Nurses are required to get continuing education. This month’s class was Ethics. I sat around a table with co-workers debating moral challenges – little white lies, getting extra change at the supermarket, etc. I kept my head down, suppressing an urge to giggle nervously, like the mortal and venial sins blotting my soul might show through my blouse- but then it got interesting.
The group leader passed around a morality problem called The Heinz Dilemma. This is a famous ethical problem posed by psychologist Lawrence Kohlberg in the 1950’s. It goes like this:
A woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to produce. He paid $200 for the radium and charged $2,000 for a small dose of the drug. The sick woman’s husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: “No, I discovered the drug and I’m going to make money from it.” So Heinz got desperate and broke into the man’s store to steal the drug for his wife. Should Heinz have broken into the laboratory to steal the drug for his wife? Why or why not?
My first impulse was that I’d stand lookout while Heinz grabbed the goods. But on second thought- is Heinz supposed to stuff a hunk of Radium in a paper bag? He’ll be glowing in the dark before he gets home.
Anyway, this is all hopelessly 20th Century. As dilemmas are said to have 2 horns, a 21st Century 2-pronged approach is needed– power politics and social disgrace.
- Step 1: Crowdsourcing. Mrs. Heinz posts a picture of her languishing self on social media with a plea for donations. This has the dual benefit of helping her with her medical expenses while outing the profiteering druggist. If they succeed in raising the cash quick they can buy the medicine, and buy time while they go on to…
- Step 2: Social Disgrace. Start with the doctors who thought Radium might save Mrs. Heinz. They may be customers of the druggist. The druggist doesn’t care about a nobody like Heinz, but ticking off the doctors is bad for business. Time is short, so direct action is needed. Heinz should get a few friends to stand out on the sidewalk with him as he begs for help. If Mrs. Heinz can’t make it they can wear t-shirts with her picture. Invite Channel 10. Clergy in garb and professionals in attire make good visuals. Heinz should have a statement prepared for when the press shows up.
- Step 3: Lobbying Politicians. This is another form of crowdsourcing- taxes fund social welfare, laws protect the vulnerable. While Heinz takes it to the streets he also needs to take it to the marble halls where decisions get made. The greedy druggist is a political opportunity to crack down on profiteers. In fact, when he feels the heat he might decide that it is better to give Heinz a break. And there may be competitors ready to make a cheaper generic version of Radium if protecting the druggist’s patent becomes a political liability.
- Step 4: Opposition Research. There’s got to be some dirt on this druggist. It’s a sure thing he’s made enemies with his cruel, mercenary ways. Go for the throat.
Poor Heinz, I picture him forever languishing in post-war Germany, with ex-Nazis for neighbors. I hope his wife got better. I see them like an old movie, perhaps because so much of the dilemma is black and white- the authoritarian stance of the druggist who puts profit before people, the helplessness of the individual, the voiceless wife…did I mention that the whole setup is hierarchical and masculinist? Carol Gilligan did.
In the bigger picture, we have to deal with ‘Heinz’ situations all the time. A part of my generation is missing, lost to AIDS. It was not so long ago that people had to break rules and make new rules as the epidemic raged. (see Dallas Buyer’s Club) Each new drug that made its way through the approval pipeline was expensive, and states were slow to pay. Internationally, pharmaceutical companies played the role of the heartless druggist, protecting their patents at the cost of lives in poor nations. (see here how the West blocked generic AIDS medication in South Africa.)
Right now we have a cure for Hepatitis C, but the cost is about $1,000 a pill. It’s a strain on the system, and how to manage it is not clear. Recent history of activism and political pressure driving down the cost of some drugs gives encouragement. It’s cheaper in the long run to treat illness, and people will not quietly go away when a cure exists just out of reach. Even poor Heinz stopped being a good German when he was pushed too far.
What if there was a wealthy nation that let millions of its citizens die over the years because they could not afford medical care? What if potential remedies were rejected in favor of protecting profits? Where is the morality in a system that values national defense, but not defense against preventable illness? What ethical standard withholds care until a citizen is disabled- then puts them on disability?
Like a wise man once said, “it’s a complex world.” The Affordable Care Act is partial and imperfect, but it has made health care accessible to millions of Americans who were previously uninsured and is something to build on. No dilemma here, the US needs to join all the other developed nations and move forward to universal health care.