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Cases

Through a Glass Darkly

Ever since the invention of the sandal, we humans have artificially mediated our experience of reality, usually with the goal of altering that experience for the better. Shoes, jackets, armor, and the like protect us from rough ground, cold weather, and swords. We have not been content with protection but have sought to experience things in better ways than nature allows. For example, glasses sharpen our vision, but reading glasses magnify what we're trying to see while sunglasses filter out harmful rays. Glasses are a sort of primitive wearable technology for enhancing our visual experience, but they have gradually evolved from being merely wearable to being unobtrusive (contact lenses) to being implantable (phakic intraocular lenses).

Numerous devices exist to enhance raw experience. Auto-tuning hardware or software corrects our pitches as we sing karaoke off-key. Night-vision goggles enhance our sight in dim lighting.

At the forefront of this technology seems to be Google Glass, a new wearable technlogy that Google introduces on its website (http://www.google.com/glass/start/what-it-does/) with the words, “Welcome to a world through Glass.” Google Glass offers a voice-activated visual experience that allows wearers, inter alia, to take snapshots, share or record live video, see GPS overlays, message others, get answers to spoken questions, and perceive written translations of words spoken by the wearer.  Google Glass promises to deliver a two-way visual adventure that blends the virtual and the real, but Google controls the virtual part of that experience. 

A 1960s science fiction television series, “The Outer Limits,” opened every episode with the following announcement: “There is nothing wrong with your television set. Do not attempt to adjust the picture. We are controlling transmission. If we wish to make it louder, we will bring up the volume. If we wish to make it softer, we will tune it to a whisper.… For the next hour, sit quietly and we will control all that you see and hear.… You are about to participate in a great adventure. You are about to experience the awe and mystery which reaches from the inner mind to—The Outer Limits.”

In the not-too-distant future, technology that is now only wearable could become implantable, zooming us right up to the precipe of “the awe and mystery” of the outer limits. We may have implantable network-based devices such as lenses and cochlea which would mediate an enormous part of our experience by controlling “all that [we] see and hear.” Colors could be enhanced or muted, loud noises dampened, pitches corrected, obscenities bleeped, foreign phrases translated, “subversive” messages censored, unwanted opinions muted, unknown faces identified, searched text highlighted, street names spelled out during walks, context-sensitive ads inserted into our waking moments, sexual encounters shared with friends on social networks, and casual conversations monitored by employers or the Department of Homeland Security. 

© Association for Practical and Professional Ethics 2014

Question:  What, if any, ethical problems are there with products such as Google Glass?

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Faith Healers

Washington is a traditionally liberal state, particularly on social issues. In 1970, Washington voters guaranteed the statutory right to abortion. The 2009 Death with Dignity Act legalized physician-assisted suicide. Washington law not withstanding, trends in hospital ownership worry many Washingtonians.

Many small, financially troubled hospitals in Washington have been taken over by Roman Catholic healthcare systems. By 2012, one third of Washington’s hospitals were controlled by Catholic systems. That portion was predicted to rise to almost one half by the end of 2013.  Consequently, in over a quarter of the state’s counties, all of the hospital beds will be governed by healthcare policies required by Catholic doctrine.

The Ethical and Religious Directives, created by the United States Council of Catholic Bishops, requires all healthcare providers in Catholic facilities to conform to Catholic dogma in providing healthcare services as a condition of employment. In Part Three, the Directives states that, “When the health care professional and the patient use institutional Catholic health care, they also accept its public commitment to the Church’s understanding of and witness to the dignity of the human person.”  That is, patients who use Catholic healthcare facilities cannot expect access  even to healthcare services guaranteed by Washington law, if they are inconsistent with the church’s moral teachings. Ironically, a 2012 Gallup Poll showed that Washington is tied with Nevada and Oregon as the sixth least religious state in the country.

Supporters of mergers point out that without some such rescue, financially struggling hospitals could close, and area residents would lose access to local healthcare. Supporters note that retaining a local hospital outweighs the loss of some healthcare services: if only Catholic institutions have the means to provide healthcare in a community, they shouldn’t be vilified for omitting services they find morally impermissible.

Opponents charge that these mergers remove the choice to receive healthcare in a secular institution, where services are not limited by a single religious perspective. In particular, Washington voters granted residents reproductive choice, end-of-life autonomy, and recognition of civil unions. These options are not supported by Catholic hospitals. This lack of support is particularly burdensome for residents of communities in remote areas.

The choice for many Washington residents seems to be Catholic healthcare or no healthcare. 

© Association for Practical and Professional Ethics 2014

Question:  Is it ethically acceptable for a hospital to refuse to provide medical treatment for religious reasons?

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Feel the Burn
 

Feeling the pinch of paying ever-increasing health insurance premiums, employers are seeking ways to manage their fiscal pain.   Recognizing the business sense of saving money on premiums and of having a healthier and more productive workforce, employers are looking with new appreciation at different options offered by  the Affordable Care Act of 2010 (ACA). One provision of ACA that goes into effect in 2014 allows employers a more lenient approach to use of financial incentives and penalties.   That is, more of the health care premium can be devoted to incentives and penalties for employee health behaviors and health status.

The ACA allows employers to offer stronger outright financial incentives to employees for participation in wellness initiatives. Employers had already been experimenting with different options for encouraging healthy behavior among employees, using both incentives and punishments.  Some companies have had wellness programs with  on-site fitness facilities and wellness directors, while others have offered employees memberships in health clubs. It also allows imposition of financial penalties for employees’ lack of participation in proffered  options intended to mitigate ‘bad’ health indicators like smoking, high cholesterol, or extra pounds. It even seems to allow penalties for not meeting certain ‘good health’ targets.

CVS Caremark, a large drugstore chain and pharmacy benefit manager, brought this issue to the public eye when it received adverse publicity about an impending change in its benefits package.  The media reported that CVS Caremark would require its 200,000 employees to report their weight, blood sugar and cholesterol or be forced to pay an annual penalty of $600. The publicity CVS Caremark got was somewhat unfair because the media implied that the personal health data would be reported directly to the employer (which is prohibited by the Health Insurance Portability and Accountability Act – HIPAA).  In truth, the employee health records would be kept by a third party wellness vendor, hired by CVS Caremark to monitor employee health and adjust benefits to encourage health improvement.

Recent surveys indicate that CVS Caremark is not the only company that uses incentives and penalties to affect health behaviors.  Some other major employers, including PepsiCo and Wal-Mart, have also adopted such policies.  An Aon Hewitt survey found that 79% of large and midsize companies incentivize employee use of wellness opportunities, while 45% go a step further by using financial rewards or penalties (like adjusting employee share of insurance premiums) to incentivize certain behaviors.  An alternative adopted by some companies,  like Regal Cinema, is to cut employee hours to avoid providing insurance benefits.  

Now that wellness programs have been around awhile, sufficient studies have been done to show that the efforts do not consistently save money or result in healthier employees. In fact, the rewards may go to already healthy employees, and penalties may fall on those with the greatest need for health care cost relief.

Thoughtful critics recognize the need for resolution of the increasing cost of healthcare and its burden on employers, employees, and society.  They note that because our understanding of the causes of many chronic conditions (like obesity) and of health behavior motivation is imperfect; our use of incentives and penalties may be misdirected. In addition, analysts caution that the interests of the employer versus those of the employee must be carefully weighed.  The U.S. Equal Employment Opportunity Commission is exploring the possibility that employer plans violate anti-discrimination laws. Some states are also looking at prohibiting the link of a worker’s health status to financial reward or punishment.

© Association for Practical and Professional Ethics 2014

 

Question: How far can an employer go in requiring employees to avoid “unhealthy behaviors”?

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Heresy or Heritage

Memphis, Tennessee bears deep scars of the American civil rights movement. Images of the Lorraine Hotel and sanitation workers picketing with placards declaring “I Am a Man” remain vivid in the memories of many here. Now the city is embroiled in a dispute that pits those who seek to honor the struggle of African Americans against others who champion less recent history.

In February 2013, the Memphis City Council voted to rename three parks that honored the city’s Confederate past. Confederate, Jefferson Davis, and Nathan Bedford Forrest parks now bear generic names, i.e. not military, whilst the Council considers permanent ones recommended by an ad hoc Council committee in April 2013.

Most observers considered the Council’s action a preemptive move to circumvent in part the intent of the Tennessee Heritage Protection Act of 2013, a bill that was moving through the Tennessee Statehouse at the time. This act, signed by the Governor on 1 April 2013, prohibits changing the name of  parks, inter alia, currently named for “any historical military figure, historical military event, military organization, or military unit.” Had the City Council of Memphis not acted when it did, the city would have been stuck with the original park names in perpetuity.

Those who support the City Council measure contend the former park names evoke a racist past and were offensive in a city of largely black residents. Others simply worry that confederate-themed names make it more difficult to attract new businesses to the city by sending the wrong message about its values.

Southern heritage groups, on the other hand, believe the renaming threatens historical knowledge, even though the parks in question do not mark battlefields and are not located on sites of historic events. Chris Barker, a local Ku Klux Klan leader goes further. Quoted in the 28 March 2013 New York Times, he claims that “[t]he Memphis City Council is basically trying to eradicate white people out the history books across America.”

Both Confederate and Forrest Parks were dedicated in the early 20th Century. The former was a memorial to the Civil War.  In 1904 the bodies of Nathan Bedford Forrest, a Confederate general and the first Grand Wizard of the Ku Klux Klan, and his wife were re-interred in Forrest Park.  Jefferson Davis Park was opened in the 1930s and named for the Confederate President who lived and worked in Memphis from 1869 until his death.

Seeking a compromise, some in Memphis suggest adding history to the city rather than taking it away. For instance, the same New York Times article reported that Doug Cupples, a history professor from Memphis, called for reinstating the original names of the parks and also building more monuments to honor African American leaders. Illustrating just how intractable the issue has become, the newspaper subsequently quoted Baptist minister Keith Norman as equating the restoration of the park names as akin to honoring Nazis in modern Germany.

© Association for Practical and Professional Ethics 2014

 

Question: What are the most important ethical considerations in this case?  What should be done?  Why would that be right?

 

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To Bee or Not to Bee

Honeybee populations have declined worldwide. In the US, the annual mortality rate for honeybees has been double to triple the expected rate each year for about a decade. Scientists estimate that there are now only about one-fourth as many honeybee colonies in the US now as there were 60 years ago. Agricultural pollination, mainly by honeybees, is essential to crop production. Diminished availability of these pollinators endangers agriculture and the food supply.

Colony Collapse Disorder (CCD), a set of symptoms related to a variety of factors, was described in 2006 after beekeepers noticed that honeybees would leave their hives and die elsewhere. Since its identification, researchers all over the world have been trying to save the honeybees.

In May 2013, the US Department of Agriculture (USDA) and the US Environmental Protection Agency issued an extensive report detailing the outcomes of a national meeting of stakeholders concerned with the disturbing decline of honeybee colonies. The report summarized the complex forces that have diminished the honeybee population: loss of wild bee habitat, loss of genetic diversity, parasites, disease, poor nutrition, and exposure to pesticides.

Experts agree that pesticide exposure is one factor in CCD. Some of the research on CCD has focused on the effects of the nerve poisons: neonictinoids, or neonics. Introduced in 1991, neonics are coated onto agricultural seeds. As the plant grows, the pesticide distributes into the pollen and nectar. Neonics are aimed at other pests, but their impact on honeybees has been noted and studied since the 1990s. Several recent studies confirm that honeybees exposed to neonics show effects consistent with symptoms observed in CCD. In particular, the pesticide is blamed for interfering with the bee’s ability to gather pollen and return to the hive.

The European Union has determined that the evidence linking neonics to CCD is sufficient to warrant issuing a two-year ban on the use of this class of pesticides. The USDA has continued to withhold judgment, asking for more research.

Monsanto is a major global company and a significant player in agriculture worldwide. It supplies pesticides and other agricultural chemicals, and it genetically engineers seed for sale.  It is a major source of seed-dusting neonics worldwide. Experts point out that honeybees may also be affected by pollen from another of the company’s products, a corn variety (Roundup Ready) whose genetic makeup Monsanto engineered to include a pesticide effect.

Cynics ask why Monsanto purchased a small company in 2011called Beeologics. Founded in 2007 in response to the honeybee decline, Beeologics’ mission, according to its website (http://www.beeologics.com/about-us, accessed 11/24/13), “…is to become the guardian of bee health worldwide. Through continuous research, scientific innovation and a focus on applicable solutions, Beeologics is developing…products to specifically address the long-term well being of honeybees…” Though Monsanto claims it is committed to having Beeologics continue its work, environmental journalist Richard Schiffman, for one, is skeptical. In his blog in the 5/3/13   Huffington Post, The Fox (Monsanto) Buys the Chicken Coop (Beeologics), Schiffman wonders if the purchase of a company dedicated to saving honeybees might in reality be a means to cover up, rather than solve the problem.

© Association for Practical and Professional Ethics 2014

 

Question:  From an ethical point of view, who needs to take the lead in solving this agricultural crisis?

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