MEDIA ETHICS AT WORK 2ND EDITION PDF, EPUB, EBOOK

Lee Anne Peck | --- | --- | --- | 9781506315287 | --- | --- Raymond R. Wong Endowed Professor in Media Ethics job with HONG KONG BAPTIST UNIVERSITY |

Negligence and lawyers 9. Litigation Alternative dispute resolution Third parties Business ethics Lawyers' social responsibilities Gender, race, and diversity in the legal profession Applying legal theories. He is a widely published author across several disciplines, including criminal law, family law, and legal ethics. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Academic Skip to main content. Search Start Search. Choose your country or region Close. Dear Customer, As a global organization, we, like many others, recognize the significant threat posed by the coronavirus. Student Price: Contact us to learn more. Explains the basic tenants of the profession, provides some historical context and details on how it is being practiced today for prospective journalists. This introduction to journalism explains the basic tenets of the profession, provides some historical context and uses primarily recent examples to inform prospective journalists and those who simply want to become better informed. As a professional journalist, I approached this project as I do my other work, starting with research and then synthesizing the information into this online textbook. It is intended to be an interactive guide to engage students and not a comprehensive history of the profession, which is why there are lists of suggested readings on themes found in the chapters. Though the material focuses mainly on journalism in the United States, I examine how it is practiced in other countries and share information about restrictions and challenges journalists face around the world. Most discussion questions are given for participation points only, to encourage students to think critically about a particular issue they may have never considered, or give them an opportunity to try something new without penalty. This Site contains links to pages on other websites. We have not reviewed, and cannot review, all of the material, including computer software, made available through the websites to which the Site links, and that link to the Site. The author does not have any control over those third-party websites and webpages, and is not responsible for their contents or their use. There may be content you find offensive. By linking to a third-party website or webpage, the author does not represent or imply that it endorses such website or webpage. You are responsible for taking precautions as necessary to protect yourself and your computer systems from viruses, worms, Trojan horses, and other harmful or destructive content. None of the content on this site should be construed as legal advice. Users should contact an attorney in their jurisdiction for legal advice applicable to their particular situation. Skip to main content back to top hat. Over the years, she has advised three student newspapers. Daily Dispatch. In the mids, she edited and wrote for publications in Indiana and Delaware; she has worked for the Fort Collins Coloradoan as an editor, a columnist and writing coach and for the Rocky Mountain News as a copy editor. Guy Reel, Ph. He received his Ph. Account Options Anmelden. Media Ethics at Work: True Stories from Young Professionals - Google Books

We suggest using the following learning objectives or component behaviors in connection with the learning activities in this toolkit: Make ethical decisions with social and digital media by applying the standards of the NASW Code of Ethics and other relevant guidelines, laws and policies; Use self-reflection and self-regulation to maintain and demonstrate professionalism with social media. Describe how to use social media ethically and professionally to facilitate practice outcomes. Demonstrate professional demeanor with social media. Use supervision and consultation to guide professional judgement and behavior with social media. Submit a Comment Cancel reply Your email address will not be published. Search for:. Follow Me on Twitter! Follow LaurelHitchcock. Signup today to be notified of new updates! Confidentiality 6. Conflicts of interests 7. Fees 8. Negligence and lawyers 9. Litigation Alternative dispute resolution Third parties Business ethics Lawyers' social responsibilities Gender, race, and diversity in the legal profession Applying legal theories. He is a widely published author across several disciplines, including criminal law, family law, and legal ethics. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Academic Skip to main content. Day in the Life game online version. Day in the Life game in-class activity. Chapter 2 - The First Amendment. The First Amendment in the digital age. The Freedom of Information Act. First, a story. And a question. Or two. Looking for and reporting the truth. Suggested additional reading 3. Chapter 4 - Early Journalism and Journalism in the 20th Century. Perspectives on journalism: Journalism as history. Chapter 5 - Investigations. Why bother investigating? You don't need an army Chapter 6 - Digital Journalism and Trends. Media Ethics at Work | SAGE Publications Inc

The deaths of Diana, Princess of Wales, Dodi al-Fayed and their driver in August tragically highlighted the way such figures are often hounded by the news media to the extent that they can have little privacy or peace regarding even the most intimate aspects of their lives. It may be thought that such media intrusion is far from justifiable. If, however, there is a link between the two, as Archard suggests, then the media attention devoted to the lives of the royals and celebrities is morally justifiable even though we may rightfully deplore the form such intrusion may take in a particular case. Cram argues that, given a lack of political will to institute a direct right of privacy, enforceable by the courts, it is worth paying greater attention to the nonlegal forms of privacy protection provided by regulators and current codes of media practice. Importantly, Cram goes on to consider how the European Convention on Human Rights and Fundamental Freedoms could, if incorporated into domestic law, provide the most substantial means by which to protect privacy. They go on to examine the likely effectiveness of increasing legal restrictions and the costs and benefits of self- xiv Matthew Kieran regulation. Especially when gossip comes to be seen to constitute news as such, the problem arises as to the forms of redress ordinary people, unable to avail themselves of the legal and regulatory avenues open to those better off, have open to them when their privacy and lives have been abused by the press. Nigel Warburton switches focus to ethical problems arising from the nature of the photographic medium. Many people are worried about the ethical problems which new media technology seems to raise. For example, the possibility of creating flawless images may undermine the trust we place in photojournalism as bearing faithful witness to an event as it happened. What it does show, however, is that news photographers must retain a commitment to retaining the causal link from the resulting image back to the originating event. For the point of photojournalism is to retain a link to the actual world so that we can understand what was true of an actual event. These worries basically amount to three claims. Namely, that it cultivates in viewers, falsely, the assumption that how things are depicted is, in fact, the way things must be. Secondly, that television indulges a fantastical, morally dubious form of escapism. Thirdly, that as a medium television precludes the use of our imagination. But, Carroll argues, these worries turn out to be unfounded. Essentially, they fail to take account of the complex ways in which we understand and respond to television, or rely on an overly simplistic view of the nature of our emotions. Thus, Carroll concludes, the television medium or image is not inherently immoral though we may nonetheless have worries about the content of certain programmes. The premiss that watching such programmes will cultivate a tendency to be violent is, Graham argues, highly debatable for all but a very few. Moreover, even were harm to result from such programmes, this would not legitimate censorship. After all, we know that allowing cars on the road will directly lead to the deaths of a number of individuals each year. But the freedoms at stake are more important than the resultant harm. The interesting point about reports or films which make gratuitous use of violent or sexual imagery, Graham argues, is their failure to engage our interest in order to deepen our understanding. Thus we should, perhaps, ask why it is that our artistic and journalistic communities are failing us. Introduction xv The last article in the collection, by Anthony Ellis, follows on to address arguments over censorship and the media. Obviously freedom of speech is valuable and ought to be protected, to some extent, against government interference given the primary importance of individual freedom. Ultimately, he argues, the harm involved in such restrictions is so great that even proven harm resulting from free speech should not be prohibited unless it is of a very high degree. But Ellis also goes on to consider whether not just harm but offence can constitute grounds for prohibition. Yet the notion of offence is intrinsically tied to morality. Given this link, at least within a liberal framework, offence cannot constitute sufficient grounds for censorship because the liberal state has no business in legislating for morality. Indeed, deeply held beliefs and moral convictions often need to be attacked. Legislation to protect the feelings of those who cherish certain beliefs is, at best, mistaken, and at worst, deeply pernicious. A culture that legislates against offence is one that not only fails to protect our basic freedoms as individual persons but one likely to stagnate and infantilise its citizens. The articles in this collection show that there are some deep ethical and social issues in journalism and the media which require careful thinking through, with regard both to their philosophical complexity and to their pragmatic aspects. Of course, the arguments here do not constitute the last word. But they do at least help to elucidate some of the central ethical issues in the media and provide arguments which must be taken into account in justifying our judgements. Thus, at the very least, they help us to understand more deeply what responses are rationally open to us and what the ethical responsibilities of the media are. It is to be hoped that the collection may play a small part in focusing the debate and emphasising the need for rational justification in such matters, as opposed to the rhetoric, prejudices and emotional responses that so often seem to hold sway. I would like to thank all the contributors for accepting the invitation to contribute to this collection and for responding courteously to editorial requests. I would also like to thank all the speakers and participants at the media ethics conference held at the University of Leeds, in September , from which this collection sprang and gratefully acknowledge sponsorship for the conference from the Society for Applied Philosophy and Yorkshire and Humberside Arts. Andrew Belsey Introduction Both the image and the essence of journalism are hard to pin down because each appears to contain contradictory strands. It is well known that journalism has a poor image with the public. They do not regard it highly. They are suspicious of journalists and the way they practise their trade. Journalists are regarded in much the same way as politicians, as disreputable, untrustworthy and dishonest, pushing a personal or sectional interest rather than the facts of the case. If people are told that the essence of journalism is truthtelling, they will react with some scepticism or derision. If they are told that the practice of journalism is founded on ethical principles they will either laugh or, if they are prepared to take the matter seriously, point out that the typical tabloid story is trivial, scurrilous or invented. But all this is contradicted by another image of journalism, illustrated by the most extraordinary event of the British General Election of May Until about a month before the election, Mr Bell was a television journalist — a respected journalist, let it be said — working for the BBC, reporting from the war-torn zones of the world with an immediacy and an integrity that made a considerable impact. When Mr Hamilton refused to stand down and was renominated by his party, the candidates of the other major parties withdrew to give Mr Bell a clear run, and he was elected as an Independent with some ease. It is unusual for non-party candidates to be elected to the House of Commons. It is even more unusual for major parties to stand aside to assist a non-party candidate. But what was most unusual was that this non-party candidate, standing on a platform of public and political honesty, was a journalist, a member of a profession usually mistrusted as much as politicians themselves. But here was the public, or at least that part of it represented by the electors of Tatton, putting their trust in Mr Bell as the right person to stand up against political corruption, or any suspicion of it. Part of the reason for this is the character of Martin Bell himself, as he is well known to the television audience who have been able to assess him as a person of integrity. But there is more to it than this. It is not that there is a general mistrust of journalists, but with Martin Bell as the sole exception. There is a different and competing image of journalism, which can indeed be focused on reporters like Martin Bell. Journalists who, for example, stand in bullet-strewn areas at considerable risk to themselves, telling the viewers via the camera what exactly is going on, are regarded as brave and honourable, and almost certainly doing their honest best to present an objective and truthful account of what is happening and why. There is, perhaps, a difference between television and newspaper journalism here. Many people rely on television as the main source of information for news, current affairs, world events, consumer matters and the like. Being able to see the journalist or presenter and whatever else is on the screen means that the audience can to some extent trust its eyes rather than rely solely on the word. Of course, in one sense this means that there is even greater scope for manipulative propaganda if the control of television broadcasting is in the wrong hands, so the audience will also take the source into account. In the United Kingdom the BBC is more trusted than channels with purely commercial profit-seeking interests, which is one reason why the maintenance of public service broadcasting is socially and politically important. Still, although of course anyone would be foolish to place absolute trust in anything that appears on television, there is a contrast with the newspaper world, where there is the suspicion among readers, justifiably based on actual cases that have been exposed, that journalists sit in their offices and invent stories. Newspapers are also known to be politically biased and to treat their readers unscrupulously, so why should they be trusted? But it is not just intentional bias that is regarded as a danger. Although both television images and written stories are taken in through the eyes, there is an enormous difference in their reception, for words are known to be deceptive, always at a remove from a reality that can be depicted directly. It would, however, be a mistake to rely on there being an intrinsic difference between television and newspaper journalism. Although stories have been invented by some newspapers, it is usually other papers Journalism and ethics: can they co-exist? And the alleged corruption against which Martin Bell offered himself as a symbol was brought to light by a lengthy and sustained campaign by newspaper journalists, and one that was legally dangerous, given the severity of British libel law. And as for the deceptiveness of the written word, this is not the place to go into this ancient and extraordinarily deep philosophical issue, so let me just say that it is a problem that we mostly manage to overcome at a pragmatic level in our daily lives. Whenever we are offered information, whether by newspapers, television, the Internet or any other source, we have no option but to use our everyday intelligence to assess it for reliability. This applies as much to a depiction as to a word or written text. There is then no general assurance of the soundness of journalism. But there have always been journalists who have stood out from the crowd because their virtue if not always their judgement seems unimpeachable. There are examples this century from George Orwell and James Cameron down to the investigative journalists of recent years, who have recognised that the proper practice of journalism must sometimes be subversive and anti-establishment, and expose what those in power would rather keep concealed from the public to whom they should be accountable. The point, however, is not that there are exceptional individuals like Orwell, Cameron and Bell who escape the public suspicion and distrust of journalists. It is rather, as I have already hinted, that there is a different and competing image of journalism, one that contradicts the low esteem in which journalism is held. No doubt there is a good deal of Hollywood in this image, but it is more than a myth. More generally this is an image which sees journalism as serving a useful, even indispensable function in society, providing the information, the analysis, the discussion and the comment without which a modern complex society could not operate. On the one hand journalism is an industry, a major player in the profit-seeking market economy, and journalists are merely workers in that 4 Andrew Belsey industry, driven by the need to make a living. On the other hand journalism is a profession, a vocation founded on ethical principles which direct and regulate the conduct of the practitioner. Since trying to live in both these realities is difficult, if not contradictory, deeper explanation and analysis is called for. There is no doubt that journalism is a major industry. Indeed, journalism is too narrow a term: this is the age of the media. The media are multifarious, transnational and interlinked: newspapers, magazines, television, radio, film, video, cable, communication satellites, the Internet are increasingly coming under the control of a handful of corporations which are based nowhere and everywhere and which seek greater market share, greater profits and greater global influence. In spite of the variety the media is, in defiance of grammar, a singular phenomenon, and one which has universal effect. Once upon a time social theorists were concerned with material production and with the means of production, the farms, forests, factories, fleets and mines which constituted the economy. Today we are sometimes urged to forget these old-fashioned concerns and to realise that this is the age not of production but of information, and that it is the means of information that now dominate economic and social life and provide an insight into its heart and mind. In such an industry media workers are like any other workers. They are concerned with getting a job, job security, working conditions, future prospects, and, quite rightly, personal satisfaction. This ethos soon permeates the whole structure of the media industry, including, it must be stressed, that part of it still theoretically devoted to the public service. But while admitting all this it is not too much of an exaggeration to say that overall it has little effect against the overwhelming demands of Journalism and ethics: can they co-exist? The market is either amoral or immoral or perhaps both at different times , and this affects the media industry as much as any other. Perhaps it could even be argued that in journalism the situation is worse, because the doctor who exploits a vulnerable patient for sexual favours can be struck off and lose the privilege of practising, and an accountant who steals from clients can be sent to prison, but a journalist who misbehaves may get a scoop and a promotion. The theoretical and practical difficulty, however, lies in deciding what constitutes journalistic misbehaviour. There are two contradictory pressures on journalists. On the one hand they are subject to the attention of the lobbyists and the publicity-seekers, who not only want their story told but want their own slant on it. This is an ethically-fraught area especially if the lobbyist happens to be also the owner of the newspaper or television channel. But it is the other hand which is even more ethically interesting and puzzling here, because a lot of journalism consists of discovering and printing information about something or some situation that those involved in would rather keep secret. Sometimes, of course, the two hands come together: journalists are deliberately given a misleading story to print but recognise it for what it is and have to investigate for themselves what the real story is. To make the situation even more complicated, this second aspect of journalism can itself be divided into at least two parts. First, much of the practice of discovering and printing information that some people would wish to keep secret is absolutely and legitimately central to journalism. Investigative journalism, finding out what is really going on in society, keeping people well informed about political, economic and other matters, providing information, analysis and comment, is precisely what a responsible press is supposed to do in a democracy in order to serve the public interest. But where are the boundaries of the public interest? That is the question. They do not coincide, as has often been pointed out, with what the public is interested in. The second part of discovering and printing what some people would prefer to keep secret often involves information that the public is interested in, but should not be, from an ethical point of view. This is what is not legitimately part of journalism. This can involve any combination of ethically dubious content, presentation and investigation. The content may be what is properly secret, or at least private the two are not the same. Dubious material is usually presented in dubious ways, involving trivialisation, sensationalism, obscenity, vulgarity, racism, sexism and homophobia. But even legitimate material can be presented in ways that are ethically offensive, a point often overlooked in discussions of media ethics. Methods of investigation have traditionally received more ethical attention. There are technological aids, like long-range cameras, telephone taps and electronic eavesdropping devices of all sorts, used to spy on people and pry into their affairs. Of course, modern technology cannot be blamed for unethical journalism, since deception, lying and trespass have always been open to journalists. We know, of course, that journalists often behave in such unethical ways, and if it is unethical, then they should not do it. It is as simple as that. If only it were as simple as that! But should activities like this, only without the condemnation, be contemplated by journalists? Let us revisit the distinction between the content, the material of journalism, and the method of investigation. Could the end justify the means? In the investigation of crime or corruption, or just incompetence, perhaps the journalist has to resort to some deception. There is a long and honourable tradition perhaps dying now of investigative journalism, in which the journalist cannot come straight out with the questions. Much investigative journalism like much police work is not glamorous but consists of the minute analysis and comparison of thousands of documents. But can we play about with the meanings of words like this? In this context the question is part of a much larger and central ethical issue about the relation of ends and means, and the related problem of dirty hands. Can we do good by doing bad? If we are doing good, then perhaps we are not doing bad. The issue usually comes up in discussions of issues much more difficult than journalism, like war and violence. Is bombing a city justifiable if civilians will be killed? Is it morally right to assassinate the evil dictator? But even in liberal democracies journalists can find themselves investigating evil and ruthless people, when prudence if not morality calls for deception. But how can the gangster, the drug pusher, the corrupt politician, the fraudulent businessman be exposed, except by methods which in other contexts would be questionable? Perhaps in these journalistic contexts such methods are morally required. Journalism and ethics: can they co-exist? I have already strayed into ethical matters but will postpone further discussion of them until the next section, when I shall deal with them more directly. Before that, what can we conclude about industrial journalism? Corporate pressures, the search for sales, the search for audience, promote the production of material that the public is interested in, rather than that which is in the public interest. The appetite is rather, and largely, constructed by the very media that feed it, in a glorious circle of supply creating demand and demand creating supply. One symptom of the resulting trivalisation of social life and the representation of it in the media is the failure to distinguish between secrecy and privacy, and a resulting failure to understand the ethical significance of the distinction. Neither term is well defined, and I do not intend to stipulate once-and-for-all definitions of them, but instead to try to bring out the differences significant in the context of journalism. Although private individuals can have secrets, I take secrecy in the political sense to be the concealing of information by those public individuals and organisations with power, when it ought to be available to ordinary people as part of the democratic process, for reasons of accountability. Privacy, on the other hand, although the term is often misused in connection with what organisations try to keep hidden,8 is something that only individual persons can have, and only in so far as they are engaged in private and not public activities. These definitions solve few problems; there is an element of circularity, and they do not provide criteria for distinguishing what may be kept hidden legitimately, whether it be a matter of secrecy or privacy. Just as there are no doubt legitimate areas of privacy for individuals so no doubt there are legitimate areas of secrecy for organisations, but they are much smaller than is often taken for granted. Consider the long struggle in the United Kingdom against official secrecy and for freedom of information. But industrial journalism, in league with supposed public demand, too often confuses the two areas, and connives with the powerful to keep secret what ought to be exposed, while invading the privacy of those who neither wish for nor deserve such treatment. This is an over-generalisation, of course. Lots of individuals love the attention of the media and are quite willing to be on the receiving end of the publicity. And at the other end of the scale there is still serious journalism dedicated to serving the public interest and to keeping the public informed as part of the democratic process. But the reality of industrial journalism is to be found largely inhabiting an ethics-free zone. But there is another reality in which journalism is a profession based on ethical principles, indeed constituted by ethical practice. However exaggerated the claims about this reality have sometimes been, it is not just a myth, a self-serving piece of propaganda put about by those with lots to hide and lots to gain. Nor is it just an ideal, never to be attained. It is a reality illustrated rather than proved by the experience of Martin Bell in Tatton, a journalist getting the support and confidence of the public in direct competition with a politician. Ethical journalism even has a sort of physical embodiment in the Code of Practice issued by the Press Complaints Commission as well as in similar codes all over the world , even though such codes fail to be sufficient from an ethical point of view. What then is a profession? Traditionally a profession involved the giving of a service by a certified expert to an individual client, for a fee and on the basis of mutual trust and respect. In areas like law and medicine the client has to trust the expertise and the good faith of the practitioner, who in turn respects the needs and vulnerability of the client. The professions are policed in the sense that a practitioner who transgresses against the ethically based standards of practice is punished in some way, with expulsion from the profession as the ultimate sanction. Almost every occupational area claims professional status. Even the traditional professions often fail to match their traditional image, as social, economic and technological changes alter the relationship between the service-seeker and the service-provider. Perhaps then the emphasis should be on the ideas of ethical practice and adherence to an ethical code. Indeed, it is the proliferation of such codes among occupational groups that is used to justify the claim to professional status. Presumably, the spread of such codes, inasmuch as they have a genuine and serious effect, should be welcomed, as it means that the idea of ethical practice permeates further into society. But if all occupational groups are codebased professions, professional status no longer points to any significant ethical distinction between one occupation and another. Thus it is claimed that the essence of medicine is the promotion of health, of Journalism and ethics: can they co-exist? On this approach the essence of journalism is telling the truth, or, to put it in different terms, journalism is constituted by truthtelling. Essentialism of any sort is not these days universally popular as a method of explanation and illumination, and these examples show some of the reasons why. For a start, we might expect all the transactions of everyday life to be based on telling the truth, so there is nothing distinctive about journalism on these grounds. Furthermore, while we might be able to deal with the truth and nothing but the truth, the whole truth is altogether more difficult. All information is selected from an infinite whole, and all information has to be presented in one way or another. And then much journalism is concerned with opinion, argument, debate and discussion, where notions of objectivity and fairness are central, rather than truth. Furthermore, essentialism of this sort is not very helpful because it is overgeneral and thus somewhat vague. It provides no way forward when the rights and interests of different people conflict. There is a very great deal in the practice of medicine, for example, which is not illuminated by generalities about the promotion of health. This so-called essence does not help much on questions about abortion and euthanasia. Similarly, the notion of truthtelling in journalism does not answer the problem, already discussed, of using dubious methods to obtain the truth. This does not, of course, suggest that telling the truth is not important in journalism. We have not, so far, tracked down what is meant by speaking of journalism as a profession, except in so far as ethical practice is necessary, but not sufficient, for a profession. So long as any occupation, or indeed any activity, is based on sound ethical principles, why should we worry whether it is a profession or not? As I have already suggested, professional status tends to be a self-awarded honorific these days, a fact that is of more sociological than ethical significance. What clearly is of ethical significance is the ethics of the activity, whether it be journalism or anything else. What then of the reality of ethical journalism? Analogies with traditional professions obstruct rather than assist understanding. A journalist is not except perhaps in a very few, exceptional cases an individual serviceprovider with an individual client. Nevertheless, journalism can best be thought of as providing a service. Journalists provide a vital service to society as a whole, but it is a political service. Journalism is part of the political process. Now of course there are dangers in such a statement. Journalists are not legislators and neither are they governors. It is bad for society and for journalism if journalists are tempted to be either. They should be considered, rather, as facilitators, to use the jargon of the modern age to make a very traditional point. Autocratic governments control information, and regard secrecy as a important weapon — and not only autocratic governments. But if a government is to be accountable to the people it must know what is going on; if the people are to cast their votes wisely and rationally they too must know what is going on. Information is necessary though not of course sufficient for a successful democracy, inasmuch as it requires the free circulation of news, opinion, debate and discussion. Hence the incorporation of freedom of expression and freedom of information in international charters like the Universal Declaration of Human Rights. A democratic necessity is transformed into a human right. As commentators on the American Constitution have pointed out, the traffic is not one way, and the privileges guaranteed to journalists by the First Amendment should be reciprocated by the responsibilities of journalists. It is in this political area that the reality of ethical journalism is located, since journalism as part of the democratic process can only be ethically informed journalism. The point is obvious, in that the ends of democracy cannot be served by media that are full of untruths, lies, invasions of privacy, scurrility, obscenity, triviality, distortion, bias and all the other sins that industrial journalism actually exhibits. All the virtues associated with ethical journalism — accuracy, honesty, truth, objectivity, fairness, balance, respect for the autonomy of ordinary people — are part of, and required by, journalism as located within the democratic process. If the media are to be part of the democratic process because of their role in the origination and circulation of information and opinion, then the quality of that information and opinion is going to be a vital issue. Quality here is meant in a typically ethical sense, so that the ethics and the politics of the media are not really different or separable issues. Ethical journalism serves the public interest. One good reason for putting the point in terms of virtues is that although virtues might become ingrained dispositions they are not arbitrary or irrational but based on sound ethical principles. Virtues are not algorithms, but the very nature of their principle-based flexibility enables them to deal more successfully with novel situations than can a set of rules embodied in a code of practice. And a democratic society, especially one in a technological age, will constantly produce situations and opportunities which are ethically novel. Cynics will say that this is myth-making and that there is no reality behind it. The less cynical might say that it is an ideal of what ought to be, and a long way in advance of what actually is, although we might aspire to make some further progress towards the ideal. The cynic, I wish to argue, goes too far, although given the nature and power of industrial journalism one can understand why there is an apparent justification for such cynicism. The lesser cynic is correct in approach, although, as I have argued, ethical journalism is not just an ideal but a reality, just as much a reality as industrial journalism. Journalism is a two-sided reality, in which the two sides contradict rather than complement each other. Is this a helpful way of putting the point? I hope so. Industrial journalism exists, and so does ethical journalism. They both co-exist and contend, battling for supremacy in a recreation of an ancient and eternal struggle. Each is armed with different weapons. Industrial journalism can call on the amoral power of the transnational corporation, but ethical journalism is undefeated, being able to rely on the undiminished strength and perennial appeal of virtue. But enough of these Manichean metaphors! What is the ordinary journalist to do in his or her everyday working life? No doubt journalists, especially when young and entering the profession, wish to be good journalists, to do a good job, and to obtain at least some degree of personal satisfaction. But they will have mixed motives and expectations, some material, some ethical. It is unlikely that many journalists are motivated directly by a desire to serve the public interest, yet they are likely to have some such notion occupying an underground area of their thoughts. The pressures of work keep it underground, mostly. Journalists do behave unethically. Yes, they have invented stories, invaded privacy, harassed the unfortunate, used sexist images and generally behaved badly. The image of journalism held by the public, according to which journalists are a shifty, untrustworthy bunch of unprincipled selfservers, has plenty of justification. And yet not all journalists suffer from this image, as is shown by the example of Martin Bell, not only in his habitual role of respected journalist but also in his unexpected role of victorious politician. There is a delicious irony in the fact that it was a journalist who stood for and was elected to Parliament on an ethical ticket. There is a job to be got, promotion to be obtained, so the story has to be written and the methods necessary to obtain the story used. The story must sell, the managers must be satisfied, the growth targets met. The market must be chased, so there is a constant temptation more than a temptation to print trivial stories, salaciously presented and obtained by suspect methods. Personal beliefs and desires do not come into it. Journalists are often thought to be hypocrites when those who are committed Labour voters work for or even edit newspapers that are little more than Conservative Party propaganda sheets. This has happened, and probably the other way round as well. Compromise is part of living in the world as it now is. Does this mean that there is no place for moral integrity in journalism? No, I am far from arguing that, having claimed that ethical journalism is as much a reality as industrial journalism. But of course ethical journalism is under pressure, as is ethics in almost any walk of life, because we live in a world dominated by economic considerations and an economy driven by market forces. Moral motivations and moral intentions are good, but they can be powerless in practice, or misled. They are powerless when the pressures of the system are too great for them to prevail against. They are misled when, for example, journalists find themselves justifying their unethical conduct in terms of their own unblemished intentions to do good, though employing dubious means. This is the doctrine of the double effect, and it is as fallacious in journalism as it is everywhere else. In spite of all the pressures ethics is entrenched in journalism, and so it will never disappear completely. There is a tradition of truth-seeking, objective reporting and fair and reasonable presentation which is sufficient to challenge if not to defeat industrial journalism. There is also a tradition, though not one that is as strong as it should be, of reasoned discussion of such matters. It is an interesting coincidence that the same Martin Bell, shortly before his sudden transformation into a successful politician, was attracting media attention not because of his own work in the media but because of his theoretical discussion of some of the principles on which it was based. The point he was making was that there is not the conflict that many people assume must exist between objectivity in reporting and commitment to values, because journalists should not try to take a neutral stand between right and wrong. The war reporter in the world of today cannot avoid witnessing an appalling collection of atrocities, massacres, torture and other crimes, and must not pretend that these are neutral events of no moral significance. Such pretence involves a failure to be objective. It is relatively easy for journalists based in liberal democratic countries to be objective about unsavoury military dictators in other parts of the world, but objectivity does not come so easily when the unsavoury character is your own boss. The case of Robert Maxwell demonstrates both the farcical and the tragic side of this. The sight of the sycophants of the living Maxwell intoning moral condemnations over his corpse was amusing for the uninvolved spectators but not for those whose pensions disappeared with Maxwell over the side of the boat. But there is, I fear, no resolution of the contradiction, no solution to the paradox of industrial journalism co-existing with ethical journalism. Yes, good intentions are fine, but they can only operate within the existing system. But systems are rarely monolithic and thus they fail to be monopolistic. There is scope for good intentions, after all. But good intentions are not sufficient, as they need to be matched by corresponding good actions. This is why I put the emphasis on virtue in journalism, as virtue is a disposition to act in ethically correct ways, even in novel situations. And whatever the difficulties caused by co-existing with industrial journalism, there is still scope for the tradition of ethical journalism to live and develop. Notes 1 2 3 4 5 6 7 8 9 See Judith Lichtenberg ed. The current state of business ethics is surveyed in Peter W. Davies ed. Schoeman ed. See Bok, Secrets, pp. See Bok, Secrets, esp. See also Nigel G. It was not a calling that I ever chose; rather, I would say that it chose me. One day a long time ago in a BBC newsroom, I happened to be the reporter nearest the door when a foreign war broke out. Having survived one war zone I would then be asked to take my chances in another — and then still more, until today I have discovered that a journalist can be typecast just as much as an actor. I am well on the wrong side of 55 and had wished to end my career with a stint as peace correspondent, if such a job were to exist; but sadly I have concluded that it does not. I even tried to resign, but was vigorously dissuaded. Have the wars themselves changed? Hardly at all. The modern high-tech high-intensity conflict exemplified by the Gulf War was probably the exception. The Bosnian War was more typical; in it civilians were targeted on a massive scale and the weapons used were essentially those of the First World War battlefields: rifles, machine guns, mines, trench mortars and artillery. They were just as lethal: an old trench mortar can ruin your day just as effectively as a bright shining new cruise missile. Sometimes as I stood amid the mud and barbed wire of these wasted emplacements it seemed to me that we had learned nothing and forgotten everything, and that we were revisiting history all the way back to , pausing only to fail to absorb the lessons of The only new ingredient was television. But our way of reporting the wars has changed fundamentally, and not only because of television and its satellite dishes, those concave discs which we pitch almost on the front lines themselves and which uplink all our tragedies and bind us to them. Our attitudes and ways of working have also changed. When I started out as a war reporter in the mids I worked in the shadow of my distinguished predecessors and of a long and honourable BBC tradition of distance and detachment. I thought of it then as objective and necessary. It concerned itself more with the circumstances of wars — military formations, tactics, strategies and weapons systems — than with the people who provoke them, the people who fight 16 Martin Bell them and the people who suffer from them by no means always the same categories of people. I am no longer sure about the notion of objectivity, which seems to me now to be something of an illusion and a shibboleth. When I have reported from the war zones, or anywhere else, I have done so with all the fairness and impartiality I could muster, and a scrupulous attention to the facts, but using my eyes and ears and mind and accumulated experience, which are surely the very essence of the subjective. This is not an argument for campaigning or crusading journalism. That has its place, from William Cobbett in the last century to G. Chesterton, George Orwell, John Pilger and many others in this, but its place is in political and polemical literature and not in the daily chronicling of the news. I am old-fashioned enough to insist on the distinction between them. Besides, it is my experience that the campaigners and crusaders tend to find what they are looking for, ignoring inconvenient evidence to the contrary and the unstructured complexity of what is actually out there. Rather, I have found it useful to do the opposite and seek out the unfavoured spokesmen of unpopular causes, whether the Afrikaners in South Africa, the loyalist paramilitaries in Northern Ireland, or the Serbs in Bosnia; they will often hold the key to a conflict and its possible resolution. In place of the dispassionate practices of the past I now believe in what I call the journalism of attachment. By this I mean a journalism that cares as well as knows; that is aware of its responsibilities; that will not stand neutrally between good and evil, right and wrong, the victim and the oppressor. This is not to back one side or faction or people against another. It is to make the point that we in the press, and especially in television, which is its most powerful division, do not stand apart from the world. We are a part of it. We exercise a certain influence, and we have to know that. The influence may be for better or for worse, and we have to know that too. In my one and only book, which was mainly about the Bosnian War and which touched on this issue, I cited a story from Sarajevo which I hope is apocryphal but I believe is not. The sniper was peering out from between two bricks in his forward defences. So he urged the sniper to shoot neither of them, made his excuses and turned to leave. As he did so, he heard two shots of rapid fire from the position just behind him. He turned and The journalism of attachment 17 looked, questioning. There are other instances which occur almost daily in the known, real world of war reporting. On one occasion an entire battery of millimetre field guns would have been fired for my benefit, had I wished. To have accepted the offer would greatly have increased the marketability of what I had to offer my news editor later in the day. Is that always the case? I somehow doubt it. I am fortunate in having worked for a news organisation, the BBC, in which — despite all its trials and travails — a culture of truthfulness still prevails, and which is not driven by the commercial imperative of maximising profits. The interesting comparison here, not on the point of truthfulness but of profit-chasing, is with another great but troubled institution, Reuters. We see things that they do not see. We know things that they do not know. We have been where they have not. Yet they command and deploy us. This discrepancy of view is even greater in television, because of the technical advances in recent years that have so much extended its reach, if not its grasp. Our staff officers — the programme editors and network executives — are on the receiving end of such a flood of information both verbal and visual that they think they see and they think they know and they think that they have been there. The news itself takes on an aspect of virtual reality; it may be that the problem lies partly in the proliferation of computer screens, and in journalists whose eyes are directed downward at the screens in front of them, rather than outward at the wider world beyond. So the screens become screens also in the traditional sense, of blocking the view and filtering out the light. I was invited, not by the BBC but by my friends in German television, to take part in a session on the ethics of television journalism; I contributed a few brief, and moderate, remarks about the limits of objectivity. I was not in fact proposing anything new and revolutionary, although there were some present who saw it as that, but merely 18 Martin Bell articulating a change in the practice of news reporting. I was not dispassionate at Ahmici in Bosnia in , just as Jeremy Bowen was not at the bombed bunker in Baghdad in , and for that matter even the great Richard Dimbleby himself was not at the liberation of Belsen in and he was operating in a much more restrictive broadcasting climate. There is a time to be passionate and a time to be dispassionate — a time and a season for all things; and I would not report the slaying of innocent people in the same tone and manner that I would use for a state visit or a flower show or an exchange of parliamentary insults. It is a matter of common sense. It is also a matter of tone and tact rather than language, for television resists the flourishes of rhetoric and fine writing. It is a cool medium which answers best to understatement and requires the sparest of commentaries, especially alongside powerful and emotive pictures. Adjectives themselves are hardly necessary, since our images are our adjectives. Lately I have come to be merciless even with the verbs. The hardest technical discipline of all is the writing of silence. I was in the process of explaining some of this to my colleagues in Berlin, when I was set upon from the floor by a middle-ranking BBC executive who clearly saw me as a heretic and backslider from long-established truths. He compared me to a priest who had grown weary of the long years of celibacy and had resolved to explore the carnal pleasures hitherto denied. The term that he used was less felicitous, but executives do not necessarily rise through the ranks by having a way with words. He then countered my argument for a principled journalism with the old and Shakespeare-derived notion of the function of news being to hold a mirror up to nature, or in this case to events in the world about us. But the analogy is, of course, a false one. It is false for this reason, that the mirror does not affect what it reflects, the television image does. This is a clear and consequential distinction. One of its consequences is that journalism — not only in the war zones and amid human suffering, but perhaps especially there — is not a neutral and mechanical undertaking but in some sense a moral enterprise. It must be informed by an idea of right and wrong. It operates frequently on morally dangerous ground. It makes a difference. It has to be aware, as in the story of the reporter and the sniper, of what that difference might be. I happen to believe — and I admit this to be a comforting, even convenient belief — that especially in the case of television the difference is mostly benign. I know there are critics who hold otherwise, and that in situations of incipient The journalism of attachment 19 riot and civil commotion the very presence of television can be inflammatory. This certainly has been so on some occasions, though people tend to hold to their own realities. I remember a long time ago during a serious loyalist riot in East Belfast being approached by an old lady who bore down on me, with voice and umbrella raised, through a hail of missiles. She had her reality, I had mine: we were apparently not even witnesses of the same event. But for most of the early s I spent my working life in an environment rather less agreeable than civil commotion: the projectiles were harder edged and moving faster. I make no exaggerated claims here; but that time served in the war zones has left me with the settled conviction that the effect of television, even as its impact and influence have grown, has been to make things a little less worse than they would have been without it. To take the simple example of prisoner exchanges: there was no deal between the three peoples and armies of Bosnia more likely to be undone, no business or transaction between them more fallible, than the handing over and retrieving of prisoners. It brought out their deepest dislike and distrust of each other, as well as a distinctively Balkan sense of the value of human life. So it was that at quite an early point in the war they came to insist on the presence of a foreign television crew at the handover point, as a means of holding each other to honour agreements already reached. But the television camera made failure less inevitable. On a broader canvas, I would argue from experience that the presence of television in the satellite age makes war crimes harder to commit, and certainly harder to get away with than in the darker ages preceding it. This may seem a difficult case to make from a war which was waged with peculiar brutality and included the massacres at Srebrenica, Ahmici and Uzdol only one of these, incidentally, involving the Serbs ; but it was one of the many lessons of the Bosnian War that, in this decade of the dish, a military victory can swiftly turn into a political defeat. So it was with the Serbs. But the killing and maiming of civilians, under the eye of the camera, left the Serbs friendless and isolated. The major bombardments of Sarajevo over a three and a half year period were viewed all over the world on the day that they happened. The counter-attacks, by Bosnian government forces, were either not viewed, or seen as acts of defence by a people cruelly besieged. Of course in all such cases a tide of lies will wash over the airwaves; the perpetrators of war crimes will attempt to cover their tracks; and as television grows more consequential it will find itself increasingly blocked, cajoled 20 Martin Bell and manipulated. But sooner or later the truth will come out, or a sufficient outline of it, as most notoriously it did many months after the massacre at Srebrenica. The war crimes will do most damage, over the long term, to those who commit them. The same applies to the indiscriminate targeting of civilians; a point may actually have been reached where television is changing the conduct of wars and the ways in which they are waged. This may be a heretical notion to introduce, but I have come to wonder whether, had satellite television existed in , the carpet-bombing of Dresden and Hamburg by the British and Americans would have been politically possible; or would the tens of thousands of civilian casualties have turned allied opinion against the prosecution of the war by such ruthless means? Further back still, could the sacrificial strategies of the Battle of the Somme in even have been contemplated? They would be unthinkable today. That there is such a connection is now accepted by all but a few unreconstructed British diplomats of the old school. The British establishment tends to resent such pressures as an impudent challenge to its wisdom by an upstart medium. Skip to main content. Founded in , the School of Communication comprises the Academy of Film, Department of Communication Studies and Department of Journalism, offering 20 programmes at the sub-degree, undergraduate and postgraduate levels to 2, students. As a leading school of communication, journalism, and film studies in the Asia-Pacific region, its faculty members work in a dynamic, interdisciplinary academic environment that entails collaboration across multiple fields of study. Raymond R. The School now invites applications for the above position from candidates with the following caliber:. Qualifications and Professional Experience Candidates should have a minimum of 20 years of journalistic experience, of which at least 10 years must be at senior editorial management levels, and a commensurate academic background. Senior editorial experience in Hong Kong would be an added advantage. Dedication to Teaching and Mentoring The appointed candidate shall have a strong passion for nurturing both undergraduate and postgraduate students with the latest thinking, knowledge and ethical practice in the news media. The initial appointment is for three years. Salary will be commensurate with qualifications and experience. Applicants should also request two referees to send in confidential letters of reference, with PR number stated above quoted on the letters, directly to the Personnel Office Email: recruit hkbu.

V International Conference on Media Ethics – V International Conference on Media Ethics

Lee Anne Peck, Ph. Lee Anne Peck has taught English, journalism, and communications courses since Over the years, she has advised three student newspapers. Daily Dispatch. In the mids, she edited and wrote for publications in Indiana and Delaware; she has worked for the Fort Collins Coloradoan as an editor, a columnist and writing coach and for the Rocky Mountain News as a copy editor. Guy Reel, Ph. He received his Ph. Account Options Anmelden. Meine Mediathek Hilfe Erweiterte Buchsuche. Sometimes this kind of rule is called a rule of practice. The rule specifies a practice that, in turn, is justified by the general principles. Even if the patient is terminally ill and suffering, intentional killing has been considered to be ethically unacceptable. According to this rules-of-practice view, it is unacceptable to overturn a general practice simply because the outcome in a particular case would be better. The conflict between those who believe that the rules themselves should be the defining factor and those who consider the situation itself to be the most critical deter- minant of moral rightness led to a major ethical controversy in the mid—twentieth cen- tury. It is sometimes called the rules-situation debate. Probably both positions taken to the extreme lead to absurdity. Rigorists are immobi- lized when two of their rules conflict. Antinomians are immobilized when they treat a situation as so brand new that no moral help can be gained from past experience. Between these two extremes are two more complex but more plausible views. A situationalist is one who considers every situation as unique and will not legalisti- cally apply rules but is willing to be guided by the moral rules. Those rules are seen as summarizing past experience in similar situations, as guidelines, but not as rules to be followed blindly. A second intermediate position is closer to the rigorist end of the spectrum. They hold that normally the rules should just be applied rather than each case evaluated from scratch. Sometimes an analogy to the game of baseball is cited by defend- ers of the rules-of-practice position. On the one hand, they claim that, in baseball, the rules cannot be changed in the middle of the game—that it is inappropriate to propose in the late innings that it should take four strikes to make the batter out. On the other hand, also in baseball, there are special moments when those in charge might get together to reassess the rules, for example, at the annual meetings of the baseball team owners. Society has reassessed cer- tain practices in pharmacy such that the moral rules have changed. Fifty years ago, pharmacists were not supposed to tell patients the name of the drugs they were tak- ing because of concern that patients would misunderstand and suffer psychological harm. For example, taking a pharmaceutical that had many uses might lead a patient mistakenly to believe that he or she had some condition other than the one for which the drug was dispensed. Over the years the rule against disclosing the name of a drug has changed. The rules-of-practice view accepts these changes in the rules—perhaps expressed in a change in the code of ethics of the pharmaceutical association while it does not accept the notion that the pharmacist should decide in the individual case whether the rule applies. The situationalist is more willing to reassess the rules on a case-by-case basis. This difference over how seriously rules should be taken cuts across the answers to the question of what kinds of action are right. One can be a utilitarian, who assesses the consequences case by case, or a rule- utilitarian, someone who believes in the rules-of-practice view, holding that rules should govern individual moral choices but that the rules should be chosen based on their expected consequences. Likewise, someone who is a deontologist, who believes there are certain inherent right-making characteristics of actions independent of the consequences, can either apply the gen- eral principles such as autonomy or veracity directly to individual situations or use them to generate a set of rules, which are then applied to individual cases. The former would be an act-deontologist; the latter, a rule-deontologist. The rules-situation debate does not lend itself to special cases grouped together. The problem arises continually throughout the cases in this volume. The final ques- tion we address is what ought to be done in specific cases. This question requires special chapters with cases selected to examine the problems raised. After the determination of the source and meaning of ethical judgments, what kinds of actions are right, and how rules apply to specific situations, there are still a large number of specific situations that make up the bulk of problems in pharmacy eth- ics. The question remains, what ought to be done in a specific case or kind of case? Pharmacists and other health care professionals, being particularly oriented to case problems, are given to organizing ethical problems around specific kinds of cases. The first two parts of this volume emphasize the overarching problems of how to relate facts to values, of who ought to decide, of respecting autonomy, veracity, fidelity, of avoiding killing, and of delivering health care in a just manner. These are among the larger questions of biomedical ethics. Part three shifts to cases involving specific problem areas. Cases in Chapter 10 raise the problems of abortion, steriliza- tion, and conception control. Chapter 11 moves to the related problems of genetic counseling and engineering and of intervention in the prenatal period. The next chapters take up in turn the problems of mental health and the control of human behavior; formularies and drug-distribution systems; human experimentation; consent and the right to refuse medical treatment; and finally, death and dying. The first line of moral defense will probably be a set of moral rules and rights thought to apply to the case. In human experimentation, the rules of informed consent pertain. Among the dying, rules concerning euthanasia conflict with the right to pursue happiness, and the right to refuse medical treatment conflicts with the rule that the health care provider ought to do everything possible to preserve life. In many cases in which the tension between conflicting rules cannot be resolved, the analysis escalates from an issue of moral rules and rights to the higher, more abstract level of ethical principle. It must also be explored whether harm to the patient justifies withholding information from the patient or whether the formalist truth-telling principle justifies disclosure. It requires considerable empirical data. Value-relevant biological and psychological facts have developed around many case problems in biomedical ethics. The predictive capacity of a flat electroencepha- logram may be important for the definition of death. The legal facts are relevant for the refusal of treatment. Basic religious and philosophical beliefs of the patient may be critical for resolving some cases in health care ethics. It is impossible to present all of the relevant facts such as medical, genetic, legal, cultural practices, and psycholog- ical that are necessary for a complete analysis of any case, but it is possible to present the major facts required for understanding. Readers will have to supplement these facts for a fuller understanding of the cases, just as they will have to supplement their reading in ethical theory for a fuller understanding of the basic questions of ethics. Introduction 17 Notes 1. American Pharmaceutical Association. This code was adopted October 27, , and published the following year. The organization changed its name to the American Pharmacists Association in but retains this code of ethics. Frankena, William. Second Edition. Beauchamp, Tom L. Childress, Editors. Principles of Biomedical Ethics. Third Edition. New York: Oxford University Press, , p. Fried, Charles. Right and Wrong. A Theory of Justice. The Moral View. New York: Random House, , pp. Firth, Roderick. Ross, W. The Right and the Good. Oxford: Oxford University Press, Kant, Immanuel. Groundwork of the Metaphysic of Morals. Paton, Translator. New York: Harper and Row, Ayer, A. Language, Truth, and Logic. London: Victor Gollancz Ltd. Ethics and Language. The Language of Morals. Oxford: Clarendon, For basic surveys of ethical theory see Frankena, Ethics, and Warnock, G. Contemporary Moral Philosophy. New York: St. For more detailed introduc- tions see Brandt, Richard B. Introductory Ethics. Principles of Ethics: An Introduction. For works con- taining classical sources see Brandt, Richard B. Value and Obligation: Systematic Readings in Ethics. Ethical Theories: A Book of Readings. Thomas Aquinas. Summa theologica I—II, A. Fathers of the English Dominican Province, Editors. Bentham, Jeremy. Kant, Groundwork of the Metaphysic of Morals. Rawls, John. Situation Ethics: The New Morality. Philadelphia: Westminster, ; Ramsey, Paul. Deeds and Rules in Christian Ethics. Contemporary Utilitarianism. Garden City, NY: Doubleday, Pharmacists and other health professionals often go through the process of determining the correct action in a specific case unconsciously. Furthermore, if asked, they would be hard pressed to articulate just what steps they went through to arrive at a sound and justifiable decision. There are many normative models for resolving ethical problems in the health science literature,1 but all require critical thinking and should result in a choice that is morally justifiable. Decision-making, whether in ethics or any other area of life, is often thought of entirely in terms of its anatomy or structure and the relationships among the structures. To appreciate the complexity of ethi- cal decision-making, one must also understand the functions of the parts of the decision-making process. Here, a framework is offered that includes the principles and a step-wise process to systematically resolve ethical problems in particular cases. The Five-Step Model The five steps listed below provide the structure for the decision-making process, and they are linear, that is, they should be carried out in the order presented: 1. Seek a resolution. Work with others to determine a course of action. The steps in the model outline a process, a way of making judgments about what should be done in a particular situation. Additional steps could be added, and much elaboration could be included within each step. But the basic framework is sufficient to focus moral judgments and simple enough to recall and apply in actual clinical practice. Application of the Model The five-step structure will be applied to Case to illustrate the process of decision-making. Roger Lucas, 70 years old, was admitted to the medical intensive care unit from the surgi- cal floor of the hospital with what appeared to be a pulmonary embolism. Lucas had fractured his femur in a fall at the nursing home where he is a patient and was awaiting surgery the next morning when he developed dyspnea, tachypnea, and tachycardia. At almost the same moment that Mr. Lucas arrived in the ICU, another patient, Ronald London, was admitted in the next room under equally emergent conditions. London was 60 years old and had a history of liver cirrhosis from alcohol abuse. London had ruptured esophageal varices. Helen Fowler, Pharm. She and two other pharmacists worked frantically to fill all the orders for intravenous drugs and parenteral solutions that came from the intensive care units. Later, after the rush had subsided, Dr. Fowler decided to conduct rounds and learned that Mr. London had died. The code team was still picking up their equipment when Dr. Fowler got to the unit. Fowler said to the nurse who was straightening up the room and conducting postmortem care so that Mr. Then Dr. Fowler noticed the label on the IV bag in the trash, the one that had held the IV the nurse had just removed from Mr. Fowler was shocked to see that the empty IV bag included heparin, not the octreotide he should have received. A hemorrhaging patient should never receive heparin. Without saying anything to the nurse, Dr. Fowler stepped next door to see what solution was hanging in Mr. Much to her dismay, Mr. Lucas was receiving octreotide when he should have been receiving heparin. And, the two names had been switched on the labels. In the rush and confusion surrounding the admissions and the critical nature of both patients, the IVs were inappropriately labeled. Fowler knew that the risk of mortality is high with patients who have ruptured esophageal varices, so the mix-up with the heparin may not have had anything to do with Mr. Fowler believed the next step should be to stop the octreotide IV and notify the pharmacy to send up the right drug for Mr. She thought she had to tell Dr. Janice Mann, the intensivist who was treating both patients, but dreaded doing so because Dr. Mann did not tolerate mistakes. But, Dr. Mann needed to know so that she could adjust Mr. Then there was the issue of Mr. Commentary This case is complex but reveals potential ethical concerns. As the pharmacist involved in the case, Dr. Fowler will need to decide what she needs to do and why. The five-step model can help Dr. Fowler work toward a justifiable resolution. Respond to the Sense That Something Is Wrong The first step in the ethical decision-making process is to respond to the intuitive sense that something is wrong in a given situation. Unlike obvious signs and symp- toms, such as a rise in partial thromboplastin time or a drop in hemoglobin level, there are no objective signs that one is involved in an ethical problem. It is obvi- ous that urgent care areas, such as the emergency department and intensive care units, can be fraught with stress and emotion. Do these emotional signs indicate that an ethical problem is in progress? The answer, as is often the case in ethics, is yes and no. Just because people are emotionally upset with each other or under a lot of stress does not necessarily mean that an ethical problem is involved. In Mr. Fowler happened to notice the discarded IV bag that led to her discovery of a drug error that may or may not have contributed to Mr. Fowler also experiences a sense of dread when she thinks about reporting the error to the intensivist in charge of both patients. She can certainly expect some type of negative reaction from Dr. Mann based on past interpersonal interactions. She may also feel guilty about the error that has occurred. These negative emotions are indications that an ethical problem is present. This first step in the decision-making process merely requires one to respond to the feeling that something is wrong. One should then move on to the next step. To organize the numerous facts in the situation in which Dr. Fowler is involved, one can classify them into clinical and situational information. Clinical information deals with the relevant clinical data in the case in question. The following types of clinical questions are relevant when reviewing a case: What is the medical status of the patient or patients involved in the situation? Medical his- tory? What drugs are involved, and what are their actions, side effects, etc.? His illness was acute and life- threatening. If not treated immediately with appropriate drug therapy and other life-saving measures, Mr. London would certainly die from hemorrhage and shock. Even if the treatment was effective in managing the bleeding, it would not resolve the underlying problem of cirrhosis. Additionally, the chance that treatment would be effective was small given the underlying condition. The adminis- tration of heparin to a patient who is already hemorrhaging would increase the risk of bleeding, but it may not have hastened Mr. As much as possible, it is important to clarify the relevant clinical information in the case before moving on to a more in-depth analysis of the moral relevance of these facts. Situational information includes data regarding the values and perspectives of the principals involved; their authority; verbal and nonverbal communication, including language barriers; cultural and religious factors; setting and time constraints; and the relationships of those immediately involved in the case. Of all the situational data mentioned, the most important is the identification and understanding of the value judgments involved in a case. An extensive discussion of value judgments is in Chapter 2. The main players in this case are the two patients, any family involved, Dr. Fowler, Dr. Mann, the pharmacist s who prepared the drugs, and members of the nursing staff responsible for hanging the IV medications. All the individuals involved in the case possess values about many things, including values about health, honesty, profes- sional competence, and loyalty, to name a few. We know specifically that Dr. Do individu- als who make mistakes lose their jobs? The case also includes a situational factor that impinges on the case—urgency and time constraints. Two emergencies occurred almost simultaneously. If the two admissions to the intensive care unit had been spaced further apart, it is possible that the error would not have happened. We know that responsibility for the error- free care of Mr. London and Mr. Lucas rested with various members of the health care team. For example, Dr. Fowler may not be the one who mislabeled the IV bags, but as evening supervisor she has overarching responsibility for all medications that leave the pharmacy. Second, she is the one who discovered the error. Knowledge of the error carries its own responsibility. These are only some of the facts affecting ethical decision-making in this case. Once all the facts are outlined, they can be examined to see whether the situation has the characteristics of an ethical problem. The distinct characteristics of moral evaluation, also mentioned in the introduction, apply to this third step of the five- step model, that is, they must be ultimate, possess universality, and treat the good of everyone alike. Ethical principles are relevant sources of ethical guidance and can serve as guidelines to identify the types of ethical problems involved in a case. The values, rights, duties, or principles that are in conflict should be identified. The ethical principles most often involved in complex cases, such as Dr. In this volume, veracity, fidelity, and avoidance of killing are treated as possible principles as well. Separate chapters presented in Part II develop each of these principles. At a minimum the principles in conflict in this case are nonmaleficence and veracity. Clearly an error has occurred. In the case of Mr. London, the degree of harm caused by the error is still in question. Even an autopsy might not be able to deter- mine whether the error contributed to his death. All we know for certain is that the error deprived him of drug therapy that could have provided benefit. The error may have caused harm to Mr. Lucas as well. He too was deprived, at least for a while, of a treatment that could have helped him. Thus, harms have occurred that, at this point, are unknown to key players in the case. Nonmaleficence suggests that Dr. Fowler has a duty to protect the pharmacist involved from having to endure the unjustified wrath of Dr. Mann but also to prevent further harm to Mr. Lucas by making sure he begins to receive the right drug. Nonmaleficence would also suggest a duty to initiate procedures to make sure this kind of error does not occur again. As far as we know to this point, only Dr. Fowler knows about the error. As soon as she calls attention to the error by stopping the octreotide IV and ordering the correct medication from the pharmacy, others will become aware of the error too. She believes she is obligated to tell the truth to Dr. Mann so that she can adjust Mr. But there are others involved in the case who have a claim on knowing the truth, the other members of the health care team, such as the nurses and pharmacists, as well as Mr. Fowler seems to feel quite certain that she has a duty to inform Dr. One could propose arguments for either telling or withholding the truth from the family. London has already occurred and is irreversible. The principle of nonmalefi- cence, or of doing no harm, could lead Dr. Fowler to be concerned about caus- ing unnecessary psychological stress on his family. Traditionally, the Hippocratic ethic permits, or even requires, health professionals to remain silent whenever information would be needlessly disturbing to patients or families. On the other hand, the family could benefit from knowing what happened. They could pursue legal action that would benefit them financially and may help them gain closure over the incident. Beneficence involves balancing the burdens and the benefits of an action, an analysis that can be extremely difficult. The ethical principle of fidelity requires that people act out of loyalty to those with whom they stand in a special relationship, such as between health provider and patient. The requirements of fidelity when a provider interacts with family members are more complex, but a case could be made that, in this situation, Dr. Fowler owes it to Mr. At this point, exploring various courses of action requires both determining which principles are involved and what their implications are. At that point, we can move to the fourth step in solving the problem at hand. Seek a Resolution Proposing more than one course of action and examining the ethical justification of vari- ous actions is, indeed, the working phase of decision-making. Many people try to avoid this step and, at the same time, to reduce the stress of the situation by settling for the first option that comes to mind or for what initially appears to be the safe choice. Several courses of action are open to Dr. Fowler: 1 She could fully share infor- mation about the error with all those involved; 2 she could tell Dr. Mann about the error and other internal entities in the hospital but not inform Mr. Lucas; or 4 she could wait to tell Dr. Mann about the error with Mr. These actions actually fall into the categories of telling, not telling, or waiting to tell, the last being a version of not telling. Because the error affected two patients, the range of possible actions doubles. To determine which options are morally justifiable, one must project the prob- able consequences of each action and the underlying intention of the action as well as whether there are moral duties that prevail independent of the consequences. This process involves the application of the ethical principles presented earlier and the ethical theories described below. By following this process, one can reject some options immediately because they would result in harm or would conflict with another basic ethical principle. Choosing the first option would be in compliance with deontological or duty- based ethical theories, which assert that the rightness of an act can be judged insofar as it fulfills some principle of duty, in this case particularly the duty of veracity. The duty- based principles of veracity and fidelity require showing respect for others, especially when some special relation exists. Not telling the family members does not respect the dignity of the family members. The third option of withholding the truth about the error and not doing anything else would be hard to justify from the perspective of these duty-based principles. Furthermore, not telling and trying to correct the error without telling anyone about it is fraught with problems, not the least of which is the great possibility of getting caught in the act of a cover-up. The credibility of not only Dr. Fowler but of the entire pharmacy would be at stake should that happen. The fourth option delays the truth but holds open the possibility that it will be disclosed at a later time. This option seems to be based on the assumption that disclosure is warranted only if the consequences require it. This brings us to consideration of the consequence-oriented principles—beneficence and nonmaleficence. Two major versions of consequence-oriented ethics were presented in the intro- duction: utilitarianism and Hippocratic ethics. Hippocratic ethics would focus on the prin- ciples of beneficence and nonmaleficence, but only insofar as the action has an impact on the patient. London is dead; he cannot be affected one way or the other. Lucas, conversely, is very likely to be affected. At least he needs to begin immediately receiving the right medication, but that may not require disclosure of the error. Then, too, disclo- sure may be distressing to him. A good case can be made that the error should be kept between Dr. Fowler and those who need to know in order to correct it. Utilitarianism differs from Hippocratic ethics by not focusing on the principles of beneficence and nonmaleficence but on which consequences are relevant. Utilitarianism holds that the option that would bring about the greatest good for the greatest number should be chosen. If telling the truth would likely produce more benefits for all the affected parties than any other alternative, then it would be good and right. If not, it would be bad and wrong. To decide whether the various options are right or wrong one would have to consider the effects of each on everyone concerned. Utilitarianism would consider the effects not only on the two patients, Mr. Lucas and Mr. London, but also on the pharmacist who apparently made the error and the nurses who failed to check the medications and catch the error. It would consider the families involved. Most critically, it would consider the effects on future patients who might benefit if the error is reported and procedures are put in place to make sure it does not happen again. We have at this point identified several possible courses of action and the impli- cations of various ethical principles for each of those courses. The same is true for ethi- cal decisions. A better decision can be reached if the people who are legitimately involved have the opportunity to openly discuss their perceptions, values, and con- cerns. In a complex case such as this, Dr. Fowler should call on the input of colleagues in pharmacy, the physician, and the nursing staff. By discussing concerns together, they can reach a more comprehensive decision that is ethically justifiable. On the other hand, the Hippocratic form of a consequence-based ethic provides the most plausible basis for supporting nondisclosure. London cannot be helped by the disclosure, and Mr. Lucas probably can be helped as much without it. A more social form of a consequence-based ethic, such as utilitarianism, leaves us in an ambiguous spot. Harms can come—to the families who will be placed in distress and certainly to the pharmacist who made the error. Significant benefits from disclosure also can be expected, perhaps to Mr. Lucas but definitely to future patients. It is possible that the family members might gain benefits as well. Notes 1. Purtilo, Ruth. Ethical Dimensions in the Health Professions. Philadelphia: W. Saunders, ; Fletcher, John C. Ethical Questions in Dentistry. Chicago: Quintessence Books, Salladay, Susan, and Amy Haddad. In fact, there are pharmaceutical dimensions to almost all of the dramatic ethical problems in health care. Abortion can involve decisions about the use of abortifacient agents; euthanasia, about the use of barbiturates and narcotic analgesics to hasten death; pharmaceutical agents are used in producing superovu- lation that precedes in vitro fertilizations; and genetic engineering includes many pharmaceutical applications in drug manufacturing and decisions about alternative therapies. Thus almost every dramatic and controversial issue in health care ethics can pose problems directly related to pharmacy. Nevertheless, many of the day-to-day ethical dilemmas faced by the pharmacist arise not in the context of these dramatic, ethically exotic cases, but in much more normal, routine pharmacy practice. Every prescription raises issues about informed consent, assessment of risks and benefits, and the ethics of determining a fair price. Many patients will be faced with difficult choices about the wisdom of using drugs their physicians have prescribed. Before turning to specific topics, such as the ethics of informed consent, pric- ing, and the dispensing of morally controversial medications, some preliminary work must be done. Identifying Value Judgments in Pharmacy Normative judgments or evaluative judgments occur constantly in all health care decisions. It is impossible to get to a clinical conclusion—to prescribe a drug, use an over-the-counter medication, substitute a generic, check the accuracy of a dosage with the physician, include a medication in a formulary, or report a suspected drug abuser—without making a normative judgment. Whenever someone decides to act or refrain from acting , some evaluation has taken place. A decision is made that a particular course is the right one. It is better than available alternatives. It is what one ought to do. One key to learning to recognize that evaluative judgments have taken place is to watch for value terms. Words like right, better, and ought all signal a process of evaluation. It is the nature of a clinical science like pharmacy that these evaluations take place constantly. Case does not raise a dramatic or grave ethical issue. It may not raise any ethical issue at all. It does involve a number of evaluations, however. In reading through this case, note all the words signaling that an evaluation is taking place. As she admired the latest in swimwear, she made a firm resolution to lose weight. Williams had tried numerous diets over the years but always seemed to lose only a few pounds and then gain back even more. Also, she really hated exercise, so a quick-and-easy way to lose weight was what she had in mind. She stopped by the pharmacy she often patronized during her lunch hour. Krause noticed the weight control pills and looked up to see if the buyer was truly overweight. He had noticed a seasonal increase in the sales of these pills following the holidays and leading into swimsuit season. Williams looked to be at least 50 pounds overweight for her height. Williams asked Dr. The formula also contains some bitter orange that will suppress your appetite to a certain degree. There is also guarana, and that has an effect similar to caffeine. These pills should be used on a short- term basis along with reduced caloric intake and exercise. The amount of weight reduction usually is small. Williams groaned. They have a stimulant effect, which can result in nervousness, restlessness, insomnia, diz- ziness, and headache. There is also the possibility of an increase in blood pressure and heart rate. Williams was getting more and more discouraged. Williams stood in the checkout line with the diet pills in her hand, tapping them lightly on the counter as she decided what would be worse: being irritable and tired or not being able to wear a swimsuit again this summer. Commentary At first this case may appear to raise no evaluative issues at all. The customer wanted the diet pills, and the pharmacist was in a position to provide her with some informa- tion about them. Searching for the value terms, however, reveals a number of judgments that are clearly in the realm of values. According to this pharmacist the pills should be used on a short-term basis along with reduced caloric intake. Two judgments are implied here. But, second, it is acceptable to use them only in the short term. Both of these evaluations are controversial. They rely in part on assessments of what the case refers to as side effects. The term is an interesting one. It is, in fact, a value judgment that certain effects are unintended and bad. The pharmacist lists several such effects: nervousness, restlessness, insomnia, dizzi- ness, headache, and possible increase in blood pressure and heart rate. The judg- ment that these are bad effects is relatively noncontroversial. It is a value judgment nonetheless. Moreover, these effects are worse for some people than for other people. Someone suffering from hypotension might be less concerned than a hypertensive. We already see how such evaluations take the pharmacist beyond what pharmacological science can provide. The move becomes even more significant when the pharmacist and patient begin to compare the risks of these harmful side effects with the possible benefits of using the diet pills. Normally that is not a medical issue. In this case, the critical ques- tion is how important it is to Ms. Williams to lose weight through the use of the drug. In order to answer that question we need to know not only how she values weight loss, but also how she compares the harms from the possible side effects with what she perceives as the disadvantages of other ways of losing weight and of not losing weight at all. If every alternative is very unattractive, then assuming continued use has at least some additional weight-loss effect she might be willing to take on the risks of using the drug for a longer period. However, if losing weight is not as important, or if other methods are not ter- ribly burdensome, then even short-term use of the substances commonly found in diet pills would make little sense. The evaluations are key, and it is hard to see how being trained as a pharmacist or any other health professional makes one an expert in making them. Williams what his personal opinions are about how one set of effects compares to another? Or is he simply charged to give her the facts? It seems strange that he would be expected to give her his personal value judgments. However, giving her just the facts would create serious problems as well. In the case of nonprescription products, such as herbs and vitamins, it may be very difficult for the pharmacist to know what the facts really are, since there is little convincing, scientific evidence about the benefit of any ingredient in weight-loss products. Also, stocking these products in the phar- macy implies a value of sorts, and that sends a message to patients when they look for assistance from the pharmacist. Moreover, in order to fully evaluate the risks, the pharmacist would have to know other important facts about the case, such as what products Ms. Williams had tried in the past and why she is worried about losing weight. Then, too, how can the pharmacist know exactly which medical facts to give her? Surely, more could be said about diet pills than is reasonable to tell to a patient. In addition, this particular patient may be unusually interested in certain relatively rare risks that would not be of concern to most. Many interesting questions lie beneath the surface of this case, questions hav- ing relevance not only for over-the-counter medications, but also for value judg- ments made about the risks and benefits of medicinal agents as part of patient education. Learning to recognize value judgments is a crucial first step. Only after these issues are confronted can we turn to more directly ethical questions, such as whether patients should be permitted to take medicinal risks based on their own judgment and whether patients have the right to know about the risks and benefits in the first place. Case presents another opportunity to identify the evaluations taking place in a conversation between a pharmacist and a patient. In this case try to identify the value judgments made by the prescribing dentist, the pharmacist, and the patient. Rudolph and Dr. Jones knew each other not only as pharmacist and patient, but as members of the same health club. The dentist said the stuff he used to numb my mouth will last a long time, maybe up to 6 hours. Would aspirin or something else over- the-counter work just as well? Are there any side effects from codeine? Jones believes that pain and pain relief are completely subjective. He feels this is especially true in the case of dental patients who have received local anesthetic agents with a long duration of action. Should Dr. Jones encourage Mr. Rudolph to try aspirin, acetaminophen, or ibuprofen to relieve the pain? Commentary As in Case there appear to be possible differences in value judgments about how to treat pain from a tooth extraction. Similar questions arise about what constitutes a side effect and how to determine just how bad the side effects could be. Rudolph seems to believe he will not need what he considers to be strong pain medication. Of course, the anesthetic has not worn off yet, but he may well know from past experi- ence that he can tolerate the anticipated level of pain. The judgment that he will not need the codeine is actually a judgment that he prefers the risk of pain controlled only with nonnarcotic analgesics to pain controlled by a narcotic. Jones apparently views these trade-offs differently. He believes he is in a posi- tion to know not only how much pain Mr. Rudolph is likely to experience, but also whether the risks of the narcotic would be justified in his case. Attitudes about pain vary tremendously from one culture to another and from one individual to another. They may believe that the risk of addiction, no matter how small, is not worth it. They may also ground their judgments in even deeper cultural attitudes about the meaning of pain and its control. Moreover, in some cultures pain is perceived as affording some advantage, as a warning of an underlying problem or as a character-building experi- ence in which the sufferer learns to cope. For other cultures and ethnic groups, pain is something to be expressed openly. This generates an attitude of sympathy while providing a rationale for explaining unusual behaviors related to pain. In addition, there are those who hold the worldview that pain makes no sense other than, perhaps, as a signal of a potential medical problem. The dentist in this case seems to gravitate toward this view, while the patient is more cautious. In effect, Dr. Jones is being asked to arbitrate a debate about which of these two worldviews is more appropriate for treating someone experiencing dental pain. In that case, the pharmacist is being asked as a friend to give counsel on a matter of personal preference, a role he might want to take on as a friend but surely not as a pharmacist. Even if we want to view the question of whether or not to fight pain aggressively as having a correct answer, it is not the sort of issue about which any medical professional—dentist, physician, or pharmacist—can really claim to have expertise. It is a question of aesthetics, of what kind of lifestyle is best. It may also be a question of what kind of lifestyle is ethical. This raises the question of the relationship between ethical judgments and other kinds of evaluative judgments, a question we address in the second half of this chapter. Pierce took the time to counsel patients about the side effects of medications and often stepped out from behind the counter to assist a customer in selecting a nonprescription drug product. However, Dr. Kelly noted that Dr. Pierce seldom asked patients if they preferred generic or brand- name medications. Kelly had strong negative feelings about the bioequivalence of some generic drugs to innovator drugs, in particular, drugs with a narrow therapeutic index. Her suspicions had been fostered by several pharmacy school instructors who emphasized their personal biases against using generics for critical-dose drugs, such as immunosuppressive agents. Kelly asked Dr. We make a larger profit on generics, so I prefer dispensing them whenever I can. Kelly is uncomfortable with the specific practice of not giving patients a real choice. The sign on the cash register is not very large. Commentary Once again the problems of this case may appear to raise questions of medical science. Furthermore, Dr. However, even if one assumes that there is less consistency in generic compounds as well as a greater risk of getting an ineffective dose, it does not automatically follow that the patient should prefer the brand name compound. If through careful consideration of the pertinent research on the efficacy of generic drugs Dr. Kelly concludes that one can buy greater reliability by paying a higher price, she still must consider whether it is wise to spend more money for the extra margin of advantage from the brand name drug. The answer will depend on how one perceives the value of the extra benefit from a brand-name drug as com- pared with all the other things one might do with the extra money. It is a question of values. Different patients are likely to make different value judgments. If a patient is quite wealthy and has a high degree of concern about the effectiveness and safety of the drug being taken, it would certainly be understandable for that patient to spend the extra money to achieve an additional level of safety. This would to some degree depend on how important the hoped-for benefits would be. It may be more reasonable to take some risk with a generic drug for a headache than for the control of seizure activity. The value trade-off is in large part not medical. If one assumes that the generic drug is supposed to have met some minimal standards in the manufacturing process, the risk may be less than Dr. Kelly fears. But Dr. Pierce seems to be engaging in evaluative judgments as well. He simply may not share Dr. His may simply be a different value judgment. There is a complicating factor, however. Pierce admits that the profit on the generic is greater. Insofar as the patient is maneuvered into the drug preferred by the pharmacist for reasons of personal profit, the case begins to raise ethical as well as nonethical questions. When the right of the patient to be informed and to choose among alternatives is violated by the pharmacist, the problem is no longer simply one of nonmoral value preferences. It is to cases that will help distinguish between ethical and nonethical evaluations that we now turn. Separating Ethical and Other Evaluations We have seen that evaluative judgments arise constantly in the practice of pharmacy, not just in the ethically dramatic cases, but also in making routine judgments about whether an effect is good or bad, whose good or bad it is, and whether the risk is worth taking given the alternatives available. Not all evaluations are ethical judgments, however. This section examines the relationship between ethical and other kinds of evaluations. In order for an evaluation to be an ethical evaluation, certain criteria must be met. When we say a painting is good, we do not make an ethical judgment; we make an aesthetic one. When we say a person is good, however, we can mean many things. If we say he or she is a good runner, we probably mean the person is technically proficient; we are not making a moral judgment. When we say a person is good, however, we may mean that that person is morally good. Moreover, we are judging it by what we take to be a certain standard, an ultimate or final standard from which no further appeal is possible. By contrast, a person may be good according to the standards of the local community or the culture. Or the person may be good according to a certain legal standard. An ethical evaluation is made according to the ultimate standard. For religious people that standard is most likely the will of God. For secular people it may be reason or natural law or some similar nonsacred standard. The following cases provide an opportunity to try to separate ethical judgments from other kinds of evaluations. In reading them, try to identify the issues you con- sider to be ethical and those you think involve nonethical evaluations. Vickers was enjoying the first day of a 3-week vacation in the mountains. For the past 7 days, Mr. Vickers had been taking Bactrim DS twice daily for a painful urinary tract infection. His physician emphasized the necessity of taking the medication faithfully and completing the course of therapy, so Mr. Vickers left to find a pharmacy in a nearby town. Vickers explained to the local pharmacist, Pat Martin, Pharm. He gave Dr. Martin the name of his physician back home and the name and daily dosage of the drug. Martin was able to access Mr. Vickers was a member of a drug-card benefit plan. Since the prescription was for a single course of anti- bacterial therapy, there were no refills. Martin then called the physician and found out he was out of town and would return in 4 days. Martin relayed this information to Mr. Vickers stated. Martin knows that state law prohibits a pharmacist from refilling a prescription without authorization. On the other hand, Bactrim DS is not the type of drug that has a serious potential for abuse. Besides, the adverse effects of the drug are minimal. Martin knows there are risks from stopping antibacterial therapy midcourse. It is really up to her to decide whether she will give a complete course of antibacterial therapy to Mr. Would it be that wrong to give him the rest of his prescription, to get him through his fishing trip? Values in Health and Illness 37 Commentary Many value judgments take place as this scene unfolds. Try to identify them. Look first for the judgments about the pharmacological effects of the medication. Vickers considers the Bactrim DS to have been successful; he is satisfied with the results. Martin also makes evaluative judgments. She no doubt would like to help Mr. Vickers but feels an obligation to obey the law. Both judgments require evaluating not only the likelihood of certain risks occurring, but also how serious the risks are. In addition, the use of Bactrim DS has its own underlying value judgments. 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