Lawrence Kohlberg: classic moral problem

[Lifeguards For Life]

Heinz’s wife has a rare form of cancer that cannot be cured with currently available drugs and therapies. But there is one drug that physicians think might save Heinz’s wife. It is a form of radium that a druggist in the same town had recently discovered. The drug is expensive to make, but the druggist is charging 10 times what the drug cost him to make it. He pays $200 for the radium and charges $2,000 for a small dose of the drug. Heinz goes to everyone he knew to borrow the money, but he could raise only $1,000, which is half the amount asked by the druggist. Heinz goes to the druggist and tells him that his wife is dying and asks him to sell the drug cheaper or let him pay later. But the druggist says, “No, I discovered the drug and I’m going to make money from it.” What should Heinz do?

*please formulate an answer based on your own morals, values, and ethics

 

[Lifeguards For Life]

You are transporting an EMT who works for your ambulance service, though at a different station. While off-duty and in his private vehicle, he was struck from the rear by a drunk driver. En route to the hospital, the EMT pulls a small baggy of marijuana out of his pants and asks you to throw it out of the ambulance. Do you throw it out? Do you tell the police?

 

[Onceamedic]

Heinz’s wife has a rare form of cancer that cannot be cured with currently available drugs and therapies. But there is one drug that physicians think might save Heinz’s wife. It is a form of radium that a druggist in the same town had recently discovered. The drug is expensive to make, but the druggist is charging 10 times what the drug cost him to make it. He pays $200 for the radium and charges $2,000 for a small dose of the drug. Heinz goes to everyone he knew to borrow the money, but he could raise only $1,000, which is half the amount asked by the druggist. Heinz goes to the druggist and tells him that his wife is dying and asks him to sell the drug cheaper or let him pay later. But the druggist says, “No, I discovered the drug and I’m going to make money from it.” What should Heinz do?

*please formulate an answer based on your own morals, values, and ethics

Be very very sure that you won't get caught (not much good to your family in jail) and steal the drug.

 

[Onceamedic]

You are transporting an EMT who works for your ambulance service, though at a different station. While off-duty and in his private vehicle, he was struck from the rear by a drunk driver. En route to the hospital, the EMT pulls a small baggy of marijuana out of his pants and asks you to throw it out of the ambulance. Do you throw it out? Do you tell the police?

Throw it out of the ambulance and say nothing to the cops

 

[Burlyskink]

Be very very sure that you won't get caught (not much good to your family in jail) and steal the drug.

Same, but I would also give him the money

 

[Lifeguards For Life]

Same, but I would also give him the money

haha. that is actually the same answer a Mr. Bryan Bledose told his medical school interview committee in the early 80's

"I told the medical school interviewers that Heinz should steal the drug and leave what financial compensation he could"

 

[Burlyskink]

haha. that is actually the same answer a Mr. Bryan Bledose told his medical school interview committee in the early 80's

Haha, well the druggist did supposedly discover it.

 

[JPINFV]

You are transporting an EMT who works for your ambulance service, though at a different station. While off-duty and in his private vehicle, he was struck from the rear by a drunk driver. En route to the hospital, the EMT pulls a small baggy of marijuana out of his pants and asks you to throw it out of the ambulance. Do you throw it out? Do you tell the police?

Throw it out. Drug use is very arguably a victimless crime and I'm under no duty to enforce the law outside of limited circumstances (e.g. reporting abuse)

 

[redcrossemt]

Same, but I would also give him the money

+1.

Throw it out. Drug use is very arguably a victimless crime and I'm under no duty to enforce the law outside of limited circumstances (e.g. reporting abuse)

Agree to those points. At the same time, I am not going to handle any drugs that aren't mine, nor throw them out of my ambulance. I may turn the other way if the patient wants to throw it out, but at the same time I am not going to get in trouble (fired/arrested/whatever) for anyone else's mistake.

 

[reaper]

Throw it out. Drug use is very arguably a victimless crime and I'm under no duty to enforce the law outside of limited circumstances (e.g. reporting abuse)

Haha, you were making a joke!

 

[JPINFV]

No. I'm dead serious. Why should the government tell me what I can and can not introduce into my body provided that I am not endangering others by my actions/stupidity? If someone has dependents, then they have a duty to provide which can cause issues (but neglect is already against the law). It's like arguing that alcohol should be outlawed because alcohol is addictive (alcoholics), can cause serious medical disorders (Korsakoff's syndrome, cirrosis, etc), and other bad things. Anyone want to comment on the success of prohibition?

 

[reaper]

Does not matter if it is right or wrong. There will always be victims of it. You may think that you doing it alone has no victims, but you would be wrong. It always ends up hurting someone else. That is a victim!

 

[silver]

Well most ethicists today don't care about laws. Obeying laws sometimes lead to horrible things.

I would leave the compensation I have, and take the drug. Which is what others had. If you think about what positives and negatives come out of it. In stealing the drug and leaving money, there would be the most prosperity and flourishing in life, or happiness.

simple stuff.

 

[JPINFV]

If you're going to take the "If somone cares about you doing X, then it hurts them if you do X" can we take it to it's logical conclusion? Driving down the road hurts people. Therefore let's ban it. Eating at McDonalds hurts people, let's ban McDonalds. Being anything but Religion X is bad, therefore everyone should be Religion X.

Where can I stop assigning hurt to your actions if the only thing I need to prove to be hurt is saying that I care?

 

[Lifeguards For Life]

This is a classic moral problem attributed to noted psychologist Lawrence Kohlberg.[2] What Kohlberg (and the medical school admissions committee) was looking for was not so much the answer, but the reasoning used to formulate the answer. Medical schools look for students who function with a high level of moral reasoning because health care providers must always put the needs of the patient above virtually all other needs.

Kohlberg followed the work of Swiss psychologist Jean Piaget and believed that people pass through different cognitive and moral developmental stages as we age. Kohlberg identified the following stages of moral reasoning:

LEVEL 1: PRE-CONVENTIONAL MORALITY

Stage 1 — Obedience and Punishment
The earliest stage of moral development is seen in young children, although adults are capable of expressing this type of reasoning. At this stage, children see rules as fixed and absolute. Obeying the rules is important because it’s a means to avoid punishment (see Figure 2 ).

Stage 2 — Individualism and Exchange
At this stage, children account for individual points of view and judge actions based on how they serve the individual needs. In the Heinz dilemma, children argue that the best course of action is whichever best served Heinz’s needs.

LEVEL 2: CONVENTIONAL MORALITY

Stage 3 — Interpersonal Relationships
This stage, often called the “good boy/good girl” orientation, focuses on living up to social expectations and roles. There’s an emphasis on conformity, being “nice” and considering how choices influence relationships.

Stage 4 — Maintaining Social Order
In this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, always doing one’s duty and respecting authority.

LEVEL 3: POST-CONVENTIONAL MORALITY

Stage 5 — Social Contract and Individual Rights
At this stage, people begin to account for the differing values, opinions and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards.

Stage 6 — Universal Principles
Kolhberg’s top level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.

Medical schools tend to want students who function in Stages 5 and 6. That is, they want people to become physicians who will place the care of patient’s first — sometimes when it conflicts with the law.

Thus, we have a conundrum. Public safety, especially law enforcement, requires employees to adhere to Kohlberg’s “Maintaining Social Order” stage (Stage 4) for much of their work. In fact, this reasoning is reinforced in law enforcement academies. In this stage of moral reasoning, adhering to the letter of the law trumps all other concerns. An example of this, of which I’m acutely aware, is a local Texas Highway Patrolman who wrote his wife a ticket for speeding. His moral reasoning was “she broke the law and the law must be enforced — no matter who the offender.”

Such a priority can conflict with the role of EMS. In our textbooks, and in education classes, we teach that the patient always comes first (after scene and personal safety). We emphasize that EMS personnel are advocates for the patient. Thus, in EMS education, we ask that EMTs and paramedics function, at a minimum, in Kohlberg’s “Social Contracts and Individual Rights” stage (Stage 5).

This then presents a moral dilemma. For example:

* You respond to an auto versus tree collision. En route to the hospital, the patient admits to having a crack cocaine addiction and dropped his crack pipe while driving and hit the tree. He tells you he’s on probation for possession of a controlled substance and being arrested again will ensure that he’ll be incarcerated. He says, “Please don’t tell the cops.” Do you keep what he tells you in confidence or do you report it to authorities?
* You’re transporting a 27-year-old male to a hospital after he was found beaten in a hotel room. En route, he tells you he was having an extramarital homosexual relationship with a man with whom he works. He asks you not tell his wife what happened and asks you to lie and say he was beaten outside the elevator of his office. His wife meets you at the hospital and begins to question you, tearfully, about what happened to her husband? What do you tell her?
* You pick up an EMT who works for a neighboring ambulance service. While off-duty and in his private vehicle, he was struck from the rear by a drunk driver. En route to the hospital, the EMT pulls a small baggy of marijuana out of his pants and asks you to throw it out of the ambulance. Do you throw it out? Do you tell the police?
* An elderly patient has end-stage COPD. She has been on oxygen for 6years and weighs 80 pounds. She has been intubated and placed on a ventilator seven times. The last time, she was on the ventilator for 17 weeks. She’s in respiratory failure and pleads with you not to intubate her. Your service does not have CPAP. The nursing home staff seemed to indicate that everything possible should be done. Should you honor her requests and let her die? Should you intubate her as “the rules say”?

In EMS, we have to make decisions in the best interest of our patients. Thus, there may not be any rules or laws to guide us — only moral and ethical principles. Sometimes, the rules and laws may actually conflict with what’s best for the patient. Law enforcement officers can always cite the law as the moral determinant of what to do. But I would maintain that the best law enforcement officers are those who enforce the laws through moral reasoning. Thus, instead of writing a public intoxication citation for a chronic inebriate (Stage 4 reasoning), they give the person a ride to a detox center or shelter (Stage 5–6 reasoning).

I realize that this is an extremely complex issue. But before we determine what EMS truly is, we have to look at the ethical and moral decisions EMS personnel have to make — for that’s truly who we are. In the overall scheme of things, EMS personnel are much more like physicians than public safety officers. Thus, I think that EMS should be more health care and less public safety .

Should EMS Be a Part of Public Safety?
Another Perspective

* Bryan E. Bledsoe, DO, FACEP
http://www.jems.com/news_and_articles/columns/Bledsoe/Should_EMS_Be_a_Part_of_Public_Safety.html

 

[reaper]

Never stated "if someone cares" it hurts them. You will will hurt someone by your actions or by letting them down, when needed. I have never seen a single drug user that did not have a trail of victims behind them.

So, to answer the question. No, I would not call the police. That is not my job. No, I would not dispose of it for them. That is not my job. I would tell them it is their problem to get dispose of it themselves and it would be documented in my report. I am not there to cover up for their choices or actions. they know it is wrong, that is why they want to dispose of it!

 

[JPINFV]

Never stated "if someone cares" it hurts them. You will will hurt someone by your actions or by letting them down, when needed. I have never seen a single drug user that did not have a trail of victims behind them.

The only way you can 'let someone down' is if they care. You can't let someone down who doesn't care. If letting someone down is worthy of banning a substance, why isn't alcohol or tobacco straight out banned?

 

[reaper]

The only way you can 'let someone down' is if they care. You can't let someone down who doesn't care. If letting someone down is worthy of banning a substance, why isn't alcohol or tobacco straight out banned?

Person does not have to care, to be let down. You could be a sales person that has an appointment with a client. You are to stoned to remember the appointment and leave the client hanging. That is letting someone down, that does not "care" about you.

You could be a Medic at work, that is stoned or drunk. You forget a treatment plan for a pt, because of this. Your pt does not Care about you, but they are now a victim of your choice.

Yes, if alcohol is affecting your everyday thinking, then it should be banned too. Tobacco does not affect your thinking or rational, so it is a moot point.

 

[JPINFV]

None of that explains why someone shouldn't be allowed to get high on their own time? Sure, if being impaired puts other lives at risk, then it should be outlawed (hence why responding to emergency calls while drunk will lose your certification and open up to legal troubles for adverse outcomes. Same reason why driving under the influence is against the law). However that's not the same as a flat ban.

...and yes, alcohol abuse can cause permanent long term neurological damage.

 

[reaper]

I see no problem with someone using on their own time, in their own home. But, make sure you do not leave the house until the drug has lost all affects!