Comment(s) Of The Day: “Ethics Quiz And Poll: The Nurse Practitioner’s Dilemma”

We have a rare two-headed Comment of the Day on “Ethics Quiz And Poll: The Nurse Practitioner’s Dilemma,”about the nurse practitioner’s dilemma when she was asked by a poor, unmarried, 16-year-old , unemployed high school drop-out to help her get pregnant. Taking a minority position among commenters (the post’s poll results overwhelmingly favored counseling the girl against pregnancy), commenter valkygrrl wrote,

“Assuming the local age of consent laws make the pairing lawful, I think we have our answer in regard to professional ethics:

(f) Not discriminate against patients who have difficult-to-treat conditions, whose infertility has multiple causes, or on the basis of race, socioeconomic status, or sexual orientation or gender identity.

Assuming the local age of consent laws make the pairing lawful, I think we have our answer in regard to professional ethics.”

Commenter Tony, a physician, added in his Comment of the Day #1, Continue reading

Comment Of The Day: “Ethics Quiz And Poll: The Nurse Practitioner’s Dilemma”

As I thought it might, the Ethics Quiz about “The Ethicist’s” position that a nurse practitioner was obligated to help an unemployed, unmarried, 16-year-old high school drop-out get pregnant provoked a lot of discussion. Here is how the poll results on the issue are running:

And here is Arthur in Maine’s Comment of the Day on the post, “Ethics Quiz And Poll: The Nurse Practitioner’s Dilemma”:

Yikes. I know you hold Appiah in high regard, and your previous posts about his work make clear why. But I agree with you – he’s very much in the wrong on this one.

Many years ago, I worked in a group home for adjudicated teenagers. We had several 15 and 16 year old girls who, like the girl in question, actually wanted to become pregnant (thank God none of them managed to achieve this goal on our watch).

I recognize that my sample size is small enough that this is nothing more than anecdotal – but as far as I’m concerned, well-adjusted 16-year-old girls may adore babies and kids but understand that now’s not the time. To desire pregnancy at that age requires one or more underlying pathologies. Continue reading

Ethics Quiz And Poll: The Nurse Practitioner’s Dilemma

Sure.

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.”

Really? Continue reading

A Professional Ethics Case Study…From Broadway

Before you read the post, can you guess who that actor is in the Afro?

Lately I’ve been helping a lot of lawyers seeking to create so-called Rule 5.4 law firms in the District of Columbia. In these firms, unique to the District, non-lawyers can be full partners. This means that they can share in the firm’s fees, which is something otherwise forbidden and a major ethics breach in the 50 states. Lawyers cannot, must not, dare not share their fees with non-lawyers…unless those non-lawyers are partners in the same firm.

There are certain requirements for that to happen, and the main one is that the non-lawyers must be supervised by a lawyer in the firm to ensure that the non-lawyers don’t engage in conduct that would be unethical for a lawyer.  The legal profession is justifiably wary that the unique priorities of the legal profession cannot be easily absorbed or understood by those who have been trained and influenced in a different culture.

It is right to be wary. Lawyers have enough trouble avoiding violations of their own rules; doctors, accountants and others, steeped in different alignments of values, can’t just shift gears like suddenly being in a law firm is like test driving a sports car. For so-called “non professionals,” a category that is increasingly contentious, it may be even harder to adjust, if not impossible.

Lawyers are often  overly optimistic about their non-lawyer partners’ ability to learn the importance of keeping all client confidences, not crossing over into the unauthorized practice of law, sensing possible conflicts of interest and illicitly soliciting clients, or engaging in misrepresentation and deceit, to name just a few. Lawyers tend to think that all professional ethics should be fungible. It’s a dangerous misconception, and there is a little cautionary tale from, of all places, Broadway, that illustrates it.

It has been mostly forgotten, but in 1969, a musical called“Buck White” opened at the George Abbott Theater. Its unlikely star: draft-resisting ex-heavyweight boxing champion Muhammad Ali.

Yes, you read that correctly. Continue reading

From The Ethics Alarms Archives: “Age and the Judge,” And A Current Day Example.

The discussions regarding Joe Biden’s age-related decline reminded me of a post that had been languishing on the runway since mid February. It was prompted by a tip from Neil Doer (I think it was Neil) who pointed me to this article about  a well-respected federal judge in Brooklyn, Jack B. Weinstein who was retiring after more than a half-century on the bench. He’s 98 years old, and it seems like he’s been an outstanding judge. My position was and is, however, that it is unethical for a judge, and indeed any professional, to continue in a position of responsibility at such an advanced age.

Obviously, I would apply that principle to politicians and leaders as well. This is another area where professional sports, especially baseball, provides useful case studies that can be instructive. Players who were great at 25 are also better when they are 40 than the more average players, whose natural decline as the result of aging will usually cause them not be able to perform  at an acceptable standard by late middle age. The great player often will still be good, but almost no player (almost) will be as excellent in his late 30s and early 40s as he was in his prime. As the financial benefits and other perks of playing major league baseball have increased over time, fewer aging greats are willing to go gentle into the good night of retirement. Their last years are often sub-par, certainly for them, or worse, but they will not voluntarily retire. Check the records of Miguel Cabrera, Pete Rose, Willy Mays, and Mickey Mantle, to name just a few.

Famously brilliant and contrary judge Richard Posner took the unpopular position among his colleagues that federal judges ought to have a mandatory retirement age. He recommended 80, but in his own case, when everyone expected him to stay until the bitter end, he retired at 78, because, he said, it was time. I’m not convinced that 80 isn’t still too old, but at least it’s a limit.

I remember well my one meeting with Antonin Scalia at a bar function not long after he had joined the Supreme Court.  He was relaxed and jovial, and when I asked him how long he thought he’d stay on the Court, he laughed and said that he couldn’t imagine staying until they “carried him out,” like so many other justices. He said it was important to leave the bench “while you still have most of your marbles.,” and to him, this meant before 80. He said he would stay about ten years.

Antonin Scalia died while still on the Court, in his 20th year of service, just short of his 80th birthday.

Here, from 2009, is “Age and the Judge.”

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Continue reading

The Three Circles, Prime Directives, And President Trump [With Addendum]

I can’t believe I have never written about this diagram before, but apparently I haven’t. That’s my fault, and a major one.

The diagram, the creation of my friend, attorney John May, shows the inter-relationship of the three ethical systems professionals must employ when they face ethics problems. For although we tend to think about making decisions in one context, there are several, and which sphere—these are circles after all—we choose will often determine what balance of values, principles and outcomes dictates the ultimate course.

Here are what the circles represent:

The Big Circle, in yellow, includes the ethics culture that we all live in. It includes our nation, society, community, family, and friends, and is a messy, inconsistent, multi-faceted, often contradictory melange of traditions, religion, customs, literature, history, heroes, fables, family influences, teachers, peers, laws, and more. This the largest system of all, the sun to the planet-sized influence of the other two systems. within it are not only the often competing ethics theories of Reciprocity, Absolutism, and Utilitarianism, but also all the variations in between and beyond–Ayn Rand, Nietzsche, Marx, and many others. In his invaluable book “The Science of Good and Evil,” Michael Shermer posits that despite all the internal inconsistencies, the Big Circle is remarkably functional, agreeing on what is right and wrong perhaps 97% of the time. The disagreements are in the realm Shermer calls provisional ethics,  akin to what Ethics Alarms is referring to when it cites The Ethics Incompleteness Principle. These are the troublesome problems where the usual principles don’t always work.

 

The Core Circle, in green, represents the values, principles, beliefs and the priority of these for an individual–you. It comprises all of those, plus such core qualities as conscience, self-esteem and courage. It’s location in the Big Circle varies with the individual. A section of it even may protrude outside Big Circle, representing the degree to which a person does not embrace the values of his or her community or culture.

Finally, there is the Compliance Circle, in red. That circle defines the special ethics of a profession, and includes ethics codes, traditions, aspirational values and professional obligations and duties.

Notice that part of the Red Circle is outside the Yellow one. These are the values about which a profession is bound to adhere to at all costs, even though the society at large often and even usually does not have the same ethical priorities. Quoting Star Trek, this is Prime Directive territory. In Gene Roddenberry’s fictional Star Fleet, it was forbidden to use the immense power a starship could muster to interfere with a planet’s inhabitants and their conduct, even to prevent what appeared to be a horrible wrong.  This principle would be repugnant to the the public at large. For example, if a starship had an opportunity to stop a genocidal race from wiping out another race on its planet, the Prime Directive would make it a crime to do so. The Big Circle would certainly view this as monstrous, but the Prime Directive wisely holds that interference must be avoided. Continue reading

From The “How Often Can Something Like This Happen In An Ethical Profession?” Files: The Art Teacher’s Meltdown

I know a lot of teachers get angry with me for my increasing certitude that they are in an unethical profession with some ethical members (like them), rather than an ethical profession with isolated unethical exceptions. This incident supports my critical views. Unless mental illness is involved, an adult doesn’t belong to a profession with well-defined standards and ethics rules and act like this.

At W.H. Adamson High School in Dallas, Texas, art students were treated to an epic meltdown by their teacher, Payal Modi, who screamed “Die!” and shot President Trump’s image on the screen with a water gun as students watched his inauguration on TV.  A student caught this on video, and Modi, who was proud of the planned display, posted it to her Instagram account.

This is more political indoctrination the classroom, which educators not today only tolerate but nurture. A teacher modelling violence toward any individual, but especially the President of The United States, in front of students, is such a stunning breach of professional ethics that no teacher should  have the idea even flicker across her mind. Payal Modi planned it.  A teacher who behaves like this cannot be trusted with students. A teacher like Modi calls into question everyone and every institution connected with her.

Adamson High School assistant principal Bobby Nevels confirmed that Modi shot the squirt gun at the TV, during class and in front of students. It is six days later. Why does she have a job? Why has the school not made a public apology? Why hasn’t the teachers’ union condemned her actions?

In eight years, no teacher did anything displaying close to this level of hostility and disrespect to President Obama. What do you think the reaction would have been by a school district if one had? Would the official position be, as Nevels’ was, “The district will not comment on personnel issues.” How about reassuring parents and the public that the district recognizes that this isn’t just a personnel issue, but an incident that calls into question the integrity of the education system and the  teaching profession? Modi is the product of an unethical culture that is rotting public education from within.

Is there a specific Teachers Code of Conduct provision, enforced and universal, that would guide a teacher not to do something this outrageous? The NEA has a Code, but there is no enforcement mechanism. There is also no prohibition against demonstrating hostility and disrespect toward public figures, or engaging in violent displays in class. Here are the provisions relevant to Modi’s meltdown: Continue reading