Ethics On Call - Center For Professional & Applied Ethics

Conflict of Interest ConferenceConflict of Interest in Biomedical and Behavioral Research ConferenceFebruary 8-9, 2007February 87:00-8:00 p.m.“Moral Courage in Clinical Research” Keynote AddressMcKnight HallSpeaker: Evan DeRenzo, Ph.D., Consulting Bioethicist, Bethesda, MDFebruary 9148:00-8:30 a.m.Registration and Continental BreakfastCone Lucas Room 3418:30-10:00 a.m.“Money and Human Subjects: Keeping the First from Harming the Second”McKnight Hall10:15-12:15 p.m.Speaker: Evan DeRenzo, Ph.D., Consulting Bioethicist, Bethesda, MD1:00-1:45 p.m.Speaker: Felix Khin-Maung-Gyi, PharmD, MBA, CEO, Chesapeake Research Review,Inc.1:45-2:30 p.m.Speaker: Nancy King, JD, UNC Chapel Hill2:30-3:00 p.m.ConclusionCampus Co-sponsors: Graduate School, College of Arts and Sciences, College of Healthand Human Services and the Departments of Philosophy, Health Behavior and Administration, Biology and PsychologyOff-Campus Co-Sponsors: Association for Clinical Research Professionals, NortheastMedical Center, Carolinas Medical Center and Bioethics Resource Group“Conflicts of interest Issues in Not-for-Profit and For-Profit IRBs”Presentation, Panel Discussion and QuestionsMcKnight Hall“Guinea Pig or Patient?” Case PresentationCone Lucas Room 341Small Group DiscussionFrom the DirectorRosemarie Tong, Ph.D., DirectorCenter for Professional and Applied Ethics andDistinguished Professor for Health Care EthicsDepartment of PhilosophySex-Ratio Imbalance: Seesawing on an EthicalDilemmaIn order to understand why the United States does notban sex-control procedures, we need to focus on threefacts. First, the United States does not have a sex-ratioproblem, for several reasons. It is an affluent nation;social safety nets for the elderly exist in the form ofSocial Security pensions and government-supportedhealthcare (Medicare and Medicaid); women outnumber men in institutions of higher education; womenconstitute about 46% of the workforce; women are increasingly visible in the professional worlds of business, medicine, law, and politics; and there are no strongcultural and/or religious reasons for preferring sons todaughters. Thus, there is no social imperative to bansex-control procedures.Second, people in the United States tend to privilegeindividual rights over the social good. Most people inthe United States remain fairly fierce about their reproductive rights, convinced that the government shouldnot meddle in their private matters. Thus, a legal banon sex-control techniques would probably be met withconsiderable public resistance.Third, physicians in the United States are a self-regulating profession with a well-developed tradition of medical ethics and a strong desire to safeguard their prerogative to make medical decisions for their patients withoutgovernment interference. To be sure, there are thosewho are willing to do just about anything for moneyor causes they favor, but most U.S. physicians try toprovide only medically appropriate treatments and prescriptions. Thus, it is the case that most U.S. physicians do not provide sex-control services for non-medical reasons. However, not all medical professionals arestrong enough to withstand the temptation to provideexpensive genetic tests and assisted-reproduction technologies to couples who will pay to get them. In fact,some profit-driven U.S. fertility clinics have begun tounabashedly advertise on the Internet a wide varietyof sex-control services available for U.S. residents andnon-residents alike.Yet, within the U.S. context, I am hesitant to lobby forlaws that would legally prohibit this practice or, moredramatically, ban abortions and ultrasounds/chorionicvillus sampling/amniocentesis. Because sex-selectionabortions eliminate a developing being who would,were it not for its “wrong sex,” otherwise be welcomeinto the human community, they are precisely the typeof abortion that, in the United States, provide particularly good ammunition for those who would outlaw theabortion procedure altogether. In other words, to protectthe reproductive rights of the millions of U.S. womenwho would never abort on the basis of the fetus’s sexalone, I am pushed to try to protect the reproductiverights of U.S. women who want abortions for what Ias a feminist, think are bad reasons—reasons like sexselection.Does my willingness to rely only on a fairly successful system of professional self-regulation mean that Iam opposed to civilly penalizing or even criminalizingsome or all of these procedures in the context of China?Not necessarily. In the first place, China does have avery serious sex-ratio imbalance of about 120 to 100.If the sex-ratio imbalance persists in China, the socialstatus of girls and women will worsen as it becomesmore difficult to safeguard their rights and interests.Domestic violence and the trafficking of women/children will increase in frequency. The commercial sextrade will grow, and social shifts will occur, including societal stress from a growing population of maleswithout partners or family.Second, China does not have a large group of peoplewho are vocally opposed to abortion.Third, physicians in China are only in the process of3

Spring Calendar of EventsFrom the Director Cont.developing a strong and detailed medical ethics. Although some physicians refuse to provide sex-selectionservices, many provide them willingly either for remuneration or because they have sympathy for people whowant a son. Chinese physicians are, after all, a productof Chinese culture.Thus, it would seem that in the short run in China, specific laws to impose civil and/or criminal penalties onmedical practitioners who identify the fetus’ sex andterminate pregnancy on that basis may be in order. Butmy concern is that the long-term consequences of suchlaws will not be much better for the Chinese people,particularly Chinese women, than the long-term consequences of the One-Child policy either in its original orrelaxed forms are. Yes, the One-Child policy reducedthe size of the Chinese population, but it also contributed to China’s sex-ratio imbalance, and led to coercedsterilizations and even forced abortions – the kind ofactions that cause a population, initially willing to sacrifice some of its individual rights to achieve a greatsocial good, to show signs of rebellion. A new batchof reproduction-controlling laws might result in morefemale babies and girls being neglected, abandoned oreven killed. People have a way of resisting the stick ofthe law, and when the people resist, the government hasbut two choices: to make its law more restrictive andrepressive or to relax its laws until they no longer makesense. I am therefore most impressed not by the lawsthat have been highlighted, but by recommendationssuch as the following:February 194:00 p.m.“Contemporary Aesthetics and Politics,” Public Lecture, Cone 210 Mount advocacy campaigns to spread informationand raise awareness about the wrongness and socialdisutility of sex discrimination. Use educational toolsand the media to convince people not to use sex-control techniques.Speaker: Gregg M. Horowitz, Ph.D., Associate Professor of Philosophy and Director ofGraduate Studies, Department of Philosophy, Vanderbilt University Change policies regarding social security, employmentopportunities, property laws, and lineage laws so as toimprove the status and value of girls and women. Improve and expand old age security to counteractson preference triggered by the custom of sons lookingafter their parents in old age. Provide preferential treatment to families with onlydaughters in order to erode son preference.These kinds of recommendations will help create rightrelations between the sexes – a recognition that girlsare as good as boys – and it is this recognition that willdo the most to restore China’s sex-ratio to a normallevel. China’s sex-ratio problem is not only a threatto China’s stability, it is a human tragedy: I mourn thegirls, the women, who could have been, but are not; weare, each one of us, less for their absence.Case ReportThoughts on the Relationship Between ExtravagantC-Suite Compensation and the Outbreak ofCorruption in Corporate AmericaJoseph J. Fiato, MBA, Duke UniversityPrincipal, Senior Change ManagerBank of AmericaGiven the accounting fraud disasters and document destruction scandals that corporate outfits such as Adel4phia, Enron/Anderson and HealthSouth have produced– including their excessive and ridiculous levels of CSuite compensation – should the public at large reallybe surprised by the resultant outcome institutionalcorruption? I think not. As a society, should we relyupon increased government legislation/regulation andcorporate self-policing to provide sufficient oversightand control of corporate America today? Once again,I think not. Let me explain.February 2712:00-2:15 p.m.2nd Annual BB&T Business Ethics Forum, Cone Lucas Room 341March 16Keynote Speaker: Michael Mulligan, President, General Dynamics, Armament andTechnical ProductsTime TBADepartment/College Workshops and Public Lecture, “Gender Issues in Academic Ethics.”March 19Speaker: Virginia Valian, Ph.D., Tutorials for Change: Gender and Science Careers,Hunter College – CUNY, New York, NY10:00 a.m.“Disaster Preparation and Emergency Response: Notes on Philosophy, Pedagogy, andSafe Campuses,” Public Lecture, Cone 11212:00-2:15 p.m.“Why BiDil is Not the Answer: The Real Disconnection Between Race and Medicine,”Luncheon/Workshop, Cone 2104:00 p.m.“What Women Have in Common and Why We Should Rule,” Public Lecture, Cone 113Speaker: Naomi Zack, Ph.D., Professor of Philosophy, Director of Graduate Studies,University of OregonMarch 28“Hooking Up: Sex, Alcohol & the Death of Romance on College Campuses” PublicLecture, (location TBA)April 24 or 25Speaker: Naomi Wolf, The Woodhull Institute for Ethical Leadership12:00 – 2:30 p.m.Engineering Luncheon/Workshop, Cone 210Speaker: Manuel Zapata, President, Zapata Engineering13

TRISTAN RESPONSE TOCOMMENTARY ON ALTRUISMThat spiritual experiences have demonstrated links tospecific structures in the brain really shouldn’t be toosurprising. Spirituality and compassion are saturatedwith meanings, and one of the brain’s functions is togauge the salience of an experience. Once we thinkabout it—it would be more surprising if it turned outthat complex social meanings did not depend in someway upon such structures. Such dependence does notcall the existence, or the legitimacy, of such experiences into doubt. Rather, it fuels speculation that suchsalience sensing structures exist for the purpose of ex-periencing God, or in the case of mirror neurons forpurpose of initiating compassionate connections between peoples and altruistic acts.After all, we are interested in explanations because wewant to better understand our experiences. A satisfactory causal explanation of an aspect of our experienceshould not result in the denial of the existence of thefeature it sought to explain. The role of a causal explanation is to explain an experience, not to explain theexperience away.2006 SE Regional Ethics BowlCompetition, St. Petersburg, FLRichard H. Toenjes, Ph.D.Department of PhilosophyOur UNC Charlotte Ethics Bowl team made a strongshowing Saturday, November 19, 2006 at the 3rd Annual Southeast Regional Ethics Bowl at the Universityof South Florida, St. Petersburg. But we didn’t win.Twenty teams competed. They finished in the following order:Eckerd CollegeClemson UniversityTuskegee UniversityU.S. Military AcademyBarry UniversityUniversity of MiamiFlorida Atlantic UniversityKennesaw StateFlorida State UniversityUNC CharlotteBelmont UniversityUnversity of RichmondEmbry Riddle Aeronautical University12University of Central FloridaUniversity of North FloridaUniversity of FloridaNova Southeastern UniversitySt. Petersburg CollegeUNC Chapel HillUniversity of South FloridaAll teams competed in three contests. We lost toTuskegee by one point, 50 to 49 (out of 60 possible).We lost to Clemson by 3 points, 53 to 50, and we beatUSF Tampa 54 to 47. We were disappointed to finishin 10th place, until we saw the small margins by whishwe lost. Next year we intend not only to make the finalfour but also to win.UNC Charlotte team members were Denver Carlstrom(sophomore undecided), Thomas McComb (freshmanundecided), Chris Outlaw (senior, philosophy), StevenSpero (sophomore, philosophy), and Pete Sikorsky(senior, English). Dick Toenjes was the team coach.The team prepared for the contest in Dick’s philosophycourse entitled “Ehtics Bowl.”CASE REPORT CONT.What these recent business disasters and industrialscandals tell us is that dependence on corporate self-policing and legislative/regulatory activities is woefullyinsufficient. In order to establish truly effective checksand balances in a capitalistic society, the response mustinclude market forces exerted by the collective will ofsociety, as well as marketplace dynamics exercised byindividuals themselves. At the individual level, influence over corporate behavior should occur through ourcheckbooks, especially with decisions made in bothspending and investing marketplaces. However, at thecollective/societal level, this influence is more difficult,though certainly not impossible, to sustain.Boards of Directors should be pushed to responsiblyengage in their oversight and control of companies inorder to raise the standards and benchmarks utilized intheir measuring, evaluating and reporting of management performance. Moreover, analysts in both the Financial and Credit Markets should be held accountableto raise the standards and benchmarks utilized in themeasuring, evaluating and reporting of corporate performance in the marketplace. However, what mechanisms can be utilized to help guarantee this type of corporate responsibility? A number of suggestions cometo mind.Considerable historical information exists, documenting corporate annual reports as well as financial ratio/analyses of corporate annual reports. Consequently,statistical analyses should be employed that wouldsupport the establishment of financial ratios or metrics.These financial ratios would yield new performancemeasures relating to the amount of compensation an individual C-level officer could receive. This analysis isalso applicable to the amount of compensation provided to the collective members of the C-Suite, includingsuch things as shareholder value, revenues, net incomeand/or other accepted financial performance measures.With these goals in mind, several examples of the typeof statistical analyses that are warranted come to mind.A few of them are listed below:--COO total compensation (defined as salary, incentives, stock/options, benefits, and perks) as a percentageof Net Income (Gross Revenue or Sales less Expenses)--C-Suite total compensation (defined as the salary,incentives, stock/options, benefits, and perks of all Clevel Executives) as a percentage of Net Income (GrossRevenue or Sales less Expenses)--changes in COO total compensation as a percent ofchange in Market Value (defined as the number of sharesin issue multiplied by their current market price)--C-Suite total compensation (defined as the salary, incentives, stock/options, benefits, and perks of all C-level Executives) as a percent of change in Market Value(defined as the number of shares in issue multiplied bytheir current market price)By establishing financial ratios such as these as measures of customary norms (comparable to the Debt/Equity ratio of 80/20 that has been a well established, traditional metric utilized in the residential mortgage lendingbusiness), efforts to curb the ethical abuses of industrialand corporate America can occur. The marketplaceunderstands when exceptions happen and exerts its influence over those behaviors that fall outside the scopeof what constitutes acceptable behavioral norms. Themarketplace addresses these exceptions through controlmechanisms such as higher cost of borrowing or adjustments in interest rate. These measures provide adequatechecks and balances.However, should we permit the abject greed of a handful of C-Suite participants to continue to distort marketplace economics in ways that devastate the lives of hardworking, dedicated employees to the point of bankrupting companies? I say no! The C-Suite must acknowledge its obligations and responsibilities to all of its keystakeholders. This includes shareholders, employees,customers, and vendors, as well as the marketplace andthe public at large.5

CASE REPORT CONT.Activist investors such as Ralph Whitworth and hisformer United Shareholders Association from theearly 1990s focused on issues such as executive pay.They had the right idea. The time has come onceagain to pick up the baton and mobilize the collective forces that only the participants in the market-place can exercise. The time is long past due for honesty,integrity and moral character to return to the C-Suite ofCorporate America. Society and the economic future/security of its citizens can ill afford to ignore the ethical implications of this important and timely issue.International Nurse Migration: Autonomy orNeo-Colonialism(SAPs). Since most public spending is on the labor force,SAPs require debtor countries to decrease the number ofpublic employees. Because most Southern countries havelittle or no private health care sector, nurses are public employees eligible for downsizing.ETHICS IN PUBLIC POLICY ESSAYSat Ananda Hayden, MSN, RNPh.D. Program in Public PolicyDebt and dependence on aid puts less-developedcountries “between a rock and a hard place”. Lessdeveloped (Southern) countries lose more healthprofessionals to developed countries (Northern)each year than they produce1. Some hospitals have asmall percentage of the nurses they need; others haveno pharmacist; others close because their physiciansmigrate2. Foreign recruitment of health professionals has become a brisk trade. This essay discussesthe ethical implications of nurse migration for bothNorthern and Southern countries.An analysis of health and ethics literature3 revealsthat nurse migration is a global concern viewedthrough two ethical perspectives. Northern countries regard nurse migration as an issue of individualautonomy; Southern countries view recruitment oftheir nurses as a social justice issue. Is nurse migration a case in which individual autonomy trumps social justice or is it neo-Colonialism4 masqueradingas autonomy?Northern nations provide financial aid and loansto bolster struggling Southern economies. To helpSouthern countries repay their debts, international lenders such as the World Bank and developedcountries have instituted structural adjustment plans6According to Southern countries, SAPs keep them indebted and prevent full employment of nurses. With a SAP inplace, the newly graduated nurse may not be able to findemployment in her own country and may have to volunteerher services while waiting for a paid position to becomeavailable. As a result nurses are more easily recruited forwork in the North; draining the South of highly educatedwomen. This drain has greater health ramifications for acountry because of the link between population health andfemale literacy5.In many countries, more nurses migrate than graduate eachyear. This results in a “care drain” at a time when HIV/AIDS and Malaria are pandemic6. The dollars received inaid from the North do not offset the investment by Southern countries in government-sponsored nursing education that is lost when nurses emigrate. Implementation ofloan repayment, bonding, or required practice programs incountry prior to migration makes costly demands on infrastructure and monitoring7. In effect, the Nor

The Center for Professional and Applied Ethics, the Department of Philosophy, and the Belk College of Business are co-sponsoring a public lecture by Patricia H. Werhane, Ph.D., on February 22, 2007 at 4:00 p.m. in Storrs 110. Dr. Werhane is Ruffin Professor of Business Ethics and Senior Fellow of the Olsson Center for Applied Ethics.