5. Hot Gifts

       Rose Stone moved into an urban ghetto in order to study strategies for survival used by low-income residents. During the first six months of research, Stone was gradually integrated into the community through invitations (which she accepted) to attend dances, parties, church functions, and family outings, and by “hanging out” at local service facilities (laundromats, health centers, recreation centers, and so on). She was able to discern that there were two important survival tactics used by the community residents which she could not engage in: the first was a system of reciprocity in the exchange of goods and services (neither of which she felt she had to offer), and the second was outright theft of easily pawned or sold goods (clothing, jewelry, radios, TVs, and so on).

        One night, a friend from the community stopped by “for a cup of coffee” and conversation. After they had been talking for about two hours, Stone’s friend told her that she had some things she wanted to give her. The friend went out to her car and returned with a box of clothing (Stone’s size) and a record player. Stone was a bit overwhelmed by the generosity of the gift and protested her right to accept such costly items. Her friend laughed and said, “Don’t you worry, it’s not out of my pocket,” but then she became more serious and said, “Either you are one of us or you aren’t one of us. You can’t have it both ways. ”

        Suspecting that the items she was being offered were probably “hot” (e.g., stolen), she was afraid that if she wore the clothes in public, or had the record player in her apartment, she would be arrested for “accepting stolen goods.” At the same time, she knew that “hot” items were often given to close friends when it was observed that they could use them. Still, this implied that there would be reciprocal giving (not necessarily in kind) at a later date. So, should she accept or refuse the proffered gifts?

4. Falsified Data

        Mickey Jordan had developed a collaborative social-impact assessment project involving two colleagues and three students. The six-person team was responsible for collecting field data in a wide geographical area at some distance from their university. Each person was responsible for a specific region. The data were fed, by region, into a computer on a weekly basis and monthly meetings were held so that progress reports could be made by team members. At these meetings, names of individuals who had been interviewed during the preceding period were given as a means of checking off the list of identified community specialists, so that the overall progress of the project could be ascertained. Information filed in the computer did not contain informants’ names or other identifiers, as a measure for maintaining confidentiality and anonymity of informants. Each member of the team was paid by the funds made available through a contract with a federal agency (the faculty members were able to buy release time from teaching with contract funds).

         Jordan had an occasion to be in the region assigned to one of the faculty members, Brian Cash, and happened to find himself talking with one of Cash’s reported informants, Henry Jones. Jordon took the opportunity to ask Jones for clarification of reported data that had puzzled him. Jones appeared confused and asked Jordan why he was asking him “these questions.” Jordan explained that he had been curious about specific details of Cash’s report and thought this would be an opportune time to get further information. Jones said that he had never heard of Brian Cash, much less having ever talked to him, and furthermore he did not even know a research project was being conducted in his community.

        Should he accept Jones’s statement as a denial of participation in the project to maintain anonymity? Should he accuse Jones of lying? Should he drop the matter for the moment and later tell Cash about the incident? Perhaps Cash had lied about interviewing Jones? Should be confront Cash with this suspicion? Since it was some distance to the field site from the university, should he [Jordan] now seek out other informants Cash had reported on to determine whether or not they had been interviewed? Or, were there other tactics to be employed?

Response: Attempted Suicide Patient

        Talking as a person who has been to the ER numerous times, I can identify with this woman. Unless you have a terminal illness and are very old, I don’t think anybody wants to die. Anybody who says they want to die is a bloody fool. The doctor is in the ER for one reason, to treat patients and save lives. He should do his job. Regarding the 35-year old woman who tried to commit suicide and wound up in the ER, first of all doctors take an oath to do no harm. There should be no hesitation to give her medical care immediately. Our laws dictate that the patient should have a durable power of attorney for medical care if she was unable to make her own decisions or a living will. The nurses, hospital or doctors should contact the doctors who gave her the medications and treated her prior to this event and get their diagnosis even if it had to wait until she had received emergency care. The doctor should know if there were any signs of suicidal thoughts with her doctors beforehand. They must give her for more specialized care. The issue that a lawsuit could give remedy to the problem is horrible. A lawsuit would do nothing for the woman except make her life more miserable and the lawsuit against the doctors would just make them more likely to not want to work with those kinds of situations. Proper health care for her in the first place would be the best plan. Today, doctors don’t even recognize their own patients, they rely on the patients to diagnose themselves, they hardly ever have all of the medical records, if a patient doesn’t have insurance, needed tests are never done and everyone is in such a hurry no matter what the patient has, even a basic non-emergency patient gets the short end of the stick. And what makes anyone think if you want to kill yourself you know how to do it? It isn’t like you get to try it a couple of times to figure it out. In life we can die for the simple cause and sometimes even the most extreme causes we still live. I doubt if any 35 year old woman would know the exact dose and combination of medications that would cause her death. Medicine is supposed to heal the patient. The system that is in use today is only reactive and uninformed for a lot of people. You can say it was too late for that by the time she made it to the ER and this time yes, but why not repair the system so these things will be decreased. And if she had that paperwork in her medical record already did anyone think to call her doctor and check? Everyone can say it is not their fault. In this case, it would seem to me that the ER doctor’s ethical position is clear. He must treat her, against her wishes. There are limits to patient’s autonomy, religious, moral and legal rights. Morally, you must consider the person; they are told that this woman was never depressed in the past (to her parents’ knowledge) and appeared to function normally until the date of her attempt. This was therefore a sudden, rush decision and she might have changed her opinion one day or week or a month later, if she were rescued. Furthermore, a physician’s duty is to save lives and to prevent an avoidable death.  

3. McDonald’s hot coffee

        A lawsuit a few years ago made headlines worldwide when a McDonald’s drive-thru customer spilled a cup of scalding hot coffee on herself. Claiming the coffee was too hot to be safely consumed in a car, the badly burned 80-year-old woman won $2.9 million in court. (The judge later reduced the award to $640,000.) McDonald’s claimed the product was served to the correct specifications and was of proper quality. Further, the cup read “Caution–Contents May Be Hot.” McDonalds’ coffee, at 180 degrees, is substantially hotter (by corporate rule) than typical restaurant coffee, despite hundreds of coffee-scalding complaints in the past 10 years. Similar court cases, incidentally, resulted in smaller verdicts, but again in favor of the plaintiffs. For example, Motor City Bagel Shop was sued for a spilled cup of coffee by a drive-thru patron, and Starbucks by a customer who spilled coffee on her own ankle.

        Are McDonalds, Motor City, and Starbucks at fault in situatuins such as these? How do quality and ethics enter into these cases?

2. Edwards Toy Company locomotive toys

        John Edwards, president of Edwards Toy Company, Inc. in South Carolina, has just reviewed the design of a new pull-toy locomotive for 1- to 3-year olds. John’s design and marketing staff are very enthusiastic about the market for the product and the potential of follow-on circus train cars. The sales manager is looking forward to a  very good reception at the annual toy show in Dallas next month. John, too, is delighted, as he is faces with a layoff if orders do not improve.

        John’s production people have worked out the manufacturing issues and produced a successful pilot run. However, the quality testing staff suggests that under certain conditions, a hook to attach cars to the locomotive and the crank for the bell can be broken off. This is an issue because children can choke o small parts such as these. In the quality test, 1- to 3-year olds were unable to break off these parts; there were no failures. But when the test simulated the force of an adult tossing the locomotive into a toy box or a 5-year-old throwing it in the floor, there were failures. The estimate is that one of the two parts can be broken off four times out of 100,000 throws. Neither the design nor the material people know how to make the toy safer and still perform as designed. The failure rate is low and certainly acceptable for this type of toy, but not at the six-sigma level that John’s firm strives for. And, of course, someone someday may sue. A child choking on the broken part is a serious matter. Also, John was recently reminded in a discussion with legal counsel that U.S. case law suggests that’s new products may not be produced if there is “actual or foreseeable knowledge of a problem” with the product.

        The design of successful, ethically produced, new products, as suggested here, is a complex task. What should John do?

1. Attempted Suicide Patient

        The case is that of a 35 year old white single female who was found on her bed stuporous and moaning by her father and mother with whom she lives. There was a note in the room written by her explaining that she had carefully considered her life and what was happening to her and that she wanted to die. There was evidence in the bathroom that she had most likely taken three bottles of different pills including barbiturates. The family immediately called the paramedics and the patient was taken to the nearby hospital emergency room. The physician there was presented with the note and the bottles and since the patient was not fully unconscious began to insert a nasogastric tube to aspirate the contents of the stomach. As he was attempting to get the tube down, the patient became briefly more responsive and cried out that she didn’t want the tube, she didn’t want any treatment and that she wanted to be left alone and allowed to die. She moaned that she had left a note which said she wanted to die and she meant it. The family arrived in the next few minutes and informed the physician that she had not seemed depressed to them and she had never seen a psychiatrist but the medications were prescribed by her general physician. When told about what she had requested of the physician, the family urged that the doctor continue treatment. The physician realized that if she had consumed the pills in the bottles she would most likely not survive without medical treatment and yet it seemed clear that she did not want any treatment. What should he do next?
        The issue is whether the doctor must follow the request of the patient and stop treatment and allow her to die. Does the principle of patient autonomy apply here? Can the physician perform a treatment against the consent of the patient? What is the responsibility of the ER physician in this matter? Must the physician be required to participate in completing a yet uncompleted suicide attempt?