The
heart pacemaker is a modern wonder. The device has a timer that resets itself
every time the patient's heart beats. If the heart does not beat on schedule
(say, within 1.2 seconds), the pacemaker gives a stimulus that causes a
heartbeat.
But
the technology was not always so sophisticated, and its early limitations form
the background of this true story, told to Markkula Center for Applied Ethics
Director Thomas Shanks, S.J., by one of the participants. Although the events
happened 20 years ago, the ethical issues they raise are still relevant.
It's 1975, and you
are on the board of directors of a company that makes transistors. Among the
many companies with whom you have a contract is one that makes heart
pacemakers.
Pacemaker technology
is in its infancy. When doctors implant a pacemaker, the patient's normal
heartbeat is disabled, and he or she relies entirely on the device. If it
fails, the patient's heart stops. Doctors are not very adept at installing the
pacemakers, which are extremely delicate; there is even a story of a person
yawning deeply, pulling the pacemaker wire in his chest, and dying.
After that and many
similar incidents, the board begins to reconsider whether your company should
sell to the pacemaker company. Members of the board feel this situation is a
major lawsuit just waiting to happen and your company, as well as the company
you supply, will be liable. In addition, you feel the specs the pacemaker
company uses to test the transistors are not very strong.
You and the board
decide to get out of the business before it's too late. You tell the pacemaker
company representatives about your conclusion, and they respond, "You
can't stop selling us the transistors. You are the sole remaining supplier for
us. Everyone else has backed out for the same reasons you're giving. If you
don't sell us the product, we'll go out of business. Pretty soon, no one will
be making heart pacemakers, and many people need them. Without the pacemaker,
people don't even have a chance."
You take that
information back to the board. People around the table have different opinions.
One person says, "This is a bad deal, and it isn't our problem. We don't
make enough on this sale to make the risk worthwhile." Another person
says, "We don't know how other companies use the transistors we sell them;
why should we be concerned about this one? What about that baby who died when
the transistor in the incubator failed? We didn't know how that company was
using the transistor." Another person says, "I think we're missing
the real issue here. Don't we have an ethical obligation to sell the product to
the pacemaker company? What will happen if we don't sell to them?" Another
person says, "Give me a break. Our only obligation is to our shareholders.
And how did we get so stupid that we're the last source? I'm telling you, we
don't need this." Finally, the chair of the board says, "OK. Let's
make a decision."
What do you do?
The moral issue(s) in this case.
The moral issue in
this case is that if the Company will stop supplying the transistors, the
Pacemaker Company will be forced to shut down its manufacturing business and
the heart patients who will need the pacemaker will die.
Facts of the case.
The
company makes transistors for electronic devices and supplying transistors to a Company that makes Pacemakers. Other
companies that make transistors would not sell to the company that makes
pacemakers. The
company is the sole remaining supplier of transistors. In
the United States, a company that sells products that are found to be defective
could be held liable for injuries or death to a consumer. The
company does not make enough on this sale to make the risk worthwhile.
Identifying and evaluating alternative actions from the
various moral perspectives applying the questions suggested in the article
"A Framework For Ethical Decision Making".
Five Sources of
Ethical Standards:
The Utilitarian Approach
We
can stop selling to the pacemaker company, avoid the risk of getting into a
major lawsuit and would eventually please our shareholders, and besides, there
are only a few people who will need pacemaker devices for their heart.
Some ethicists
emphasize that the ethical action is the one that provides the most good or
does the least harm, or, to put it another way, produces the greatest balance
of good over harm. The ethical corporate action, then, is the one that produces
the greatest good and does the least harm for all who are affected-customers,
employees, shareholders, the community, and the environment. Ethical warfare
balances the good achieved in ending terrorism with the harm done to all
parties through death, injuries, and destruction. The utilitarian approach
deals with consequences; it tries both to increase the good done and to reduce
the harm done.
The Rights Approach
Heart
patients have the right to live, so we will protect their right to life by selling
to the pacemaker company and besides, it is our duty to make the transistors
reliable in the first place.
Other philosophers
and ethicists suggest that the ethical action is the one that best protects and
respects the moral rights of those affected. This approach starts from the
belief that humans have a dignity based on their human nature per se or on
their ability to choose freely what they do with their lives. On the basis of
such dignity, they have a right to be treated as ends and not merely as means
to other ends. The list of moral rights -including the rights to make one's own
choices about what kind of life to lead, to be told the truth, not to be
injured, to a degree of privacy, and so on-is widely debated; some now argue
that non-humans have rights, too. Also, it is often said that rights imply
duties-in particular, the duty to respect others' rights.
The Fairness or
Justice Approach
“We
don’t make enough on sales to the pacemaker company, and there is a risk of
being sued should one of our transistors fail, it is only fair that we should
look after our company and share holders first”
Aristotle and other
Greek philosophers have contributed the idea that all equals should be treated
equally. Today we use this idea to say that ethical actions treat all human
beings equally-or if unequally, then fairly based on some standard that is
defensible. We pay people more based on their harder work or the greater amount
that they contribute to an organization, and say that is fair. But there is a
debate over CEO salaries that are hundreds of times larger than the pay of
others; many ask whether the huge disparity is based on a defensible standard
or whether it is the result of an imbalance of power and hence is unfair.
The Common Good Approach
“We
feel pity for those people who need the pacemaker, What if we too would need
one someday; let us sell the transistors to the pacemaker company”
The Greek
philosophers have also contributed the notion that life in community is a good
in itself and our actions should contribute to that life. This approach
suggests that the interlocking relationships of society are the basis of
ethical reasoning and that respect and compassion for all others-especially the
vulnerable-are requirements of such reasoning. This approach also calls
attention to the common conditions that are important to the welfare of
everyone. This may be a system of laws, effective police and fire departments,
health care, a public educational system, or even public recreational areas.
The Virtue Approach
“Let
us sell the transistors to the pacemaker company for the sake of the patients."
A very ancient
approach to ethics is that ethical actions ought to be consistent with certain
ideal virtues that provide for the full development of our humanity. These
virtues are dispositions and habits that enable us to act according to the
highest potential of our character and on behalf of values like truth and
beauty. Honesty, courage, compassion, generosity, tolerance, love, fidelity,
integrity, fairness, self-control, and prudence are all examples of virtues.
Virtue ethics asks of any action, "What kind of person will I become if I
do this?" or "Is this action consistent with my acting at my
best?"
What we would do in this case.
As members of the
board, we should continue to sell to the pacemaker company with conditions
that: The
pacemaker company will be solely responsible legally, should their pacemaker
fail and the
pacemaker company should continue to develop their pacemakers to make it less
prone to failure.
Commentary on the Case of
the Sole Remaining Survivor
by
Thomas Shanks
As the story of the
Sole Remaining Supplier was told to me, the Board conversation went pretty much
the way the case describes it. Legal was saying, "This is a time bomb
waiting to happen. Why are we even talking about this?" Engineering was
bemoaning the lack of standards for testing the electronics of pacemakers, and
the majority of the Board understood that they had a problem with no easy
solution.
One of the people on
the Board told me later that the founders of Silicon Valley were the sons (and
a few daughters) of blue-collar parents. Their fathers were plumbers,
electricians, and carpenters, who had passed on a core set of values to their
children. This was the Valley before greed and early retirement (at the age of
30) had swept through it. So they took seriously their responsibility and duty
to protect the rights of people who needed pacemakers at the same time as they
balanced their fiduciary responsibility to the current company. They understood
that "doing the right thing" did not have to be stupid, and that they
could both do the right thing and do well for the company ("DO RIGHT"
AND "DO WELL," rather than having to choose one or the other.)
So, they continued to
sell to the pacemaker company. But they also instructed their engineers to
develop more rigorous testing and technical standards they could hold the other
company to. They reserved the right to stop selling if the other company did
not improve its technical standards. They took steps to be sure they did not
have a legal liability down the line and then turned it over to the other
company to improve the quality of its products.
In these ways they
felt they were reducing harms and maximizing utility. They felt it fair to
single out the industry because it was new and standards were developing, an
equal way of treating start-up industries. They felt they were showing compassion
without sacrificing business, and were living out their parents' other virtues.
In this way they felt that they were serving the common good, protecting
people's rights to a promising new medical technology, the pacemaker.
Submitted by:
Kerwin Salvador P. Caragos
Ernie Ecol
Jonainah Usman
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