The 2022 Ethics Bowl is packed with cases that give teams the opportunity to advance dialogue on a range of complex and important ethical issues.
Unlike other Regional Bowls, many of the Michigan Bowl case studies are written by community members, all of whom are working in Michigan or have a longstanding Michigan affiliation. The Michigan Bowl also has a fine editing team: several philosopher coaches from the University of Michigan Department of Philosophy Outreach Program.
As always, each case is accompanied by study questions to fire up the neurons and jumpstart discussions. And don't forget to take a look at the author bios highlighting their current work and experiences. In 2022, two of the cases are written by former Michigan Ethics Bowlers from Wayne Memorial and AA Huron. Several of the case writers come to Bowl weekend to learn about what team members think and to hear arguments about theirs as well as all the other case studies.
CASE 1: 3...2...1...HORRORphobic: An Analysis of Homophobia in a Horror Game Franchise
Armani just entered the doors of Lee High School, named after Commander of the Confederacy during the Civil War, Robert E. Lee. A new school was nothing new for Armani, considering that Armani had moved between several schools in Los Angeles. However, this time Armani relocated to Tulsa, Oklahoma, an area very different from what Armani was used to.
Armani is a part of the LGBTQ+ community and is non-binary, identifying with the pronouns they/them. Armani is anxious about trying to make friends at their new school, but they worry that people at Lee High School may be less accepting of non-binary and LGBTQ+ students than the people at their previous schools, in Los Angeles.
After not being able to introduce themselves to anyone all day, in Armani’s last class of the day, they meet John and Dakota, who are two boys sitting in the row next to them. Armani overhears the guys excitedly talking about a new video game release. Though Armani did not catch what video game the guys were talking about, they also enjoy video games and determine they may have something in common with the men. In an effort to make new friends, Armani gathers their courage and introduces themself to John and Dakota.
“Hey, my name is Armani, I just moved here! I heard you guys talking about a video game, it sounds familiar but I didn’t catch the name.”
John replies, “Yeah, we’re talking about Five Nights at Freddy’s—have you played it before?”
In 2014, the first video game in the horror franchise Five Nights at Freddy’s (FNAF) was released. In the years since, the franchise has garnered a loyal following of fans. These fans have created a community surrounding the game, and this community has allowed fans a platform for creative expression through
outlets like art, writing, and game design, all based on details from the original series. The fans know this tight knit community as an open and inclusive place for people who identify as LGBTQ+, since these people make up a large portion of the fanbase, including Armani.
However, in 2021, it was revealed that Scott Cawthorn, the creator of the Five Nights at Freddy’s franchise, had made financial donations (of more than $40,000) to various political campaigns, including candidates who are known for their stances against LGBTQ+ rights. This put many LGBTQ+ fans like Armani in an uncomfortable position, since they believed that their support for the franchise, and by extension its creator, helps fund candidates who pose risks to the LGBTQ+ community’s rights.
That John and Dakota were discussing FNAF left Armani in an especially difficult situation. On one hand, Armani felt a moral duty to the LGBTQ+ community. They felt they just had to tell John and Dakota about the FNAF’s failing relationship with the LGBTQ+ community, and to let these guys know that they, too, should be wary and concerned about the potential harms that supporting FNAF would have on the LGBTQ+ community. On the other hand, Armani was afraid about alienating these boys and, thus, losing potential friends, opening the door to being bullied, and outing their own moral convictions to people who may not share them.
Does Armani actually have a moral duty to the LGBTQ+ community to tell John and Dakota about the history of FNAF—to raise awareness about the moral issues at stake, and to call John and Dakota to action (i.e., not supporting FNAF)? If so, how strong or weighty is this duty?
Is it true that members of the FNAF community like Armani should stop supporting the franchise when the actions of its creator contradict their own values and stand to harm their communities?
To what degree should the blame afforded to the words and deeds of a franchise’s creator carry over to the company itself, such that FNAF itself is guilty because the creator is guilty?
Should Armani’s self-interested concern in getting new friends and being accepted at their new school outweigh the moral concerns they may have with John and Dakota supporting a franchise whose creator stands to harm the LGBTQ+ community?
Khushi Patel was a former member of the Wayne Memorial High School Ethics Bowl Team, The Herd, for four consecutive years. In 2018, the team won the State Championship and advanced to Nationals in North Carolina. She will continue her education at Brown University, where she plans to study Public Health and Economics. She has a personal interest in the Ethics of Educational Equity and Bioethics.
Kathryn Bigelow is a graduate of John Glenn High School and will be attending the University of Michigan Dearborn to study Computer and Information Systems. Although Kathryn did not participate in Ethics Bowl during her high school career, she is passionate about ethical issues and advocating for those in need.
Case 2: Physician Assisted Suicide
Mrs. Williams is a 68-year-old woman with ALS, a progressive nervous system disease that destroys motor neurons and impairs voluntary movement. She was diagnosed with ALS 4 years ago, and has since lost all control over her limbs. She is now experiencing difficulty talking, chewing, and breathing. She is completely reliant on her adult son, her primary caretaker, for all her daily activities. Mrs.Williams knows that based on how ALS progresses, she will soon not be able to breathe on her own. The lack of control over her own life, and the overwhelming burden she feels she is placing on her son, has caused Mrs. Williams to ask her physician for a prescription to help end her life more quickly.
The use of prescription medication to hasten end of life is known as physician-assisted suicide (PAS) or (more recently) assisted dying. Assisted dying was first legalized in Oregon in 1997, and has since been legalized in a handful of other US states. There are several safeguards laid out in the law to protect patients and prevent physician abuse. First, there must be at least two witnesses to confirm the patient’s competency, terminal illness, and voluntary request. Second, the patient must make a written request for assisted suicide, followed by an oral request fifteen days later. Lastly, there is a time lapse between the order and subsequent filling of the patient’s prescription. Active euthanasia (via lethal injection) is still illegal in all 50 states.
Proponents of PAS argue that a physician’s priority is the patient, that this includes respecting the patient’s autonomy. Thus, a repeated request from a competent patient should be honored, even if it conflicts with a physician's own sense of what is right. Those in favor of PAS also argue that it allows terminally ill patients to die peacefully on their own terms, and spares them from the suffering that accompanies debilitating diseases such as ALS. Additionally, the many safeguards in place protect patients in the event that they change their mind. Most patients who request PAS ultimately do change their mind.
Opponents of PAS contend that it undermines the physician’s role as a healer and erodes trust between physicians and the public they serve. Additionally, they argue that patients who request suicide often do so while suffering from extreme pain, concomitant mental illness, or immense guilt from being a burden on loved ones. They argue that these factors might influence their request for PAS, but that these problems can be better addressed by providing better palliative care, treating depression, or providing more spiritual and emotional support. Thus, challengers of PAS feel that physicians should focus on improving these factors rather than cooperating with assisted suicide. Lastly, many share the belief that human life itself is sacred and worth saving, regardless of illness or incapacity.
How does allowing patients to end their own life by refusing medical interventions (known as passive euthanasia) differ from physician-assisted suicide? Do you think it is consistent & ethically permissible to allow one and not the other?
Should a physician who is morally opposed to assisted suicide be required to help a patient who requests it? In other words, does a patient’s autonomy always come before a physician's moral/professional integrity?
Those who oppose PAS believe that legalizing it on a national level could be a slippery slope, leading to the use of assisted suicide even for those who are not terminally ill. What societal implications, if any, do you foresee? What other groups besides the terminally ill might be affected?
Would allowing PAS to become more acceptable place a new burden on terminally ill patients? In other words, if assisted suicide is seen as an appropriate alternative “treatment,” how might this harm the patient’s well-being?
If PAS becomes more acceptable, how should physicians manage requests from family to honor medically assisted death for patients with impaired decisional capacity who suffer from a terminal illness and expressed wishes in the past, to avoid prolonged suffering when dying? In other words, patients might tell their family “when I’m no longer able to walk/smile/eat etc. I want my doctor to
give me a pill so I can go.” If that same patient later becomes mentally incompetent due to an illness like dementia, and can no longer make their own medical decisions, how should the physician manage requests from the family to honor their patient’s past wishes?
Death with Dignity Acts (n.d.). In Death with Dignity. Retrieved from https://deathwithdignity.org/learn/death-with-dignity-acts/
Lo, B. (2009). Resolving Ethical Dilemmas; A Guide for Clinicians (4th ed., pp. 151-159). Philadelphia, PA: Lippincott Williams & Wilkins.
Lorenz K, Lynn J. Moral and Practical Challenges of Physician-Assisted Suicide. JAMA. 2003;289(17):2282. https://jamanetwork.com/journals/jama/fullarticle/196487
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy. Physician-Assisted Death: Scanning the Landscape: Proceedings of a Workshop. Washington (DC): National Academies Press (US); 2017 Jun 27. 2, Conceptual, Legal, and Ethical Considerations in Physician-Assisted Death. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525943/
Physician-Assisted Suicide (n.d.). In AMA Code of Medical Ethics. Retrieved from https://www.ama-assn.org/delivering-care/ethics/physician-assisted-suic…
Sulmasy, D. P., Travaline, J. M., Mitchell, L. A., & Ely, E. W. (2016). Non-faith-based arguments against physician-assisted suicide and euthanasia. The Linacre Quarterly, 83(3), 246–257. https://doi.org/10.1080/00243639.2016.1201375
Jessica Cristiu is a second-year medical student at the University of Michigan. She graduated from the University of Michigan-Dearborn in 2019 with a Biology major. During her time at UM-Dearborn, she took classes in the Honors college, where she studied philosophy and ethics. This led to her interest in medical ethics and her involvement in the Ethics Path of Excellence at UMMS! In her free time, she enjoys reading, exercising, and spending time with her family and her dog Biscuit!
Link to Ethics Path of Excellence at the University of Michigan Medical School:
Case 3: Sexual Assault Nurse
Many hospitals and other health care systems employ sexual assault nurse examiners (SANEs) to provide medical care for sexual assault survivors, while also collecting evidence for potential investigations and prosecutions. One day, (in a state whose legal age of consent for sex is 16 years old), a parent brings their 16-year-old daughter, Teen, to the hospital to be seen by a SANE. When the SANE is alone with Teen, it becomes clear that she does not want to proceed with any sort of exam or evidence collection. Teen explains that her parent “dragged” her to the hospital, that she had consensual sex the night before, and that her parent found out and is furious about it.
The SANE now needs to decide whether to proceed with the exam and evidence collection over Teen’s objection.
Should the SANE proceed with the exam/collection?
How does what the SANE should do change (or not) if the following factors are varied:
Teen is 15 versus Teen is 16.
Teen says she had consensual sex with her high school boyfriend of four months, versus
with a 25-year-old man she met last night after a week-long electronic communication
versus declines to give any detail about the other person.
Parent is Mother versus Parent is Father.
Teen says before/during sex she was totally sober, versus “buzzed”/“high,” versus “pretty drunk”/“totally out of it.”
Case 4: Conflict During Birth
You are a unit administrator responsible for the safe and consistent practices of a labor and delivery unit in a tertiary care hospital (i.e., a hospital able to manage complex cases). One night at 2am, you get a call at home from the nurse in charge, requesting assistance with a conflict occurring on the unit.
There is a patient in labor with a history of a cesarean birth with their last pregnancy. The patient has an extensive and detailed labor and birth plan. However, their plan includes one wish that falls outside of current guidelines for safe care in labor of a person with cesarean birth history: they are refusing continuous fetal heart rate monitoring.
The guidelines suggest that continuous fetal heart rate monitoring is safer for the fetus, because it can allow for early identification of a rupture of the cesarean scar--which is deleterious to fetal (and possibly also maternal) well-being. The clinician caring for this person is insistent that the guidelines for continuous monitoring be followed and implemented, but the laboring person is insistent that they will not consent to its use.
What factors should you consider and prioritize as you make your decision?
Consider a similar scenario: patient insists on the same parameters (no monitoring) and the clinician has agreed to make an exception. But the assigned nurse does not agree to care for a patient outside the boundaries of established guidelines. What factors should you consider as you resolve the conflict?
How should clinicians and administrators weigh a patient’s wishes against practices meant to protect their well-being, when the two are in conflict?
Author Bio (Cases 3 and 4):
Lisa Scheiman has been a Certified Nurse Midwife at the University of Michigan Hospital for 29 years, and the lead Sexual Assault Nurse Examiner there for about 20. In both of those roles, she also provides teaching/training for midwife students, medical students and residents, social workers, and law enforcement. In her free time, she is learning to play the cello and enjoys discussing ethical conundrums while running with her friends.
Case 5: Unknown Assailant
Over the course of ten days in a medium-sized city, three different women in their 20s are physically assaulted late at night in public-but-not-busy areas. Each woman promptly reports the details of their assault to police; none sought medical treatment. While none of the women are able to provide a precise or detailed description, various details of the victims’ accounts lead police to suspect that one assailant is responsible for all three assaults. All three women report their assaults happened between 11:30pm and 1:15am; that the suspect was wearing dark clothing but not gloves, a hat, or any sort of mask; that no weapon was seen; that the assailant did not speak; and that they were originally accosted on a sidewalk and pushed or pulled between buildings/houses, or into an alley or store-front vestibule. All three women were able to fight off and escape their assailant within thirty seconds. Two of the women were “certain” about their recall of the assailant’s hair color and appearance, and skin complexion; the third was “pretty sure” about hair color and appearance, and skin complexion (and the two “certains” and one “pretty sure” were consistent). The various age ranges provided by the victims spanned from 18 to 30.
After the third assault, the police release a statement to local media that includes all of the reported descriptions of the assailant. The local media outlet publishes its story with all of the consistent identifying parameters, except for skin complexion.
What are the ethical considerations associated with the decision whether to publicize the skin complexion of the suspect?
Which groups bear the costs of a decision to publicize the skin complexion? Which groups bear the costs of a decision not to publicize the skin complexion?
Consider the issues above as they relate to a decision whether or not to publicize the suspected gender of the assailant.
Mark Kneisel is a long-time resident of Ann Arbor, where he was an assistant prosecuting attorney for 23 years. Before that, he taught and coached at the high school level, and currently he is the novice/frosh coach for the University of Michigan Men’s Rowing Team. He has authored Ethics Bowl cases in the past, and wishes he would have taken more Philosophy courses in college.
Case 6: Family Secrets
For her 60th birthday, Helen takes a DNA test on 23andMe. A few days later, she gets a message from a woman named Alice, who has noticed that the two of them have 15% shared DNA — a high percentage which means that Helen is either Alice’s aunt or her first cousin. Alice says that she would like to meet up to try to figure out what the connection between them is.
Helen realizes that Alice is the eldest daughter of her older brother, Daniel, but that Alice doesn’t know about it. Daniel is currently married and has three grown children from that marriage. However, forty years ago, Daniel was married to another woman, whom he had a child with. They divorced, and, upon their divorce, both agreed that Alice would stay with her mother and that Daniel would no longer be present in Alice’s life. Shortly afterward, Daniel remarried and moved away to another city. Alice’s mother also remarried and raised Alice along with her new husband. Helen realizes that Alice does not know that the man who raised her is her adoptive, rather than her biological, father.
Helen calls Daniel and tells him what happened. Daniel, however, says that he is not interested in connecting with Alice in any way. He says that everything that happened is in the past. Daniel’s children do not know about the fact they have another biological sibling, and Helen suspects that Daniel is worried that the discovery might upset them and his wife, and he does not want to hurt them.
Helen looks Alice up on the internet and discovers that Alice’s mother passed away several years ago, but that her adoptive father is alive. She discovers that Alice is married and has two children. While browsing through Alice’s photos and posts on Facebook, Helen sees that Alice looks almost exactly as Helen did at her age and that she has very similar interests to Helen. Helen feels an instant connection to her, and because of this, she really wants to meet Alice.
On the one hand, Helen believes that Alice has a right to the truth. She thinks that Alice has a right to decide whether she wants to meet her biological father, siblings, and extended family. On the other hand, Helen worries that, by telling Alice, she’d expose her to information that Alice never wanted to know. She worries that the information might upset Alice, and might strain the relationship with her adoptive father. Moreover, Daniel still says that he doesn’t want Alice to find out anything about their biological connections. What should Helen do?
Should Helen tell Alice the truth? Should she lie? Should she even reply to her message?
Does one have the right to know what their birth heritage is?
Does Daniel have a right to keep the secret away from Alice and from his other children? Is his
desire to “keep the past in the past” valid? Should he be the one to decide what steps to take, rather
Helen feels that she wants to have a relationship with Alice and to befriend her. Yet she’s worried that taking action might ruin Alice’s relationship with her adoptive father. Likewise, she knows that Daniel is concerned about his relationship with his other children and his wife. Which of these three relationships should take precedence as Helen weighs her decision?
Ellie Makar-Limanov is a sophomore at Princeton University. Her academic interests include literature, philosophy, and Slavic studies. She’s from Ann Arbor, where she was an avid Ethics Bowl participant in high school. Ellie is also a former A2Ethics intern — during her internship she ran two virtual discussion series, exploring culture, ethics, and cinema. She enjoys cooking and loves art and languages.
Lara Braverman is a senior at the University of Chicago, where she studies math, physics, and history, and is the co-author of two research papers on soft condensed matter. Lara loves to debate ethical and political questions with her friends and family. Her hobbies include playing board games, reading, and learning about other cultures. She also enjoys acting and directing. Incidentally, Ellie and Lara are cousins! They discovered they're related a few years ago after Ellie’s mother took a DNA test...
Case 7: Contact Tracing
This case was originally written in April 2020, shortly after the Covid pandemic hit the USA.
Spreading of the Covid-19 infection was greatly reduced in Singapore, South Korea, and Taiwan through aggressive detection of people infected with the Covid virus, and tracking of their contacts.
For people with smart phones and Bluetooth (i.e., almost everyone), it is not difficult for an app on a smart phone to detect when another smart phone with that app comes within a specified range (say, 6-10 feet). The cell phone number is an ID, which can be linked to most other identifiers. Those contacts can then be tested, and for those infected, *their* contacts can be identified and tested. And so on.
At least one computer vision startup has an app that uses surveillance camera data to estimate physical separation in crowds. It is not hard to imagine how an extension of this technology could make it possible to detect which individuals in a population were *not* running the tracking app, so those people could also be tested.
On the one hand, such a tracker allows potentially infected individuals to be identified, tracked, and isolated, making it possible for the larger population of uninfected individuals to open up and carry on economic and social activities important to the functioning of society.
On the other hand, it’s hard to imagine a more effective tool for political surveillance and oppression. Simply replace “viral infection” with “opposition politics.” Civil liberties and individual freedoms are meant to allow for dissent and protect against the tendency of powerful people increasing and concentrating their power.
How should we resolve a conflict between two important values: (a) the value of controlling the pandemic by tracking and isolating infected people, allowing the economy and society to be opened sooner;
(b) the value of preserving the civil rights to dissent, critical to democratic society.
Should we ban this tracking technology to protect civil liberties, accepting increased spread of disease and prolonged damage to society and the economy?
Can we define a middle ground, controlling the use of a tracking tool and the data it collects, allowing us to fight the disease and to protect our non-authoritarian political system at the same time?
Suppose you are an expert computer scientist and programmer, and you have been asked to develop this contact tracing tool to help control an ongoing pandemic that is killing many people. But the request comes from a repressive government agency that might well use your software to identify people with opposition political opinions. Do you accept this job?
France Weighs Its Love of Liberty in Fight Against Coronavirus.
Norimitsu Onishi and Constant Méheut, 4-17-2020. https://www.nytimes.com/2020/04/17/world/europe/coronavirus-france-digi… Seoul’s Radical Experiment in Digital Contact Tracing.
Max S. Kim, 4-17-2020. https://www.newyorker.com/news/news-desk/seouls-radical-experiment-in-d…
Benjamin Kuipers is a Professor of Computer Science and Engineering at the University of Michigan. He was previously at the University of Texas at Austin, where he held an endowed professorship and served as Computer Science department chair. He received his B.A. from Swarthmore College, his Ph.D. from MIT, and he is a Fellow of AAAI, IEEE, and AAAS. His research in artificial intelligence and robotics has focused on the representation, learning, and use of foundational domains of commonsense knowledge, including knowledge of space, dynamical change, objects, and actions. He is currently investigating ethics as a foundational domain of knowledge for robots and other AIs that may act as members of human society.
Case 8: Water Water Everywhere
“Water Water everywhere- which one should I drink?” The Baby Boomer generation could be known as the ‘Pepsi generation.’ They were also targeted by Coca Cola with ads that promoted ‘the real thing’ and seduced with lofty lyrics of “I’d like to teach the world to sing in perfect harmony; I’d like to buy the world a Coke and keep it company.” And the Boomers were big consumers of those soft drinks.
More recently, health concerns have encouraged all generations to reduce intake of empty caloric drinks. The consumption of soft drinks has decreased, and is now often exceeded by water- not just plain tap water in most cases, but what has become known as ‘designer water.’ In response to this trend, both the Coke and
Pepsi companies have expanded their product lines to include designer water.
Coke still tries to wax proverbial with their mission statement: “To refresh the world in mind, body, and spirit. To inspire moments of optimism and happiness through our brands and actions. To create value for making a difference.” Pepsi is less ethereal, and perhaps more understandable with their mission statement: “to provide consumers around the world with delicious, affordable, convenient and complementary foods and beverages from wholesome breakfasts to healthy and fun daytime snacks and beverages to evening treats.”
Both companies have been successful in their shift away from their original products and toward selling water: Pepsi’s Aquafina is the number 1 bottled water seller in the US, and Coke’s Desani is the number 2. Both products are basically tap water that is purified and then bottled. The companies enjoy a mark-up of 133% by using local tap water from Detroit (Coke) and Phoenix and Denver (Pepsi). This practice has led to substantial controversy in cities like Detroit, where many residents have had water shut off by the City for unpaid water bills--while Coke has continued to profit, at the same time as having unpaid bills.
The sale of bottled water raises many ethical considerations, including: is glass better for the environment than plastic? Where is this water sourced? How should we think about the variety of options available to customers--from tap water to spring or glacier water, from distilled to purified to flavored--and the fact that attractive packaging can influence buyers? Why are soft drinks--alive and well in the US--often cheaper than bottled water?
So we are asking you, the next generation, what you think about the moral and ethical considerations of bottled water and the implications for today’s world? Of note, both Pepsi and Coke have documented commitments to social and environmental sustainability.
Should water be allowed to be sold commercially? Should it be free?
Is it ethical for companies like Coke and Pepsi to exact such a huge profit for bottling what is
basically tap water? What could they do to make this practice more ethical?
Should the free-market economy dictate how water is sold and distributed?
Is it morally acceptable for unhealthy soft drinks to be cheaper than water?
Apologies to poet Samuel Taylor Coleridge for paraphrasing a line from “The Rime of the Ancient Mariner” who preceded the Boomers by two hundred years! https://www.poetryfoundation.org/poems/43997/the-rime-of-the-ancient-ma…
Part II, Stanza 9
“I’d Like to Teach the World to Sing in Perfect Harmony” Coke “Hilltop” Advertisement
“How Pepsi and Coke make millions bottling tap water, as residents face shutoffs | US News | The Guardian- Ryan Felton of Consumer Reports, 23 April 2020.
Case 9: DNR During COVID
The Covid pandemic has enabled a number of ethically fraught clinical situations that could not have been anticipated prior to its onset. The health care systems of every country were affected, and there were widespread issues of scarce resources, like shortages of equipment, PPE, staff, and available vaccines.
This case focuses on a longstanding sacrosanct policy, at least in the English-speaking world, about the end of life, the DNR (Do Not Resuscitate), which are orders not to revive the patient if they stop breathing.
In the US, federal law mandates that all patients admitted to health care institutions, such as hospitals, clinics, and ERs, must be asked if they have a documented stance on what to do in case their breathing stops and, if they don’t, the admitting entity must offer to help them complete one. Individual states have more specific and contingent laws that discuss how and who can help complete such DNR orders.
During the Covid pandemic, we saw—for the first time--- blanket DNRs, which are DNRs issued for large groups of people, often without their consent. In England, a watchdog organization for human rights found more than 500 cases where DNR decisions were made without discussion with the patient or their family, and that blanket DNRs were in effect for everyone starting March 2020. In the US, various states and health care organizations developed their own set of criteria about blanket DNRs and, again, there are multiple examples of patients with DNR status, though patients and their families were not consulted about their status.
Most health care providers who support blanket DNRs argue that there just aren’t enough public resources to do things the normal way, and that we need blanket DNRs, otherwise we would be using up a lot of resources to save people who are more than likely going to die anyway. Consider how providing CPR to a COVID patient puts the CPR providers at great risk, and how a lot of medical technology—which would otherwise have helped other patients—would have to be used on patients who were unlikely to make it. Defenders of blanket DNRs said that “times were desperate,” and that this pandemic was like the special circumstances during wartime. In war, we don’t distribute resources equally to everyone; some people have to be let go for the good of the majority. As it is sometimes said: “Desperate times call for desperate measures.”
1. Are blanket DNRs obtained without the patient’s consent ethically permissible or impermissible? Why or why not?
2. Does protecting the general good health of most patients in society supersede any individual patient’s right and autonomy to decide whether they should be revived or not? Defend your answer.
3. What should a clinic’s guiding moral principle be during Covid? Should the medical community care more about saving the most sick lives that they can even if that means letting some patients die and lose their autonomy, or should they focus more on respecting the rights of every patient even if many others could suffer as a result? Or some combination of the two? Explain and defend the answer you choose.
DNR and COVID-19: The Ethical Dilemma and Suggested Solutions
Hala Sultan,1,† Razan Mansour,2,† Omar Shamieh,3 Amal Al-Tabba',4 and Maysa Al-Hussaini5,* Front Public Health. Published online May 12, 2021; 9: 560405
Covid-19 concerns over ‘do not resuscitate’ decisions during pandemic . https://www.bbc.com/news/health-56435428
Author Bio (Cases 8 and 9):
Teri Turner graduated from the University of Michigan with a BSN and MS, and also took coursework in Bereavement Studies at Madonna University. Her work experience includes oncology in the University of Michigan hospital network and international work in nursing administration and education in the Middle East. She has worked in hospice and palliative care since 1992 and currently serves as a compliance officer and consultant for Angela Hospice, focusing on ethics, implicit bias and compassion fatigue. Teri has also taught at or guest-lectured at Eastern Michigan University and the University of Michigan on a number of subjects; sits on the board of A2Ethics and the Children’s Palliative Care Coalition of Michigan, and volunteers as a docent at the University of Michigan Museum of Art.
Case 10: Loyalty in Professional Sports
Lebron James is a professional basketball player who grew up in Akron, Ohio. Coming out of high school in 2002, it was predicted that he would become one of the best basketball players in the country. It was further claimed that he was the most talented rookie out there. In the NBA draft, James was the Cleveland Cavaliers’ first pick. The prediction came true. James quickly became one of the League’s best players, and over the first few years of his career, he helped make the Cleveland Cavaliers into one of the best teams in the League.
The team failed, however, to win a championship during his first eight years in Cleveland. Though he was an excellent player, striking fear in his opponents, the final shot just never seemed to count in favor of a Cavalier victory in the finals.
In 2010, James’ contract expired with Cleveland. He was contacted by several other teams, all of whom tried to convince him to leave Cleveland to join them. After a week of recruitment, James announced on live television that he was leaving Cleveland to join the Miami Heat. The Cavaliers’ owner and many Cleveland fans shamed James, saying that he was not loyal to the team and city to whom he owed his career.
We often believe that successful athletes have an obligation to their teams, even though they are paid employees who can be fired for poor performance. Why do we expect an obligation of loyalty to a sports team, when we don’t typically expect an employee to be loyal to their company? Is there a morally relevant difference between the two cases and, if so, what is that difference?
What is the moral responsibility of athletes to the sports teams and communities in which they are based? Is our feeling that there is an obligation for an athlete to be loyal to a team and their city a real obligation, or are we mistaken?
James returned to Cleveland in 2014 and helped Cleveland win the city’s first sports championship in more than 50 years. If it was wrong for him to leave the team and city in 2010, does his return in 2014 make up for and excuse his leaving? More broadly, can the fact that we do something later to correct a wrong truly ever make up for it?
Gabe Kahn grew up in Austin, TX, so he wasn't exposed to A2Ethics and the Ethics Bowl until he joined as an intern during his last semester at the University of Michigan. His time as an intern emphasized the complexities of so many of the decisions we take for granted in our everyday lives, and he was drawn to the idea of consistently challenging his ethics and beliefs through respectful conversation with others. Gabe currently works in Capital One's credit card business in the Washington D.C area. Both living in the nation's capital and working in consumer finance has emphasized the importance of promoting conversation about complex ethical dilemmas we face in our personal and work lives. Gabe was honored to accept the Board's offer to join in June 2020 to help promote and fulfill A2Ethics' mission.
Case 11: Drug Use in the United States
Substance use disorder is the medical diagnosis for a person who uses drugs (e.g., alcohol, cocaine, prescription opioids) even though their drug use creates significant problems for their mental or physical health. According to the DSM-5, which is the manual used to assess and diagnose mental disorders, substance use disorder comes with a whole host of symptoms. Individuals with substance use disorder can face severe social impairment, like an inability to reliably care for one’s child; physical impairment, like chills, aches, seizures, dizziness, vomiting, or fever; and mental illness, like anxiety, depression, paranoia, mania, or hallucinations.
While substance use disorders are recurrent and often serious, most experts agree that they are treatable. Treatment aims to help people reach long-term recovery from their drug use, which often includes weaning off the drugs completely. Treatment is unique for every individual, and there are many available therapies for drug use and the individual’s hampered social, mental, and physical health. But as the National Institute for Drug Abuse explains, substance use disorder is a chronic disease with frequent relapses (i.e., return to substance use during treatment), so individuals need long-term support to stay in long-term recovery.
All of this said, substance use disorders are often treated differently than other disorders. Terms like “alcoholic” and “drug addict” carry different meanings than “cancer patient” and “physically disabled.” In the United States, people who use drugs in illegal contexts are deemed criminals, and they are punished as such. Many people believe that addiction is a choice, and that people who use drugs are weak-willed and that they choose to continue illegal and dangerous behavior despite the costs to their own health, friends, and family. Stigmatizing language like “addict,” a criminal record related to drug use, and general ill perception from society makes it more difficult for people who use drugs to find effective treatment for their problem and improve their health.
People who stigmatize addiction would also say that they want to reduce the negative consequences associated with drug use, and to help people who use drugs get better. Indeed, they would say that it is a good thing to help these people. To that end, should we always refrain from using the language of shaming and blaming when talking about substance use and shift, instead, to the language of understanding and compassion? What moral goods and bads do we stand to incur by shifting in this way?
Like many medical conditions, we have an understanding of why people use drugs, and the evidence indicates that a person’s environment plays a large determining role in their risk of addiction. A person in certain conditions is very, very likely to become addicted to drugs. If it is indeed true that for many people who use drugs, because of situations not of their own making, but a result of circumstances outside their control, should we excuse and forgive the moral wrongs that they may do--stealing, neglecting a child, say--in the process of struggling with addiction? Defend and explain your answer.
There is evidence that people who use drugs are often self-treating their chronic pain, anxiety, depression, and other symptoms via the drugs. As a matter of distributive justice, should governments and policy makers spend public resources--particularly tax money and state funding, medical staff and technology--to provide people with chronic pain, anxiety for example, another form of treatment rather than self-treating via legal and illegal substance use, though those resources might otherwise have been used to help a larger number of people by building roads and funding cancer research, for example? Why or why not?
https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use… https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-d… https://www.cdc.gov/alcohol/features/excessive-drinking.html
Kate Leary is a research administrator and project manager at the University of Michigan Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center). At the DASH Center, she prepares applications to the NIH, the FDA, and other funders so that DASH Center researchers can continue to study substance use and its consequences. She graduated from the University of Michigan in 2017 with a B.S. in Philosophy. While at Michigan, she was a member of the University of Michigan Ethics Bowl team. Kate has stayed involved with the Ann Arbor ethics community by writing cases and serving as a judge for the Michigan High School Ethics Bowl. Outside of work, Kate spends her free time writing, baking, cooking, and learning new sports (currently climbing).
For information on the DASH Center: Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center)
Case 12: Suffering in the Wild
Throughout most of human history, we have lacked the capacity to significantly reduce wild animal suffering. Recently this has changed. In some countries, wild animal populations are currently being vaccinated against diseases, such as rabies, that threaten domesticated animals or humans. In the future, larger-scale interventions may become feasible, as there are ongoing research efforts to explore effective ways of reducing the suffering of wild animals. Potential methods to reduce wild animal suffering include birth control and more extensive disease management. Even more ambitiously, some argue that gene editing technologies could be used to reduce the ability of wild animals to feel pain, change the reproductive strategies of animals so they have fewer offspring, or turn carnivores into herbivores.
In recent years, some philosophers, zoologists, and animal rights activists have argued that when it is in our power to reduce the suffering of wild animals without significant unintended negative consequences, we ought to do so. Since wild animal suffering is bad, we ought to prevent it if we can, as long as we don’t thereby sacrifice anything of comparable moral importance. At the very least, some argue, we should invest more resources in researching potential interventions and their possible ecological effects. And others reason that since human actions already have massive effects on wild animals (via climate change and habitat destruction, for example), we should do our best to make our overall impact on wild animals a more positive one.
However, some critics worry that disrupting complex, dynamic ecosystems may, despite our best efforts, produce significant negative unintended consequences. Relatedly, some feel that by intervening, we are meddling with the natural order, or coercively interfering with the lives of wild animals in an objectionable way. Others argue that rather than devoting our attention to the suffering of wild animals not caused by human activity, we should focus on the suffering of non-human animals for which humans are responsible (such as the suffering of factory-farmed animals).
Moreover, some critics argue that the scale of wild animal suffering is so large that there is unlikely to be a feasible, cost-effective way to address it. And others object that more radical proposals to reduce wild animal suffering—such as eliminating carnivores—require the mass extinction of species which bear sacred, irreplaceable, or intrinsic value.
Should we intervene to reduce the suffering of wild animals if we can safely and effectively do so?
When is intervening to help others morally permissible or morally required, and when is it objectionably coercive or paternalistic?
Does being “natural” make something more valuable or worth preserving?
From the National High School Ethics Bowl 2021-2022 Regional Case Set Writing Committee.
Case 13: Predictive Policing
Recently, the Pasco County Sheriff’s Office (PCSO) in Florida sent out a letter to some of its residents informing them that they had been selected to be enrolled in the Prolific Offender Program. Here is an excerpt from the opening lines:
‘This program provides you with an opportunity to receive assistance from the Pasco Sheriff’s Office and several community partners who will work with you to identify and overcome barriers that have hindered you in your life’s journey. Ultimately, the goal of this program is to empower you to live a lawful, productive and fulfilled life.’
The program uses various metrics, including, “an evaluation of your recent criminal behavior using an unbiased, evidence-based risk assessment” in order to identify what it called, “prolific offenders in our community.” The letter claims that barriers to “successful living” include struggles with mental health, substance use disorder, domestic violence, homelessness, and employment. Enrollment is based on those criteria. Enrollees who refrain from criminal activity for two years are removed from the program.
PCSO also created a program designed to detect potential crimes and stop them before they happen. To do this, the office would use a variety of metrics including “arrest histories, social networks, and unspecified intelligence in order to create a list of potential criminals.” They would then use the list to preemptively investigate these individuals and perform regular checks on them.
PCSO and its supporters claim that these are innovative ways to prevent crime and to conduct policing in a less reactionary manner. By using known metrics that lead to criminal activity, police might be able to intervene before someone even has the opportunity to commit a crime. Part of this prevention might involve providing would-be offenders with the support they need in order to cut down on potential risk factors, including mental health care, support for substance use disorders, assistance in finding work or a place to live, and so on.
People who oppose these kinds of programs claim that it is overreaching and authoritarian. It leads to the kind of over-policing witnessed in the case where “deputies gave the mother of one teenage target a $2,500 fine because she had five chickens in her backyard.” Having some risk-factors associated with criminal activity is a far cry from actually committing crimes. Furthermore, regardless of how likely someone is to fall into criminal activity, perhaps no one should be subject to intervention and investigation until they actually commit a crime.
What difference is there between predictive policing tactics that focus on prior offenders and those predictive policing tactics which focus on preventing non-offenders from becoming offenders?
Is it responsible for police departments to try to participate in preventative policing by stopping crimes before they happen? Is there a right and a wrong way to go about doing that?
Is there ever a time when certain “risk factors” should ever be considered in beginning an investigation?
Does something like the Prolific Offender Program run contrary to a notion in our justice system of “innocent until proven guilty?” Does it assume guilt on behalf of those that it enrolls in the program?
From the National High School Ethics Bowl 2021-2022 Regional Case Set Writing Committee.
Case 14: Just the Facts
On May 19, 2021, journalist Emily Wilder was fired from the Associated Press after three weeks on the job. Wilder, who is Jewish, was fired after right-wing media sources began publicizing her involvement in pro-Palestine activism in college, and drew attention to tweets she had made about the topic.2 In late May 2021, Alexis Johnson was told by her employer, the Pittsburgh Post-Gazette, that she would not be allowed to cover the Black Lives Matter movement. Johnson, who is Black, was told this was because she had demonstrated bias in a tweet that she had posted the day before. Felicia Sonmez was banned in 2018 from reporting on cases dealing with rape and sexual assault at her job at the Washington Post after she wrote about her experience as a survivor of sexual violence.
Some people see these actions by news organizations as justified measures to protect the objectivity of the reporting in question. News organizations should strive for objectivity, and this is impossible when the person reporting has made it clear that they have strong personal views on the matter. Most reporters have opinions about the things they report on. However, they are expected to put these opinions to one side while they are reporting. It is inconsistent and irresponsible, one might argue, only to prevent those who are public about their opinions (or, in the case of Sonmez, their experiences) from reporting on controversial issues. It may also constitute discrimination.
What is better, say critics of objectivity, is to report the facts while also acknowledging one’s (limited and biased) point of view. This is a sign of humility, and it may also have the benefit of opening up more ethical reporting standards. Perhaps shrugging off the myth of objectivity would release journalists from lending undue credence to what they take to be morally problematic stances, in the name of remaining neutral.
However, if objectivity and neutrality are completely discarded, some worry that this would effectively mean the end of fact-based reporting. This brings to the fore another important issue: trust. If media consumers find out that a story was written by someone who has an undisclosed personal stake in the matter, this might erode the trustworthiness of the reporting or the news outlet. This, according to Felicia Sonmez, is the reason that she was not allowed to cover stories involving sexual assault. “The reason I’ve repeatedly been given by senior editors,” she said in a tweet, “is that they are worried about the ‘appearance of a conflict of interest’ if they allow me to write on sexual assault. They’ve told me they don’t believe there’s an actual conflict, or even that my writing would be biased in any way.” Thus, even if Sonmez can report responsibly on these issues, perhaps she should not be permitted to do so, given the fact that some readers might believe her to be untrustworthy.
Do news organizations have an ethical duty to maintain a certain relationship to the general public? If so, what is the nature of that relationship?
In which contexts, if any, is it permissible for employers to restrict (or impose consequences for) their employees’ speech outside of work hours?
What, if any, is the value of objectivity in journalism?
https://www.thecut.com/2020/06/black-reporter-barred-from-covering-blm-… https://www.theguardian.com/commentisfree/2021/mar/30/washington-post-f… t-sexism
https://lawandcrime.com/high-profile/washington-post-reporter-sues-the-…- discrimination-claiming-she-was-punished-after-sexual-assault-disclosure/ https://medium.com/@lewispants/objectivity-is-dead-and-im-okay-with-it-… https://twitter.com/feliciasonmez/status/1376274971207602184
From the National High School Ethics Bowl 2021-2022 Regional Case Set Writing Committee.
Case 15: Paralympic Pay Parity
The Tokyo 2020 Summer Olympics, held in summer 2021 due to COVID-19, was the first time that the U.S. Paralympic athletes received the same monetary prizes for winning medals as the Olympic athletes did. After public outcry in 2021 because Australian Paralympians received no prize money at all, the Australian government also committed funding such that both Olympians and Paralympians would receive the same prizes. Advocates of Paralympic pay parity argue that it is an important way to signal to athletes that they are equally valued and celebrated as representatives of their countries. They also argue that the prize money can play a significant role in offsetting the costs of training, especially for Paralympians who are less likely to sign high-paying sponsorship deals.
However, other countries do not take the same approach. Canadian Olympians get up to $20,000 for winning, whereas Canadian Paralympians win no money for medaling. This difference is due to the fact that different organizations run the Canadian arrangements for the Olympic and Paralympic Games. One organization has the funds to offer medal prizes and the other simply does not.
Japanese Paralympians do win cash for medaling, but at lower amounts than Japanese Olympians. The Japanese Para-Sports Association (JPSA) explained that the disparity between the prize value of a gold medal for a Paralympian and an Olympian comes in part because the JPSA prioritizes having prize money be distributed more equally among all three medal levels. And, Japan offers non-prize financial support to meet the unique challenges faced by Paralympic athletes, by sponsoring needs like prosthetic limbs and medical treatments.
Explanations of the pay disparities cite that the Olympics is much more popular than the Paralympics among viewers and attendees. Critics of the activist movements for equal pay argue that focusing on having equal prize money only benefits the small percentage of athletes who actually win. They also worry that it distracts from the larger need of directing funding to increasing sports access at all levels, not just at the elite stage.
Though some countries do pay their athletes outright, in other countries, including the U.S. and Canada, medal prizes are not considered payment for work, like salaries. The athletes are not employed by the government nor by a private organization. In these countries, no athletes, Olympians or Paralympians, earn salaries for competing. If prize money is an extra bonus for athletes and not their primary income, then the governments or private organizations that give the prize money do not have an employee-employer obligation in which athletes can expect to rely on receiving payment.
Do governments have an obligation to provide equal award money for Paralympians and Olympians, either by paying them directly or by paying their organizing committees?
Does it matter that the medal awards are prize money and not salaries? Do countries who do pay athletes need to pay them equally, regardless of which competition they play in?
Ought public popularity and viewership to be factors in determining athlete pay?
From the National High School Ethics Bowl 2021-2022 Regional Case Set Writing Committee.
Case 16: Familial Obligations
Amir is an immigrant to the United States, and has been living in Denver, Colorado, for just over ten years.
Both he and his wife work very hard, sometimes holding down multiple jobs each. However, these jobs are low-wage, and the family’s expenses are high, especially the medical bills for one of their children, who has a number of health issues. As a result, Amir’s family is poor, and they often feel like they are just barely able to make ends meet.
Amir's sister, Yusra, is still in their home country of Lebanon, where she lives with her four children. She is a widow, and Amir and Yusra’s elderly mother also lives with her. The poverty they live in is much more severe than any poverty Amir has experienced in the United States and has grown especially dire as the country endures a financial crisis. Yusra was thrilled when her brother was finally able to move to the U.S. She was happy for Amir’s family, but also her own. She imagined that he would be able to send some money back home to help her larger family there. They all understood that it might take Amir a few years to establish himself, but now that ten years have passed, they are confused and frustrated because he has not sent money. They tend to think that he doesn’t sufficiently care for his extended family back home, and they have remarked that he must think he's too good for them now that he has a new life elsewhere.
Everyone back home believes that Amir is quite wealthy because he lives in the U.S. Thus far, he has done nothing to contradict their impression. He would feel embarrassed and humiliated if they found out how much he was struggling financially. He also thinks it would deeply upset his mother to know that her son and grandchildren are suffering. So, Amir continues to let his family believe that he's well-off and thriving in America. At least this way, he reasons, his mom is happy for him and proud that her son is so successful. Amir does sometimes feel terrible for giving his mother a false impression, but he tells himself that there’s no point in breaking her heart with the hard truth. He’s resigned himself to the thought that when his children want to visit their family back home, they can bring gifts for everyone, but otherwise, he can’t contribute much. He certainly won’t be sending money regularly. Amir often wonders if he’s doing the right thing.
Has Amir done anything wrong?
Does Amir have an obligation to share details about his financial situation with his sister or mother?
Is Amir morally obligated to help his family back home financially? Would a change in his own financial situation change your answer?
From the National High School Ethics Bowl 2021-2022 Regional Case Set Writing Committee