife and I have a weekly tradition-slash-ritual. Every Saturday (we have a subsription so we get the Mag on Saturday) over breakfast, I read aloud a question, then before we read Randy's answer, we discuss the question, and we each give our opinion of what the correct approach should be. Then I read Randy's answer. Sometimes my wife and I agree, sometimes not. And sometimes we agree/disagree with Randy.
If anybody regularly reads this column, and would like to raise some of the issues treated in the column, I think it would be a fun/enlightening thing to do.

For example, this week someone wrote in asking whether she was morally obligated to donate part of her liver to her estranged and antagonistic sister who needed a transplant. Randy, my wife, and I were all in complete agreement with our opinion - which was HELL NO! Your opinion?

 

[novella]

What if the sister who needed the transplant was not 'estranged and antagonistic' and the damage to her liver was caused by the well sister, say through giving her the wrong medication or dosage of something? Does that change your answer?

Clearly one is never 'morally obligated' to give up one's body part (a ridiculous formulation by any standards), though in an age when this is scientifically possible we now can have guilt associated with our own ongoing good health in the face of others' injury.

BTW, I do see his column, but I don't seek it out. I don't particularly like his rhetorical style.

 

[Libre]

Organ donation is a very tangled web - that's for sure. But, if the sister caused the damage, that WOULD change my answer. And that is whether or not the relationship was strained.
I agree that his rhetorical style is laborious, his attempts at humor are often pathetic, and he is an all-around pain. What I do like are the questions that are posted, and the discussions that I have with my wife. They are often thought provoking, although sometimes the questions are so petty as to make me wonder why Randy selected them for publication. After I read the question and we discuss it, I somtimes just skim over Randy's long-winded rhetoric, just to get the gist of his answer.

 

[novella]

Organ donation, from the point of view of the donor, is pure generosity. Giving a body part to someone, stranger or not, is a higher order of gift--far beyond obligation-- than, say, stopping on a highway to help someone or letting them use your telephone or feeding someone who is hungry.

From the point of view of the recipient, there are moral obligations, I believe.

For instance, George Best was morally obligated to quit drinking after he received a donated liver, but he didn't, which angered very many people. He was seen as reneging on his promise to treat the donation with the respect it deserved.


If you're done with this one, Libre (though I'd wecome further discussion), let's have another?

 

[Libre]

Well, here are a few that stick in my mind.
-A woman wrote in, saying she lent her car to her friend (a woman) and that her car was seen parked overnight in a neighboor's driveway, whose wife was out of town. Her car is identifiable because of a bumper sticker. Now the neighboors are abuzz with the rumors and people are looking at her funny. Should she rat on the friend?

-A doctor asks if it is ethical to accept a large cash gift from a patient whose life he saved after he was hit by a car, and who subsequently won a huge cash settlement in court.

-A woman wants to know if it is OK for her husband, a psychotherapist, to charge the damages to the building that were caused by his patient when she threw a temper tantrum in the lobby, back to that patient because he was stuck with the bill. Also, she wants to stick subsequent moving expenses to that patient because the therapist had to move.

 

[novella]

Well, here are a few that stick in my mind.
-A woman wrote in, saying she lent her car to her friend (a woman) and that her car was seen parked overnight in a neighboor's driveway, whose wife was out of town. Her car is identifiable because of a bumper sticker. Now the neighboors are abuzz with the rumors and people are looking at her funny. Should she rat on the friend?

.

I'll take just one for now. I think (and I would) talk to the friend and tell her the problem. If she really is a friend, she might come up with her own solution. If she just says, "oh, don't worry what other people think," I would say, "I'm glad you said that. Then you won't mind if I tell everyone it was you who was keeping X company that night."

What would you do?

 

[Libre]

This one is pretty tough (as all the "good ones" are). If I were confronted directly by anyone, I would give a minimal but definite statement that it was not me, but that's all I would say.

 

[novella]

-A doctor asks if it is ethical to accept a large cash gift from a patient whose life he saved after he was hit by a car, and who subsequently won a huge cash settlement in court.
.

Okay, let's move on to the second here.

I think it's entirely ethical to accept such a gift, for the following reasons:

--accepting it hurts no one.
--it is given of pure gratitude with no strings attached.
--the money was fairly granted in court, not obtained unethically.
--gifts are given all the time in a professional context. The Christmas present for the teacher, the bottle of wine for the accountant, the dinner out for the client. These all have ethical questions attached to them because there is an ongoing relationship, i.e., strings are attached. In the doctor's case, it is all post facto and free of obligation.

 

[Doug Johnson]

Politicans shouldn't accept large cash "gifts" for obvious reason. I don't see why it should be OK for doctors.

 

[Libre]

In the case of politicians, gifts raise the spectre of conflicts of interests - clearly unethical. But with this doctor, I initially thought there should be no reason why it would be unethical (as I mentioned, my wife and I always discuss the question before reading the published answer). Randy thought it was OK too, but he did bring up a good point. It WOULD NOT be OK if the doctor participated in the court case as an expert witness. That would be a clear conflict of interests. Not that expert witnesses don't testify for gobs of money every day - it's a pretty fine line - like ANY good moral dilemma.

 

[Kookamoor]

I thought the second one was easy because I'm pretty sure it wouldn't be ethical in the medical profession to do this. It's technically not okay for a teacher to accept gifts from students, you know. Something about receiving gifts in a position of authority or something.

Where's mehastings? She's in the medical profession, I know. So's Geenh, I think.

By the way, there's a similar column in the Australian paper I read in the Sunday magazine. My parents get a kick out of it every week. Moral dilemmas are wonderful to ponder on. I think this could be a really fun thread.

 

[novella]

I thought the second one was easy because I'm pretty sure it wouldn't be ethical in the medical profession to do this. It's technically not okay for a teacher to accept gifts from students, you know. Something about receiving gifts in a position of authority or something.

Where's mehastings? She's in the medical profession, I know. So's Geenh, I think.

By the way, there's a similar column in the Australian paper I read in the Sunday magazine. My parents get a kick out of it every week. Moral dilemmas are wonderful to ponder on. I think this could be a really fun thread.

You're not reading v. carefully, Kook. Look again. There're no strings attached to the ongoing relationship.

And I think MEH, as a first-responder, is in an entirely different position in that any gifts rec'd might alter the response.

MEH: BTW I am having a big issue personally with some local FDs stopping traffic every wkend for some cause or other, not local. I am getting fed up with the hold up. Last time it was "Jerry's kids" in Dutchess County (Jerry Lewis). I'm on the verge of stopping my donations to the local VFD, cause I don't know where the money is going. This is a BIG problem. (Hey, just using you as a vein.)

 

[Kookamoor]

You're not reading v. carefully, Kook. Look again. There're no strings attached to the ongoing relationship.

And I think MEH, as a first-responder, is in an entirely different position in that any gifts rec'd might alter the response.

No, I still don't think it is appropriate to accept such gifts, and I think the AMA would concur. If a doctor was to receive a gift then it doesn't "look" good. The impression is that some patients may receive better care than others if they give gifts.

In my engineering ethics class we were taught that gifts are inappropriate. Period. You are paid to do your job. If you do it well there are bonuses for doing it quickly and intangible benefits such as being recommended for awards, word-of-mouth recommendations and general goodwill. I would think a doctor should be in entirely the same situation. He healed the man to the best of his abilities. It is entirely inappropriate to receive a cash gift, or indeed any large financial windfall, because his patient happened to reap a reward. Technically, even a bottle of wine is inappropriate. In our industry receiving such gifts must be reported (to ensure transparency) and if they are deemed inappropriate due to expense or some connotation that would not be beneficial for the business then they may be returned or donated to charity. In the case of flowers or a bottle of wine or a hamper it is generally shared within the office because all people contributed to getting the reward. In this case a nurse or another doctor who assisted in saving the man should also reap rewards by that parallel.

Personally, I feel it would be appropriate for the doctor to decline the man's offer and instead suggest that if he wanted to contribute then he could donate to the hospital that helped save him. He may even specify what sort f equipment to purchase.

I thought MEH would be able to at least comment as I'm sure she sees gifts come in from time to time.