It is seldom that I strongly disagree with NYU philosophy professor Kwame Anthony Appiah, “The Ethicist” of the New York Times Magazine’s long-running advice column. A month ago I did, and emphatically so.
The question posed to him involved a professional ethics dilemma, and “The Ethicist” was so certain he had the correct answer that he was uncharacteristically terse about it. I’m pretty certain about the answer too, except that my certainty is that he’s wrong. But I have some doubts, based on my ethical positions in related situations.
The inquirer was a a nurse practitioner working at a primary care clinic for low-income patients. She said that a 16-year-old patient told her that she had stopped coming by the clinic to have her birth control pills replenished because she and her partner were trying to have a baby together. She had been having unprotected sex for a while, and she was concerned that she might have some physical problem preventing her from conceiving. The nurse practitioner asked, “Would it be ethical for me to steer her away from trying to get pregnant? …Or, as her health care provider, do I have an ethical duty to try to help her conceive?”
Appiah doesn’t see any wiggle room. He says,
“You’re her health care provider. You should certainly tell her about the medical consequences of pregnancy. But the social and economic consequences don’t fall within your professional competence. An intervention about her life choices may seem moralizing and intrusive to her, and it could drive her away; and then she’d be losing your guidance on the things you are trained to help her with.”
We are told that the woman 1) is 16, 2) is not attending school, 3) is unemployed, 4) is not married, and that her “partner” has a “steady job,” whatever that means. Moreover, regardless of how steady a job he has, the partner, assuming he is an adult, is committing a couple of crimes, including statutory rape. On a more mundane level, however steady it may be, his job is not so well-paying that his intended baby-mama can get her medical care somewhere other than a clinic for low-income patients. I would add, though this might be harsh, that the young woman is naive, ignorant, and quite possibly not very bright. The nurse practitioner would be, in my view, professionally and from a general ethics perspective negligent not to explain to the girl why having a child under these conditions is irresponsible and reckless.
My position is informed by my professional ethics perspective which is, admittedly, heavily influenced by specializing on legal ethics. Though ethics priorities differ among the professions, the basic principles are the same. All professions exist to benefit society and human beings generally. In the ethics rules/guidelines lawyers must follow, ABA Rule 2.1, on the topic of advice, states,
In representing a client, a lawyer shall exercise independent professional judgment and render candid advice. In rendering advice, a lawyer may refer not only to law but to other considerations such as moral, economic, social and political factors, that may be relevant to the client’s situation.
A Comment adds,
Advice couched in narrow legal terms may be of little value to a client, especially where practical considerations, such as cost or effects on other people, are predominant. Purely technical legal advice, therefore, can sometimes be inadequate. It is proper for a lawyer to refer to relevant moral and ethical considerations in giving advice. Although a lawyer is not a moral advisor as such, moral and ethical considerations impinge upon most legal questions and may decisively influence how the law will be applied.
I see no reason, ethically, logically or practically, why this should not apply to other professionals as well. The second reason I find Appiah’s advice inappropriate in this situation is the Ethics Alarms principle, “If circumstances place you in the position to fix a problem, and you have the ability to do so, fix it. Don’t look for reasons to pass the buck.”
It doesn’t require professional economic or societal expertise to recognize that the girl’s plan is a recipe for disaster. The nurse is the one currently in a position to—perhaps— save the young woman from a life-wrecking choice. She has an obligation as a human being, not merely a medical professional, to make the effort. So what if the advice seems “moralizing and intrusive” to the girl? Find a way to get her to listen. If the nurse drives her away, the girl is in no worse straits than she is already. Find her a counselor. Make the effort to see that she talks to someone skilled and persuasive.Do something.
Do not help her get pregnant. Nurses are also bound by the general ethical edict not to do harm. Harm is not always defined by the patient, as the “Please cut off my arm, it is possessed” cases show. It is objectively harmful for this young woman to get pregnant in the situation presented. You don’t need a professional certification to make that call. You need a modicum of awareness, a functioning cerebrum, and courage.
The fact that this case involves the criminal exploitation of a minor and a sex crime makes it easier for me than if the young woman were past the age of consent. The position here on Ethics Alarms regarding doctors, nurses and pharmacists refusing to do their jobs because they have moral objections to an individual’s need, be it a birth control prescription, an abortion or a same sex marriage is that their ethical options are to so their jobs or find another field, unless they received consent for their conscientious objections at the time they were employed. But the objection to the 16-year-old’s plan doesn’t have to be moral; it’s objectively wrong on practical grounds. The fact that the nurse would also be assisting in the corruption of a minor and allowing statutory rape to continue takesrefusing to help the girl get pregnant out of any professional obligations, or should.
Your Ethics Alarms Ethics Quiz to begin this Tuesday is..
Who’s right, “The Ethicist,” or this ethicist?
And because I am curious about how the opinions are distrubuted, here’s a poll: