Case 1: Evaluating the Bounds of Professionalism in a Pandemic
Alice is a nurse who works on the general floor of the children’s hospital. She is six months pregnant. To date, her pregnancy has been uncomplicated and she is otherwise healthy. However, she is nervous about contracting COVID-19. She has requested a note from her obstetrician (who also works for the same health system) excusing her from all clinical duties in the current pandemic due to fear of harm to herself and her fetus from COVID-19.
Her obstetrician recognizes that the scientific community is still gathering data on the risk of viral transmission in pregnancy. The impact of illness on pregnant women and their fetus is unclear. She also knows there is a scarcity of skilled healthcare providers and the importance of keeping them at work during this time. Her clinical judgment is that it would be reasonable for Alice to continue working in the children’s hospital, as her job does not involve contact with COVID positive patients.
This is not the first request, however, that the obstetrician has received to excuse patients from work. The day prior, her patient Mary, who is three months into her pregnancy and works at Kroger, asked whether she could be excused from work as well. This patient has a history of asthma as well as heart disease, both of which put her in a higher-risk category if she were to get the virus. Like Alice, she is concerned about viral exposure to herself as well as to her fetus. The obstetrician is not sure how to proceed in a way that is fair and safe for both of these patients. She anticipates that she will receive more requests like these in the future and wonders how to respond.
Author Bio: Katie Feder is a fourth year medical student at the University of Michigan. She is a predoctoral clinical ethics fellow at the Center of Bioethics & Social Sciences in Medicine. The fellowship involves working on the Ethics Consultation Service at Michigan Medicine to help patients and providers work through real-time, healthcare-related ethical dilemmas. Katie graduated from Williams College in 2014 with a Bachelor of Arts in English, after which she studied bioethics at Columbia University, receiving her Master of Science degree in 2016. This year, she will be applying for residency in Internal Medicine.
Case 2: The Unwitting Taxi Driver
In May 1980, a pro-democracy uprising in the town of Gwangju, South Korea was violently suppressed by the South Korean military. Chun Doo-hwan, a dictator who had seized power a year earlier following the assassination of President Park Chung-hee, ordered the military to fire into the crowd of protesters, leading to the deaths of hundreds of civilians. The protests were in response to Chun’s declaration of martial law and the decades of authoritarian rule they experienced under Park.
Today, the general consensus is that protesters were demonstrating peacefully until the military deployed lethal force. Reports estimate at least 160 dead, over 70 missing, and 3,500 injured. But like other democracy movements, information about the crackdown was muddied by a government cover up. A military blockade, for example, prevented journalists from entering the city during the shootings. The episode is regarded by UNESCO as the May 18 Democratic Uprising and to many in East Asia as the Gwangju Massacre.
There are several moral agents relevant to this case: 1) the government led by Chun; 2) the protesters and; 3) individuals not directly involved, but play a decisive role in the outcome. This case revolves around the third, specifically, the responsibility of individuals incidentally thrust into a situation with deep moral consequences.
Kim Sa-bok is a taxi driver in Seoul, South Korea and a single father to an 11-year old daughter. On the morning of May 20th, 1980, Mr. Kim picks up a foreign passenger at the airport who requests a round trip to the city of Gwangju for an unusually high sum of ₩100,000 Korean Won (= $500 dollars adjusted for inflation). Mr. Kim eagerly accepts the trip and begins what he expects will be a long but lucrative journey.
Upon reaching the edge of Gwangju, Mr. Kim discovers that the military has blockaded the main roads leading to the city, meaning that entering by means of an alternative route, while possible, would be illegal. He relays this information to his foreign passenger and recommends they turn back to Seoul. The foreign passenger, however, insists that he must be taken to Gwangju, otherwise Mr. Kim will not get paid — so Mr. Kim obliges.
Once Mr. Kim enters the city, he hears the sound of gun shots and witnesses the clash between student protesters and the South Korean military. He discovers that his passenger is actually a journalist who begins filming the atrocities. Mr. Kim did not know the situation in Gwangju before he arrived due to heavy government censorship.
Mr. Kim would not have chosen to go to the city on his own volition had he known all the information at the outset. The passenger, which we now know to be the German journalist Jürgen Heinzpeter, requested Mr. Kim a round trip back to Seoul, which would require him to stay in Gwangju while Heinzpeter films the ensuing carnage. Accompanying the journalist is a tall task for anyone, but Mr. Kim also has a daughter waiting for him at home. Because of these reasons, he considers leaving his passenger in Gwangju and returning home.
Yet much more is now at stake. Leaving Heinzpeter in Gwangju during the crackdown will almost certainly endanger the journalist’s life. Moreover, his duties as a taxi driver suggest that he should observe his initial agreement with his passenger. There is also no denying the political ethics here: what Mr. Kim witnessed in Gwangju is horrifically unjust. By not returning Heinzpeter back to Seoul safely, Mr. Kim may undermine the only credible evidence of his own government’s brutality. The footage has indisputable ethical value: it may bring the truth to light after weeks of state subterfuge, hold an authoritarian government accountable for their actions, bring some justice to the victims, and pressure South Korea to democratize (though the value of this last consequence is unclear).
Author Bio: Chang Che is a writer from Ann Arbor, Michigan. He attended Greenhills High School where he was a captain of the Forensics and tennis teams. He has a degree in Comparative Literature from Princeton University and a Masters in Political Theory from the University of Oxford. His essays and criticisms are published or forthcoming in the Los Angeles Review of Books, The Point, Quillette, and others. He is also the editor of the Oxford Political Review and hosts a podcast series on politics and current affairs.
Case 3: Cat Ethics
Eight-year old Maya longed for a cat, but couldn’t have one because her family had a cockatiel. Instead, Maya had to be satisfied with trips to the Cat Café as special treats. Two months after the cockatiel died in an unfortunate accident, a clearly hungry cat began to appear regularly at the door of Maya’s family’s house and the family began feeding the cat at first outside--but they eventually let the cat come into the house. Soon the cat was spending long hours on the family’s couch with Maya petting and playing with her. She gave the cat the name Misty. Maya’s family posted notices on social media and looked for signs around the neighborhood about a missing cat. No responses on social media and no signs about a lost cat.
After four weeks, the family decided the cat was there to stay and since Misty had spent many nights outdoors, they worried about whether she might be pregnant and wondered if she needed shots. So, they took Misty to a vet. The vet discovers that Misty has a microchip and tells Maya’s family that he will return the cat to the family that implanted the microchip. Maya’s parents ask the vet to let that family know how attached Maya had become to the cat and ask if it would be possible for them to arrange a visit to the cat for Maya.
Maya’s family did not hear anything more from the vet or the family to whom Misty was returned. They assumed that Misty was out of their lives. Maya was despondent. After three weeks the cat reappeared at Maya’s house and settled in on the couch and again became part of the family. The family debated how to handle the situation.
Case 4: Campaign Promise
“If the horrors of the Holocaust taught us anything, it is the high cost of remaining silent and paralyzed in the face of genocide.” These are the words of presidential candidate Bill Clinton criticizing the Bush Administration’s response to the reports of atrocities committed in Bosnia. With these words Clinton indicated that were he president, he would not remain silent “in the face of genocide.” Yet, during Clinton’s time in office, 800,000 Tutsi and moderate Hutu were killed by Hutu extremists in Rwanda. Despite full knowledge of these killings, the Clinton Administration “remained silent” by neither acting to prevent this genocide from occurring, nor acknowledging it.
According to the United Nations Convention on the Prevention and Punishment of the Crime of Genocide, genocide is the intentional killing of members of a national, ethnic, or religious group with the intent of destroying that group, and those who signed on to the Convention were committed to preventing genocide. The United States was a signatory to that agreement in 1988.
In 1993 the Clinton Administration intervened in Somalia to capture a prominent Somali government leader who was abusing human rights in Somalia. The operation was a failure and resulted in the deaths of 18 US troops. Images of the corpses and prisoners were distributed widely by the Somali press, leading to widespread criticism of Clinton for endangering American lives by his approval of this operation in Africa.
In 1994 the massacre of the Tutsi and moderate Hutu began in Rwanda. The Clinton Administration was well aware of the genocide that was taking place via the CIA and various reports to the United Nations from Doctors Without Borders and other organizations. The UN sent a peacekeeping force, but after 10 Belgian soldiers working for the UN were killed and mutilated by the extremist Hutu, the UN reduced its forces in Rwanda. In the US at the time, there was little public awareness of the situation in Rwanda and Members of Congress and Senators felt little public pressure to support US action in faraway Africa. At the same time, Clinton was under pressure to cut government spending. Further, the United States did not have economic ties to or interests in Rwanda.
Sensing the lack of public support for intervention in Rwanda from both Republicans and Democrats and burnt by the failure in Somalia, the Clinton Administration did not intervene. Instead, it “remained silent,” and members of the Clinton Administration were urged to avoid the language of “genocide” when referring to the situation in Rwanda.
In 1998, President Clinton addressed Rwandan survivors and admitted that the international community did not act quickly enough to prevent the killings and again pledged “to build a world in which no branch of humanity, because of national, racial, ethnic, or religious origin, is again threatened with destruction.”
Author Bio for Cases 3 and 4: Arlene W. Saxonhouse is the Caroline Robbins Collegiate Professor of Political Science Emerita at the University of Michigan, where she taught political theory for almost 50 years. She is the author of several books including--Women in the History of Political Thought: Ancient Greece to Machiavelli; Fear of Diversity: The Birth of Political Science in Ancient Greek Thought; Athenian Democracy: Modern Mythmakers and Ancient Theorists (1996); Free Speech and Democracy in Ancient Athens, and of numerous journal articles and book chapters on ancient and early modern political thought. Her three children all graduated from Greenhills School, a founding member of the Michigan HS Ethics Bowl League.
Case 5: Incarcerated Mothers in Healthcare
You are a nurse in Labor and Delivery at a community hospital. A 20-year-old woman who is 37 weeks pregnant (which is a full-term pregnancy) arrives in triage, and she appears to be in labor. The patient is in custody at a nearby prison, and she is accompanied by two young male correctional officers. You notice the patient is restrained with wrist shackles. You ask the correctional officers to remove the shackles, but they refuse. They say that there is a flight risk and a risk that the patient may harm other people around her if she is not restrained. You argue that the shackles prevent you from being able to fully evaluate the patient, and it is unsafe for her to be restrained this way because she cannot catch herself if she were to fall. The officers respond that they will only remove the shackles with approval from their superiors.
Once the patient is moved from triage to a room, the correctional officers state that prison policy requires them to be in the room at all times. This makes you uncomfortable because you need to ask the patient questions about her medical history and later, sensitive exams will be performed. You are unfamiliar with how the prison’s policy and local law guide action in this situation, so you reflect on the ethical arguments you can use to advocate on behalf of your patient.
Author Bio: Samantha Chao is a resident physician in Emergency Medicine at the University of Michigan. She is certified by the American Society of Bioethics and Humanities in healthcare ethics consultation. She went to medical school at the University of Michigan, where she also completed a predoctoral fellowship in clinical ethics. She has a BA in Chemistry and English from Carleton College.
Case 6: Section 230 Showdown
The president has signed an executive order directing the Federal Communications Commission (FCC) to look into whether Internet platforms, such as Twitter and Facebook, should lose their legal immunity for content posted by users. This immunity is guaranteed as part of the Communications Decency Act, a federal law that also says platforms shall not be held liable for moderating content, for example, by “flagging” it or blocking it. (Heitmann, Augustino & Laughlin, 2020).
The executive order was signed after two Twitter decisions. In one case, Twitter fact-checked two presidential tweets about mail-in voting; in another, it flagged a presidential tweet for violating its policy against glorifying violence. The order asked the FCC to set out the conditions under which Internet platforms might lose legal immunity under Section 230’s “good faith” provision because of political bias.
Tech critics outside the Trump Administration are angry that tech companies are not doing more to moderate content, particularly hate speech, incitement to violence and fake news. Facebook, for example, has been shown to have contributed to the ethnic cleansing of the Rohingya people in Myanmar (Meixler, 2018) and Russian interference in the 2016 presidential election (Isaac & Wakabayashi, 2017).
A coalition called Change the Terms has put together alternative terms of service it recommends for Internet platforms (https://www.changetheterms.org/). A research team called the Dangerous Speech Project (https://dangerousspeech.org/) has developed similar guidance.
In other democracies, hate speech is largely prohibited and subject to criminal penalties in accordance with international human rights covenants (Eddy & Breeden, 2019).
Author Bio: Sandra L. Borden is a professor in the School of Communication at Western Michigan University, where she also directs the Center for the Study of Ethics in Society. Her book, Journalism as Practice: MacIntyre, Virtue Ethics and the Press, won the 2008 Clifford G. Christians Ethics Research Award and the National Communication Association’s 2008 top book award in applied ethics. Her other books are Ethics and Entertainment: Essays on Media Culture and Media Morality (co-edited with Howard Good, 2010, McFarland), Making Hard Choices in Journalism Ethics (with David Boeyink, 2010, Routledge), Ethics and Error in Medicine (co-edited with Fritz Allhoff, 2019, Routledge), and the forthcoming Routledge Companion to Media and Poverty.
Special note: A2Ethics' Think Over & Above podcast series includes a 2020 interview featuring Professor Borden, discussing several of the themes and topics in the 2020 publication, Ethics and Error in Medicine, with co-editor Professor Fritz Allhoff.
Case 7: Comparing Models of Cultural Integration: Mosiac Vs. Melting Pot
Canada considers itself a 'mosaic' of cultures; a society in which, in principle, government and society actively promote the preservation of cultural identities and distinctions, through legislation and public financing, in the hopes of promoting support for and pride in diversity. This is manifested in federally assisted cultural festivals, language classes, conferences, etc. Meanwhile, the image of the melting pot, often evoked in countries like the United States, appears to favour a more assimilative approach to cultural diversity; that newcomers and minorities should strive to consider themselves "Americans first" and be willing to let go of cultural norms that differ from the practices of the dominant culture.
In Canada, some feel that the ‘mosaic’ approach to multiculturalism has not done enough to prevent marginalisation and has led to complacency and a sense of self-satisfaction among a majority of Canadians; a sense that, since racism does not appear as overt when compared to other countries, there is no reason to discuss it and less reason to complain about it. This raises some ethical questions.
Case 8: Death and Wellbeing
Many non-American cultures confront death head on. There are holidays and festivals based solely on the remembrance of death. Such holidays often consist in honoring the lives of departed family members and friends, and in remembering that death is just a natural journey in the human life cycle. For a good example, consider Day of the Dead, Dia de Muertos, in Mexico. Furthermore, in many non-American cultures, families and friends are intimately involved in what happens to the body after death. Families and friends also tend to arrange funerary rites, setting up everything on their own, and they care for and clean up the body of the deceased.
Generalizing a bit, American society runs away from death, ignoring it as much as possible. We don’t have days devoted to honoring, remembering, and celebrating our dead ancestors. Moreover, most people die in hospitals tucked away far from home. Americans entrust funeral arrangements and give the body to a growing list of services built around death, the Undertaking industry.
Author Bios for Cases 7 and 8:
Special note: The 2020 Canadian National Ethics Bowl champions and students from École secondaire Kelvin High School received a special invitation from the Michigan High School Ethics Bowl organizers to submit case studies for the 2021 Bowl after participating in the first Six Feet/Two Metres Apart Virtual Symposium with Michigan HS Bowlers from Saline High School in May, 2020.
Case 9: Inmate Ballots
Voting is often associated with democracies, but in the United States there are several distinct populations that have been systematically barred from this right. An example: inmates at prison facilities, whose electoral representation can vary largely by state. Just Maine and Vermont allow citizens to retain their voting rights during imprisonment, while other states restore voting once they are released and/or also complete their parole period.
There are justifications to withdraw a citizen’s vote when they are incarcerated, such as that prison is designed to limit its inhabitants’ freedom. But others might argue that voting cannot be prohibited to inmates, especially when elections involve such issues as prison reform. And when inmate demographics are considered, it is evident how much felon disenfranchisement can reduce minority voices and communities. Referencing one such statistic, a relatively recent summary from the Bureau of Justice Statistics states that “the imprisonment rate of black males was 5.8 times that of white males, while the imprisonment rate of black females was 1.8 times the rate of white females.” Hence, reducing the opportunities to have a government that fairly represents and accounts its entire population.
Author Bio: Anna Luisa Romeri studies at the University of Michigan and is a History major. Anna participated for several years in the Michigan High School Ethics Bowl as a member of the Ann Arbor Huron High School team, and has enjoyed discussing the ethical dilemmas proposed at the Bowl. She wrote this case study during her A2Ethics summer internship, in addition to completing a capstone project that focused on the development of the Michigan Alumni Bowl Network. Anna’s hobbies include photography, sports such as soccer and volleyball, and learning to bake and cook.
Case 10: Access to Information and Privacy
A worldwide pandemic of coronavirus is raging across the world. Government officials have declared that extensive contact tracing must be enforced to slow the surge in infections and deaths. Meanwhile, individuals everywhere are fearful that their right to privacy and freedom from unlawful searches and seizures pursuant to the Fourth Amendment of the United States Constitution will be seriously violated.
Regulations generally allow health officials to keep track of people’s personal health information for the purpose of helping them get treatment and stopping the spread of high consequence communicable diseases. However, it is not mandatory that people name contacts, and if they do, the health official is legally barred from naming the “original patient” who named them, when they are informed of a possible exposure. Individuals who are likely to have contracted the virus are often encouraged to self-quarantine in order to prevent further spread.
Violation of health department orders is a crime punishable by fine, imprisonment, or both. Nonetheless, there is little enforcement of these orders. Besides the lack of capacity, health departments must maintain a good relationship with the community to be effective.
Author Bio: Wendell Goddard attended University Liggett School (a Michigan Bowl League member), for ten years. He graduated from Yale University majoring in History, the Arts and Letters and from UC Berkeley Law School, where he was a member of the Law Review. He then clerked for U.S. District Judge Whitman Knapp in the Southern District of New York and has practiced law in the San Francisco Bay Area for over 40 years. For the past six years he has taught a course on Current Issues in Public Policy at Charles University in Prague and has also given talks on this subject in France and Thailand. He grew up hiking in the woods of the Upper Peninsula. In 1975, he was the driver for his late sister Sarah Goddard Power in her first successful statewide campaign for Regent of the University of Michigan.