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2015 Michigan Bowl Case Studies

About the Case Studies

The 2015 Michigan High School Ethics Bowl includes 12 case studies. Five of them come from the 2014/2015 Regional Bowl competitions affiliated with the National High School Ethics Bowl. These studies have been written by National Bowl committee members.

Seven of the case studies are contributed and written by Michigan-based professionals whose work is in an applied ethics field. Alternatively, these case study writers are or have been in positions and careers where ethics dilemmas regularly occur.   

To use a sport comparison, the Ethics Bowl case studies represent the "ball." Without them, no team would be able to compete. Teams' mastery of the case studies--based on intensive research, thorough preparation and practice arguments and exchanges--determine the outcome of the Bowl. 

The case studies for the 2015 competition are below. Case studies from the first Michigan Bowl in 2014 are also available. Finally, you may want to look at the entire National Bowl case studies archive.

1. One Time Slip-Up?

Marcie is a pediatrician who lives and works in the same community.  Over the years, her family has become well-entrenched in community activities.  Marcie’s husband coaches one of the community soccer teams and Marcie serves on several school committees.  Her children are friends, classmates, or teammates with some of her patients. 

Marcie enjoys this familiarity and likes the feeling of knowing her patients as “people,” aware of their interests, goals, and activities, outside of the medical setting.  She feels it makes her a better doctor.  Nevertheless, she is careful about keeping her personal and professional relationships separated, understanding the complications that can occur when treating close friends.  

Last night, Marcie’s daughter, Shannon, came to her with a problem.  Shannon is friends with Julie, one of Marcie’s diabetic patients. They are in the same 7th grade classroom.  Shannon is concerned because she just saw an Instagram photo of Julie having a big slice of cheesecake at a restaurant.  In the comments, Julie wrote that she “hardly ever” follows her diabetic diet.  Shannon wants to know what she should do.  Marcie replies that Shannon should encourage her friend to follow her diet, telling her that diabetics who don’t monitor what they eat can end up in a coma in the hospital. 

After Shannon leaves, Marcie looks up Julie’s chart. It shows that she was in the office just a few weeks ago.  Her blood tests were a bit abnormal then, but Julie had said it was just a “one-time slip-up” and that she usually followed her diet. Looking back further, test results suggest that Julie has been mostly adherent to her diet.

What should Marcie do now?  Was Julie telling the truth about her (lack of) diet adherence on Instagram and were the abnormal lab values part of that change? Or was she just kidding around, and is she really following her diet? Marcie feels she can’t ignore this information and has to find the truth soon.  Julie’s next appointment with her isn’t for several months – which would be fine if she’s really following her diet. But if she isn’t, she could develop some serious complications by then. Marcie looks for another reason to justify getting Julie into the office in the next week or so, but she doesn’t find any.

Study questions:

1. How could Marcie find out the truth from Julie, her patient, without revealing that her daughter, Shannon, is the source of the information?  Is this what she should try to do?
2. Alternatively, should she ask Shannon to spy on Julie’s food choices?  What would be the moral issues involved here?
3. Do doctors simply have responsibilities to recommend healthy courses of action to their patients, or do they have responsibilities to make sure that patients are following their recommendations? Would things be different if Shannon discovered evidence that Julie had been neglecting to take her prescribed insulin injections, rather than simply following an unwise diet for a diabetic?
4. Under what circumstances, if any, should patients have the right to ignore their doctor’s recommendations?

Author Bio: Kathryn Moseley, MD, MPH, FAAP, is the author of the One Time Slip-Up case study. Dr. Moseley is a clinical bioethicist and a general pediatrician/former neonatologist with the Child Health and Evaluation Unit at the University of Michigan Health System. She holds a dual appointment as an Assistant Professor of Pediatrics and faculty member/researcher with the U-M Center for Bioethics and Social Sciences in Medicine. In 2013, she was appointed to the Council on Ethical and Judicial Affairs of the American Medical Association. Dr. Moseley was an early practitioner in the relatively new field of bioethics in the 1980s, when she joined the faculty of St. Louis University Medical School and its Center for Health Care Ethics. Further, her eleven year experience as Director of Biomedical Ethics at Henry Ford Health System in Detroit influenced her extensive and wide-ranging research interests. Among these interests is her focus on the racial differences in health care decision-making; how those decisions are affected by culture and trust; and how these decisions may lead to health disparities. Most recently, Dr. Moseley received a $2.1M grant from the National Institutes of Health to examine culturally appropriate public health interventions to decrease the disproportionately high incidence of Sudden Infant Death Syndrome among African American infants. In 2011, Dr. Moseley described key aspects of her research and her work in the bioethics field in an interview with A2Ethics: The Pediatric Bioethicist Who Builds Trust.

2. World Cup Controversy

Football, or “soccer” as it’s called in the USA, is the world’s most popular sport. Every four years, billions of people from all over the planet tune in to support their nation’s team during the World Cup. Hosting the World Cup is an honor, especially for countries as crazy about football as Brazil. However, hosting the tournament comes with a number of expensive obligations, such as building new stadiums, improving transportation infrastructure, and preparing accommodation for the millions of tourists the competition brings. According to most estimates, the Brazilian government spent more than $11 billion in preparation for the 2014 World Cup.[1]

Initially, many Brazilians were elated when Brazil was selected to host the 2014 World Cup; for some, that excitement dwindled as the tournament drew near. Protests took place in cities all over Brazil, with hundreds of thousands of citizens criticizing the government for the enormous amount of money spent in preparation for the tournament. In a nation in which an estimated 11.4 million people live in poverty in “favelas” — slums — that surround major cities, many believe that the taxpayer dollars should have been spent on education and health care rather than World Cup projects. Many Brazilians also felt that the government was catering to wealthy tourists rather than fulfilling its moral duty to provide much-needed social services to its own citizens. Those visiting for the World Cup spent huge amounts of money on vacations while ignoring the fact that millions of Brazilians live in poverty. Protestors carried signs with slogans like “The party in the stadiums is not worth tears in the favelas.”

Others defend the government’s spending, saying that the projects provided jobs for the unemployed and increased confidence for future international investment and tourism in Brazil. Brazilian President Rousseff called the grievances of protestors a “false dilemma,” claiming that the money spent on preparations for the World Cup did not detract from spending on any social services or welfare programs. He noted that the infrastructure built would not be taken home by tourists “in their suitcases.”[2]

Furthermore, some argued that it would have been a grave injustice to deny football fans the right to attend the World Cup on account of Brazil’s impoverished state. Individuals may do whatever they please with their time and money. It is also argued that the increased tourism is steering many in the favelas away from crime as new jobs are created. There is some evidence that the development the tourists stimulate is actually helping the underprivileged people of Brazil.[3]

[1] http://www.cnbc.com/id/101750395#
[2] http://www.bbc.com/news/world-latin-america-27789775
[3] http://www.forbes.com/sites/ricardogeromel/2013/01/31/eduardo-paes-rio-d...

Study Questions:

1. What obligations, if any, do the wealthy have to those who are not as fortunate?
2. Was it ethical for the Brazilian government to host the World Cup, when some of the public funds it used could potentially have been spent on improving the nation’s education and health care systems? If not, does this mean that only nations with top-notch social services should have the privilege of hosting large international events such as the World Cup?
3. Is it morally permissible for the affluent to spend huge sums of money on traveling and attending an event such as the World Cup, when others are living in extreme poverty?

Author Bio: World Cup Controversy case study written by The 2015 National High School Ethics Bowl Case Study Committee.

3. The Open Purse

In Michigan, HIV-related information is confidential and cannot be released unless the patient authorizes disclosure, or a statutory exception applies. This confidentiality statute applies to all reports, records, and data pertaining to testing, care, treatment, reporting and research. It also applies to information pertaining to partner counseling and referral. A patient may authorize a disclosure of his/her medical records. This authorization must be in writing, and must contain a specific statement if the release is to also cover HIV-related information in the records.

Michigan statutes also provide that an individual who is a “health threat to others” may be arrested and placed in custody in order to prevent transmission of HIV or any other serious communicable disease. The “health threat to others” law applies to anyone who is known to be infected with an infectious agent or is reasonably believed to harbor an infectious agent, and by the individual’s conduct, has displayed an unwillingness or an inability to conduct himself/herself in such a manner as to not place others at risk of transmission. This includes past or present behavior evidencing an intent to transmit the infectious agent, showing a disregard of whether transmission may occur, or lying about his/her condition before engaging in behavior that could transmit the infectious agent.

Denise was driving her SUV and probably didn’t realize that her brake lights were out until she was pulled over by a local police officer.  Denise has been living with HIV for 11 years and has finally gotten to a better place in her life after suffering from very low self-esteem. 

The police officer approached the car and asked Denise and her passenger to get out of the vehicle. When Denise opened her purse to get her driver’s license, the officer asked her what else she had in her purse (he thought that he smelled marijuana).  When he saw bottles of medication in her bag he asked her “What is that?”  Feeling under duress, Denise reluctantly shared with the police officer that they were her HIV medications.

The police officer immediately seemed upset and said to her, “That’s probably something you needed to tell me when you got out of the car.” The police officer then continued to comment on the situation, and on his perceived risk, referring to the possibility of getting stuck with anything sharp inside her purse.  Denise had no such sharp objects inside her purse or on her body. 

Study questions:

1. Given the state law on HIV confidentiality and the “health threat to others” statute, do these circumstances allow Denise to keep her HIV status private?
2. Is the officer justified in thinking that Denise is a health threat? Is there a difference between what he may justifiably believe, what he may justifiably say to her, and what he may justifiably do to her or require her to do? 
3. Would the situation be different if Denise actually did have a syringe, or another sharp object, in her purse, but the officer did not know this?
Given the evident tension between Michigan’s confidentiality statute and its “health threat to others” statute, should either of these be changed? If so, which one?

Author Bio: Jimena Loveluck, MSW, is the author of The Open Purse case study. She is the President/CEO of the HIV/AIDS Resource Center (HARC) in Ypsilanti, Michigan, a position she has held since 2000. Ms. Loveluck has almost 25 years of expertise and experience in establishing vital services for people living with HIV/AIDS. Her leadership and commitment to community-based partnerships distinguishes her forward-thinking approach to the provision of health services. A recent example is HARC's collaboration with the Center for Sexuality and Health Disparities at the University of Michigan School of Public Health, in which community-based participatory research is being put to use to address the needs of people at risk or living with HIV/AIDS. To learn about several ethical issues people at risk or living with AIDS confront--please listen to A2Ethics' podcasts with Jimena Loveluck, most recently: The Good Work of Michigan's HIV/AIDS Center (HARC).

4. Taking Notice

People who experience homelessness are often lumped together as “the homeless.” Lumping them does not take into account their very different situations or multiple reasons for being homeless. Some among them, however, are considered chronically homeless, especially when they live completely unsheltered or do not go to any type of emergency shelter, even in the harshest weather conditions, such as the Michigan winter of 2013.

Those termed chronically homeless often have some combination of mental or physical disabilities and substance abuse problems. They also have little or no income and dislike living in emergency shelters or similar institutions because of the rigid environment. It can also be difficult to fit the chronically homeless into the bureaucratic institutions intended to meet housing needs: most such programs require at least a modest rental payment, for which many homeless people do not have the means available. Thus, they often “live rough,” either in tents or other outside areas such as doorways and the space under bridges. But this requires a location where a tent or sleeproll can be maintained, and one which is near services and jobs or other income. Sleeping in these areas can create conflicts with property law.

Camp Take Notice (CTN) was a tent community with several dozen residents set up on Michigan Department of Transportation (MDOT) land in Ann Arbor. It was organized with rules to promote safe and healthy conditions, and the group stayed at that site for a couple of years. MDOT officials finally served notice to vacate in June 2012. 

After the notice to vacate its original site, CTN residents and their advocates partnered with a nonprofit group called M.I.S.S.I.O.N. This collaborative effort allowed the group to receive donations and contributions. In November 2013, the group was able to buy a house and a 3.5 acre property on Stone School Road at the south edge of Ann Arbor. They had hoped to allow tents to be pitched and to support a self-governed, drug-and-alcohol-free living community there. In addition, there has been some talk of installing “tiny houses,” following other communities (such as Portland, Oregon) that have committed public land and some funds to their chronically homeless residents.

The tent community proposal requires approval by the Ann Arbor City Council. Local elected officials and city residents have been discussing several unresolved issues the plan presents — from zoning laws and their application to residential neighborhoods, to the requisite infrastructure (water, sewer, lights and heat) for habitable, safe and sanitary housing.  Some council members have stressed that the rule of law, including a variety of city ordinances and respect for public and private property, must be enforced.  The proposal also raises questions about the responsibilities of the city in ensuring a safe and adequately structured community in this context, as well as any liability the city might incur. Likewise, financial questions have been raised about the city’s role in such a project, suggesting that the city does not have a source of funds to create such a micro-community and pointing out that the targeted money is already directed at replacing aging public housing.

The fact is that shelter for all in the city remains an aspiration. The winter of 2014 is fast approaching.

Study Questions:

1. Who has responsibility for the homeless? How far do these responsibilities extend?
2. Given that the Council has limited funds, is it ethical for it to divert money that had previously been earmarked for another purpose towards CTN’s project?
3. What are the principal ethical issues concerning the site selection process for such projects?   Should these be relevant to the Council’s decision?

Author Bio: Former Washtenaw County Commissioner Vivienne Armentrout is the author of the Taking Notice case study. As an elected official, Ms. Armentrout held positions on several urban planning committees and was instrumental in the issuance of the Washtenaw County Comprehensive Plan. Ms. Armentrout has continued her public service as an appointed member of the City of Ann Arbor Pedestrian Safety and Access Task Force. While she is not originally from Ann Arbor--she is an exceptionally knowledgeable guide for city residents through her popular blog Local In Ann Arbor, a thoughtful, detailed go-to resource about city issues. An accomplished writer and book editor, Ms. Armentrout has edited another guide--Gleason's Plants of Michigan. A former college professor, Ms. Armentrout has a PhD in botany and plant pathology.

5. Best Practices

It is estimated that 13 to 14 million adults over 18 suffer from one major depressive episode each year. This figure represents almost 7% of all adults living in the United States. Among those who suffer from a major depressive disorder, the risk of suicide is greater. As one study recently reported, of all completed suicides, one half to two-thirds are by people who have suffered from mood disorders. [1]

Lin is a 25 year old who just landed her first journalism job working for a local TV news organization in Detroit. She knows something about major depression. Her favorite cousin Deshi suffered for years. She watched his personal battle with it. Deshi died by suicide a few years ago. 

So when Lin was asked to do a follow-up story summarizing everything that was known about the death of actor and comedian Robin Williams, she was unsure what to do. She had read and seen the media coverage after the news of his death. She knew that much of it did not follow the best practices reporting guidelines for covering suicide. These guidelines had been developed by the leading worldwide institutions knowledgeable about the issue of suicide.

Among the recommendations of what to avoid are: (1) sensational headlines and stories; (2) explicit descriptions of the suicide method; (3) speculations on the reasons for the suicide, including those which made it sound as if it was caused by one event in a person’s life.

Lin wrote her story following these guidelines. At the same time, she focused on the fact that suicides are a public health issue, and further emphasized that suicides almost always have complex and multiple causes. Lin believed her story could be used to educate others; in addition to outlining current local and national resources for treatment options, she included a list of warning signs of suicide along with a list of emergency lifeline numbers. 

She looked forward to talking with her boss about getting possible interviews with psychiatrists and mental health experts working on major depression. She was also interested in talking with experts whose work on copycat suicides, had shown that the publication of celebrity suicide methods resulted in more suicides. [2]

When they met, however, her boss told her that her story would “bore the viewers to death”—and that no one watching local news would be interested in either the copycat suicide statistics or the public health aspects of the Robin Williams story. Before she ended the meeting, her boss said, “There are best practices. And there are real practices. The earlier you learn that what is said about local news is actually true — ‘if it bleeds, it leads’ — the more stories you will get produced.”

[1] http://www.ncbi.nlm.nih.gov/pubmed/12813115
      http://www.ncbi.nlm.nih.gov/pubmed/25559346
[2] http://www.sciencedirect.com/science/article/pii/S0165032712006015 
     http://www.ncbi.nlm.nih.gov/pubmed/24355649

Study Questions:

1. Do journalists have a duty to ensure that the information they provide to their readership will conduce to the public good? Or do they have a duty merely to give the public whatever kind of story they want?
2. Are journalists morally permitted to lie to the public for the sake of a good story? Are they permitted to present the truth in a misleading way for the sake of an exciting story?
3. Should Lin change her story in response to her boss’s comments? If so, in what ways?

Author Bio: The Best Practices case study writer Patricia Ryan, MD, is a psychiatrist with over 30 years of experience in the field. A graduate of Fordham University and the St. Louis University Medical School, she completed her psychiatric residency training at Indiana University. She has worked in a variety of health care settings, including inpatient and hospital consultation liaison psychiatry as well as in outpatient care. For the past two decades, she has offered psychiatric services in private practice.  Early in her career, Dr. Ryan served in the National Health Service Corps to provide community mental health services to underserved communities in rural areas of Missouri. Dr. Ryan's professional interests are broad and eclectic. She is currently involved in improving the effectiveness of science communication among medical practitioners, scientists and the public. She is a graduate of the 2014 Summer Institute of the Alan Alda Center for Communicating Science at Stony Brook University. Dr. Ryan's other recent focus is exploring ways to integrate effective psychiatric treatments directly into primary care physician offices to help expand access to mental health services. 

6. Battle Tested

You are the platoon leader for 40 soldiers deployed to a combat zone, where you have lived and trained with your platoon for 18 months. You know them as soldiers and people.  Every day you trust them with your life — as they do you.  Because you are the platoon leader, they depend on your professional skill and judgment to accomplish the mission while keeping them as safe as possible.  Infantry combat is inherently dangerous, and all of the soldiers in the platoon knew they would be risking life and limb when they volunteered.  They trust that you and the commanders above you will not risk their lives needlessly.

You are leading a foot patrol and must cross an open field to get to a village.  In that village you are to meet with the local leaders, who are supportive of your mission.  Your patrol is halfway across the field when you start receiving rifle and mortar fire from the village.  One of your soldiers is wounded and needs to get to the field hospital right away.  The field is flat, offering no cover from either the rifle or the mortar fire.  The longer you stay where you are, the more likely your soldiers will be killed or wounded.  Going back will also expose your soldiers to lethal fire and likely result in further casualties.

Your training says that in this situation you should call in for artillery fire while you direct your machine guns at the source of the rifle fire, and that you should direct your soldiers to attack the enemy location to defeat the ambush. This approach is battle tested.  It provides the least risk to your soldiers. 

You know, however, there are civilians in the village. Among them are the local leaders that you are going to meet.  You also know from experience that the “Laws of Land Warfare” are neither respected nor followed — it is likely the enemy is deliberately fighting from positions near or surrounded by civilians. 

So, what should you do? The “means” you have at your disposal are:

The rifles that your soldiers carry. They are accurate. They are also unlikely to penetrate the walls of the village buildings.
The machine guns in your platoon.  They are accurate and effective. They will penetrate the walls of the village buildings.
Artillery support.  The high explosive shells have bursting radius of 25 meters and a direct hit will destroy a house, killing anyone in the house.  Artillery is initially inaccurate.  The first rounds would likely miss by up to 200 meters, becoming more accurate will each shot.
Artillery Smoke.  The smoke is created by white phosphorous, which burns at a very high temperature and cannot be extinguished.  Using artillery smoke to cover your withdrawal risks setting the field or the nearest buildings on fire. 

Author Bio: Battle Tested case study writer, Don Welch, PhD, is the President/CEO of Merit Network, Inc. a pioneering leader in research/education network infrastructure for universities and school systems. Among the many awards Dr. Welch has earned: his recent honor at the White House as a "Champion of Change," and as 2013 recipient of the 21st Century Achievement Award from Computerworld Foundation. Dr. Welch has held executive and leadership positions in business and the military. He was the Director of Enterprise Technology and Merchandising Applications for H-E-B, a $12B retailer in Texas and Mexico. In addition, Dr. Welch served in the U.S. Army, attaining the rank of Colonel and earning the Legion of Merit for his service. Key assigments include: West Point, Delta Force and the 25th Infrantry Division. He has earned the Army's Ranger Tab and Paratrooper Wings. Dr. Welch's longstanding interest in ethics education continues through his teaching at Academy Leadership, a leadership training initiative founded by West Point and Annapolis graduates with successful careers in both the military and the private sector. A2Ethics interviewed Dr. Welch about this program and his diverse leadership experience in 2013: The Values We Carry: Don Welch Discusses Academy Leadership.

7. Drunken Racism

Four college friends are hanging out one night and decide to have a few drinks. None of them has much experience with alcohol. They’re all having a good time until one member of the group, Molly, starts endorsing some stereotypes about a racial minority group. Her friends all tell her to stop, but this only fuels her rant; she goes on and on, her rhetoric becoming more hateful and violent. Finally, to everyone’s relief, Molly passes out.

The next morning, when the others confront Molly about her behavior, she says she doesn’t remember any of it. She assures them that her statements are not reflective of her true self. “You know me!” she says, “Of course, I don’t really feel that way!”

When Molly’s friends discuss her behavior amongst themselves, some differences of opinion emerge. Some of Molly’s friends are angry, arguing that Molly is fully blameworthy for her drunken behavior. They want, at the very least, a heartfelt apology and show of contrition. Others, however, are not so sure, noting that usually we are only blameworthy for voluntary actions under our rational control. Still others wonder whether her real crime was simply having rather than expressing racist thoughts.

Study Questions:

1. To what extent is Molly blameworthy for her rant? Explain.
2. Does Molly owe the group an apology? How is the situation different if one of the friends present that night is a member of the group Molly attacked?
3. How should Molly’s friends react to her claim that her drunken words do not reflect her “true self?”
4. Can we be blameworthy for bad thoughts that are unexpressed?

Author Bio: Drunken Racism case study written by The 2015 National High School Ethics Bowl Case Study Committee.

8. Eating for Free

Milan is a part-time employee at a local burrito restaurant called Ponchos. She usually works at night after her classes. Milan believes she is a good employee — she shows up on time, is polite to customers, and listens to her managers. The official policy at Ponchos states that employees, not including managers, must pay for food. Managers are allowed to eat one meal for free per day.

Milan is close friends with Kai, one of the managers. Kai is lenient with the employees about Ponchos’ food policy, and sometimes lets employees, including Milan, eat for free. As a result, when the restaurant closes at night, Milan often makes herself a burrito and quesadilla without paying for them. Although Milan knows this is against the rules, she believes she is not doing anything wrong because Kai gave her permission. Milan also thinks the food she takes is compensation for not getting paid well. She also knows that leftover food would not be saved, but would be thrown directly into the garbage.

Suspecting that employees have been stealing food, Ponchos installed video cameras and announced that employees caught taking food without payment will be fired immediately. Milan is caught on tape, and is fired.

When Milan confronts Kai, who had given her permission to take the food, Kai says that when they’re at work, she is a manager, not Milan’s friend. Kai does not feel responsible for Milan’s firing. Kai believes that Milan was aware of Ponchos' policy, and consciously made the decision to keep stealing food.

[4] http://www.foodservicewarehouse.com/education/restaurant-management-and-...  

Study Questions:

1. What constitutes stealing? Is Milan stealing even when the food is going to be trashed? If Milan secretly took napkins, plastic-ware, and condiments packages instead of food, should this action be valued the same?
2. What moral obligations do managers have to subordinates who are also their friends? Are they different from the moral obligations managers have to subordinates whom they are not friends with?
3. It is the manager’s responsibility to supervise the compliance of employee rules and ethical standards. When employees violate the rules due to unclear standards, how can ethical lapses between managers and employees be prevented or limited? Provide an example.
4. Do restaurants have a responsibility to its employees (managers and staff) to provide a meal? Are there benefits to providing employees with free or discounted meals?[1]

[1] http://www.foodservicewarehouse.com/education/restaurant-management-and-...  

Author Bio: Eating for Free case study written by The 2015 National High School Ethics Bowl Case Study Committee.

9. Watch and Wait

The Cancer Support Community is nonprofit support center designed to provide support for adults and kids who have cancer or care for someone with cancer. The Cancer Support Community does not provide medical care — rather, the organization provides psychological expertise and support- based services that have been shown to decrease anxiety and depression, while improving other quality-of-life factors and boosting immune system response. The organization is very clear that it does not offer medical advice, nor take a stance on the “traditional vs. alternative medicine” debate.

Chanda  has just come to the Cancer Support Community as a new member.  She is a 20 year-old University of Michigan student, and was recently diagnosed with stage one uterine cancer. Chanda’s cancer is a very treatable cancer, and with surgery she could be totally cancer-free. 

Chanda came to the Cancer Support Community to find a support group, as well as for some nutrition and exercise programs. Since her first visit, Chanda has insisted that she is opposed to medical treatment. She described that she has had some negative experiences with needles and surgeries in the past. She is extremely fearful of being hospitalized and debilitated. Moreover, she is fearful of the long-term side effects on her body image; she is convinced that if she pursues recommended medical treatment, she will feel that she is no longer a woman and no man will ever love her. She is instead opting for a “watch-and-wait” approach, combined with alternative techniques like exercise and visualization.

Chanda’s family is very worried about her. They have been actively advocating for her to receive surgery and are coming to the Cancer Support Community for help.  Not only do they want Chanda to receive the treatment so that she can be cancer-free, but they also feel that Chanda is being selfish in her choices — after all, her family members will be the ones left behind if she does not live.

Chanda’s support group is also pressuring her to reconsider, and Chanda is considering leaving the group because of this. The facilitator of her support group at the Cancer Support Community is concerned that Chanda’s anxiety and depression are guiding her choices. If Chanda leaves the support group with no follow-up she is likely to continue to make decisions based on her emotional reactions.

Study Questions:

1. Why do some support groups have an explicit policy not to give medical advice? What are the advantages of such a policy? What are the disadvantages?
2. Does Chanda have the right to refuse treatment in her situation? If it could be proved that her anxiety is causing her to want to avoid treatment, does she lose the right to refuse it? Under what circumstances do family members have the right to make a medical decision on someone else’s behalf?
3. There are lots of people who do not seek medical help for minor ailments because they do not like going to the doctor’s, because they are too busy, or because they do not want to cause a fuss. Some of them do in fact have genuine illnesses. How, if at all, is the situation of these people different from Chanda’s?
4. Would things change if Chanda’s condition were not life-threatening? If so, why?

Author Bio: Barb Hiltz, MSW, and Bonnie Dockham, LMSW, authored the Watch and Wait case study. Ms. Hiltz is the Executive Director and Ms. Dockham, the Program Director, at the Cancer Support Community (CSC) of Ann Arbor. Before joining the CSC, Ms. Hiltz held leadership roles in several nonprofits in program administration, education and training, including the executive directorship of a non-violence education program in St. Louis, Missouri. In addition to her position on the Board of the headquarter office of the CSC, Ms. Hiltz is a lecturer in the University of Michigan School of Social Work. Ms. Dockham is a licensed medical social worker, and has practiced in the inpatient hospital as well as the Department of Radiation Oncology at St. Joseph Mercy Health System. As founding Program Director at the CSC, her particular professional focus is in applying evidence-based practices to benefit patients and families affected by cancer. Ms. Dockham has presented at state and national oncology conferences in addition to serving as a guest lecturer at the University of Michigan Schools of Public Health and of Social Work. The CSC is a unique organization; its integrated programs are dedicated to providing the psychosocial needs of adults and children touched by cancer. Ms. Hiltz and Ms. Dockham spoke eloquently about one of the many ethical issues they contend with in their field in a 2009 A2Ethics interview: Privacy and the Cancer Patient.

10. A Busy Day

Frank is a state senator running for reelection. His schedule today is extremely busy. He starts the morning by speaking to the state chapter of the Environmental Protection League (EPL), a group that lobbies state politicians for stricter pollution controls. The EPL supported Frank during his last campaign, largely because Frank’s best friend, Bob, is the chairman. After Frank’s speech, he catches up with Bob. Bob’s daughter, Helen, has just graduated from college and is looking for work. Frank informs Bob that he has an open legislative aide position in his office, and asks Bob to send Helen’s resume to his chief of staff.

Frank then goes to a luncheon held by the Dairy Farmers’ Cooperative (DFC). The DFC is a trade organization that has a small presence in the state capitol — most of their lobbying efforts are focused on Congress and in Washington, DC. Tom, a constituent of Frank’s, who belongs to the DFC, is very upset at the new national farm bill, which lowered the price floor of a gallon of milk to $1.00.  He tells Frank that it will be impossible for him to make a profit, and that his farm, which has been in his family for 100 years, might go out of business as a result. Frank assures Tom that he will look into the issue. Shortly after he leaves the DFC luncheon, he calls Larry, Tom’s congressman, and asks him to raise the price floor to $1.50. Larry tells Frank that he’ll see what he can do.

After lunch, Frank has a meet and greet at the Minority Empowerment Network, a statewide group that researches and promotes laws on voting access issues. Harold, a senior member of MEN’s board, says to Frank that he is very concerned about a new set of voter ID laws proposed by the state house. Harold says that if Frank doesn’t make an effort to stop the laws in the state senate, MEN will refuse to endorse Frank, and instead support a challenger in the party primary. Frank disagrees with MEN’s position on the voter ID bills, but promises Harold that he will attempt to fight the laws in the state senate when they come up for a vote, after the November election.

The final event of the day is a cocktail reception at the state Chamber of Commerce. After getting a drink, Frank speaks with Joe, the CFO of an out-of-state oil company that wants to expand its operations in Frank’s district. Joe tells Frank that state environmental regulations are so restrictive that it is almost impossible to drill new oil wells. Frank feigns agreement with Joe — he is actually strongly supportive of the anti-drilling regulations — because he is tired and doesn’t feel like getting into an argument. Joe is so happy that Frank seems amenable to his position that he promises to have the company donate $50,000 to Frank’s PAC, which it does the following week. Frank’s PAC uses the money to run attack ads against Frank’s opponent.

The remainder of the campaign goes extremely well. Frank wins the endorsement of the EPL and MEN, and coasts to reelection in November. With the help of his new aide, Helen, he orchestrates the defeat of the state house’s voter ID laws. He also refuses to support a senate bill relaxing restrictions on oil drilling in the state, and his opposition is crucial to the bill’s eventual defeat.

Study Questions:

1. Is it ethical for Frank to pretend to agree with Joe about the regulations? Once Frank has accepted money from Joe and used it to be re-elected, is it ethical for him to vote for the continued regulations, in line with his own preferences but against Joe’s? Is it ethical for him to honor his agreement with Harold but not his one with Joe?
2. How should state senators balance the competing claims made on them by the multiple individuals and groups that it is their duty to represent?
3. Was it permissible for Frank to hire his best friend’s daughter as his legislative aide?

Author Bio: Ted Lawrence wrote The Busy Day case. Ted, a 2013 graduate of the University of Michigan Law School, is currently a judicial clerk at the Michigan Court of Appeals. Prior to law school, he worked as an assistant editor at The National Interest, a foreign policy journal based in Washington, DC. He also served as a research assistant to veteran Supreme Court journalist and lawyer, Joan Biskupic, while she wrote her biographies of Supreme Court Justices, Antonin Scalia and Sonia Sotomayor. His community involvement in Ann Arbor includes membership on the development committee for The Dispute Resolution Center as well as research and advisory roles in local political campaigns.

11. Army Hairstyles

On March 31, 2014, the United States Army updated regulations to their official appearance and grooming protocol (AR 670-1). The changes establish tougher tattoo, fingernail, and hair and makeup rules, while also outlining how and when Army uniforms should be worn. Soldiers who do not abide by the policy face non-judicial punishment.

New hair regulations for women that were previously authorized are now unauthorized. For example, Chapter 3, Section 2 of the new document states: “Examples of hairstyles considered to be faddish or exaggerated and thus not authorized for wear while in uniform, or in civilian clothes on duty, include, but are not limited to: locks and twists (not including French rolls/twists or corn rows no bigger than a quarter inch); hair sculpting (eccentric directional flow, twists, texture, or spiking); buns or braids with loose hair extending at the end; multiple braids not braided in a straight line; hair styles with severe angles; and loose unsecured hair (not to include bangs) when medium and long hair are worn up.”[1] Many of these unauthorized hairstyles are common among the Army’s population of African American women, numbering 26,700 on active duty.[2]

After 670-1 was published, thousands of soldiers and non-soldiers signed a White House petition calling for the president to order the Army to re-adjust the appearance and grooming policies. Critics said that the policies were racially biased against African American women. The updated appearance and grooming policies were also cited as “white-washed”, and as offering little to no options for African American women with natural hair. Additionally, female members of the Congressional Black Caucus wrote this in a letter to Defense Secretary Chuck Hagel, “Though we understand the intent of the updated regulation is to ensure uniformity in our military, it is seen as discriminatory rules targeting soldiers who are women of color with little regard to what is needed to maintain their natural hair.”[3]

In response, Army Officials have said AR 670-1 applies to all soldiers, regardless of race, and that hair grooming standards are necessary to maintain uniformity within a military population. Officials also defended the process they used to devise the new appearance and grooming policies. Hundreds of women, including African American women, were involved in the process of developing the new female hair policies.

[1] http://www.apd.army.mil/pdffiles/r670_1.pdf
[2] http://www.nytimes.com/2014/04/21/us/politics/armys-ban-on-some-popular-...
[3] http://www.armytimes.com/article/20140423/NEWS07/304230054 

Study Questions:

1. If the Army is concerned about maintaining uniformity and professionalism, is it ethical to apply different policies for hairstyle for different gender identities? Should hairstyle policies be genderless?
2. Are the new hairstyle regulations discriminatory despite the fact they apply to all soldiers?
3. The Army requires uniformity for the safety and protection of soldiers when on the field. To what extent should the military maintain uniformity versus embrace ethnic diversity?
4. Could a regulation similar to AR 670-1 be applied in other circumstances? For example, should students, employees and/or athletes have a dress code?

Author Bio: Army Hairstyles case study written by the National High School Ethics Bowl Case Study Committee.

12. Writing Your Own Letter of Recommendation

Micah, a high school senior, was starting her college application process. The colleges Micah was applying to required three letters of recommendation. She asked three teachers who knew her skills, academic accomplishments, and personality to write her recommendations. Micah met with each teacher to discuss her intentions for college and supplied the teachers written, detailed information about her achievements, specific examples of her academic work, and courses taken over the years. Micah made her request in August and her applications were due in the beginning of December — giving her teachers plenty of time to write a letter of recommendation.

Two teachers gladly agreed to write a recommendation. Another teacher, Mr. Rutinel — Micah’s mentor — said he did not have time to write letters of recommendation. However, Mr. Rutinel told Micah that she could write her own letter that he would edit as needed and submit under his name. Micah felt uncomfortable about Mr. Rutinel’s proposition, but agreed to the plan.

Micah talked with a close friend, Cameron, about her situation. Cameron believed Micah should be happy because she could write whatever she wanted; “If Mr. Rutinel is too busy”, she said, “then he probably won’t really edit your letter.” Even though Micah agreed with Cameron that she had the opportunity to embellish her qualities and academic accomplishments if she wished to, she decided that honesty was the best policy, and tried to write an accurate summary of her achievements. Micah finished her letter of recommendation for Mr. Rutinel in November. Micah was proud of what she wrote about herself. Mr. Rutinel told Micah it looked good, and said that he would sign the letter, and submit it when needed.

Micah then met with another teacher, Ms. Shaw, who had also written her a recommendation. In conversation, Micah told Ms. Shaw about having to write her own letter for Mr. Rutinel. Ms. Shaw believed this situation was wrong and told Micah to take Mr. Rutinel off her list of recommendations. Micah told Ms. Shaw that she would withdraw Mr. Rutinel’s letter. However, she knew that this would leave her with only two letters of recommendation. Micah did not know what to do. There was no time to ask another teacher to write an adequate letter and she could not submit her college applications unless there were three letters of recommendation. Micah decided to keep Mr. Rutinel’s letter on file.

Study Questions:

1. In this situation, is it ethical for Micah to lie if she is not harming anyone? Would Micah’s situation be different if she did exaggerate on her letter of recommendation?
2. Does a teacher have any obligations or duties to their students outside the classroom (such as writing letters of recommendation, providing career guidance, etc.)?
Ms. Shaw felt it was wrong to ask a student to write her own recommendation letter. If Micah had told Ms. Shaw about her decision to keep Mr. Rutinel’s letter, would it be fair for Ms. Shaw to re-adjust her recommendation for Micah, calling her “ethically unconscientious?”
3. Under what conditions (if any) is it ethical to write one’s own letter of recommendation?

 

Author Bio: Writing Your Own Letter of Recommendation case study written by The 2015 National High School Ethics Bowl Case Study Committee.