Identify at least two ethical concepts that are relevant to the case study. Define these terms, and explain how they apply to the case.

Case Studies for Discussion Board Twelve

Case One: Barreling Through the Hills

In early April, residents of the Texas Hill Country listen for the songs of golden-cheeked warblers. These small, endangered birds come every spring to the only place in the world where they build nests and raise their young. But, in April of 2020, bulldozers drowned out the familiar birdsongs as work crews began laying the Permian Highway Pipeline. The pipeline, when complete, will cut a 430-mile long swath across the heart of Texas Hill Country. When completed, its operator plans to deliver two billion cubic feet of natural gas from West Texas to a processing facility on the Texas Gulf Coast. There it will be converted to liquified natural gas and pumped onboard tanker ships bound for the world market.

Even though Texas is a “property rights state,” Texas law gives pipeline companies the right of eminent domain even if property owners whose land lies on the path of the pipeline object to construction for environmental reasons or loss of property value. The companies can build where they like if they claim to be providing infrastructure for transporting natural resources. The Permian Highway Pipeline, for instance, will cross through thousands of properties, including the city of Kyle, and claim a 125-foot easement on these properties. They can do that by simply ticking a box on a form provided by the body that oversees the oil and gas industry, the Texas Railroad Commission (which, oddly enough, has had nothing to do with railroads since 2005).

Texas leads the nation and the world in the production of oil and gas. The proceeds of mineral leases on state land largely fund the University of Texas and Texas A&M University systems. The fracking boom, centered in West Texas, where the pipeline will originate, has made the Texas Public University Fund one of the wealthiest in the country.

Nevertheless, numerous lawsuits challenge the pipeline, primarily for lack of proper environmental studies. Besides the effect on native animal species, a major concern has focused on the karst topology characterizing much of the region. Karsts are underground systems of tunnels and caverns formed by limestone or dolomite rock dissolving over time. Karstified landscape like that in this region magnifies the dangers of pollution to local aquifers, as groundlevel pollution may flow unimpeded into a water system, without the usual filtration that happens in a porous aquifer. Concern over the effects of a spill in this fragile terrain has prompted much public outcry. The courts so far have mostly sided with the pipeline’s builder and operator, Kinder Morgan, a Houston company and one of the largest infrastructure companies in North America.

“At a time where we as a country are facing uncertain outcomes,” Elizabeth Coldwell, a spokeswoman for Texans for Natural Gas, told the Houston Chronicle in response to a court ruling rejecting a challenge from property owners, “it’s reassuring to see critical infrastructure projects like the Permian Highway Pipeline avoid falling victim to litigious activists seeking to undermine the energy industry. Now, more

than ever, Texans need the comfort of knowing that the industry that helps fund our schools, pay our teachers, and fill the coffers of Texas’ Rainy Day Fund maintains its license to operate.” Another challenge to the pipeline is the current oil and gas glut on the world market, exacerbated by the coronavirus pandemic that has driven down demand and prices. “It seems pretty hard to argue with a straight face that these projects are financially essential right now when we’re seeing a reduction in production,” said Erin Zwiener, a district representative in the Texas legislature who represents a portion of the Texas Hill Country. “I think a lot of folks are assuming that it will suddenly reverse one day, but I suspect we’re looking at a much longer term issue.”

The Railroad Commission has accepted Kinder Morgan’s claim that the pipeline will not have a significant impact on the golden-cheeked warbler.

Case Two: Dirty Hands

New York City was an early epicenter of the COVID-19 pandemic in the United States, largely due to its population density, which created ideal conditions for contagion. But 2020 was not the first year an epidemic visited New York. Eerie relics from past diseases may still be seen, if one knows where to look. In the middle of the East River, just between the Bronx and Rikers Island are two tiny islands, overgrown with vegetation, currently designated as bird sanctuaries. The larger island, North Brother, contains crumbling old buildings, now abandoned for over half a century, that played a role in the epidemiological history of New York. The twenty-acres of North Brother once contained hospitals and residences in which patients with highly communicable diseases were quarantined. One famous patient wrote to her lawyer in 1908, “I am not segregated with the typhoid patients—there is nobody on this island that has typhoid. There was never any effort by the Board authority to do anything for me excepting to cast me on the Island and keep me a prisoner without being sick or needing medical treatment.” The author of this letter was Mary Mallon, known in popular culture as “Typhoid Mary.”

In 1907, Dr. George A. Soper, an epidemiologist, was called in to investigate a sudden typhoid outbreak in the family of a New York banker, one General William Henry Warren. Mr. Warren had rented a house at Oyster Bay where he and his family of three and their seven servants stayed for the summer. Of the eleven people in that household, six contracted typhoid within days of each other, and the landlord was afraid he would never be able to rent the place again unless the mystery surrounding the disease’s source was solved. At the time when Dr. Soper investigated the Warren family, very little was known about how typhoid spread. Then current theories blamed it on contaminated water or milk, or rotting organic matter, or sewer gasses. But because of the odd pattern of outbreaks in this and other cases, Dr. Soper came to suspect that humans were somehow spreading the disease. Meticulous sleuthing narrowed the possibilities down to one person: Mary, the cook, who had left shortly after the first case of typhoid appeared in the household.

Dr. Soper uncovered Mary’s recent employment history through the agency that placed her. He discovered that in the previous few years, she had worked in several households that exhibited the same pattern. In Dr. Soper’s own words, “a well-to-do and socially prominent family, soon after moving from the city to the country for the summer, experienced an outbreak of typhoid fever. In no instance had its cause been satisfactorily explained. The cook always left soon afterward. She had never been suspected.”

We now know that typhoid is a type of salmonella, and is mostly spread through uncooked food contaminated by fecal matter. Mary, when she used the toilet, would apparently soil her hands and return to the kitchen without washing them. While the food she cooked was probably safe, the fresh fruits and vegetables were most likely not.

After Mary was captured, she was held against her will on North Brother Island, where she was housed in a private bungalow. She had a comfortable arrangement and freedom to move around the island, but still felt herself to be a prisoner. After almost three years, she was released with the promise that she would not work as a cook or handle the food of others, and also that she would check in with the Department of Health every three months. She kept none of these promises, and for five years eluded detection by changing her name and seeking work on her own, without going through the agencies that knew her. Among other places, she worked at a hotel, a restaurant, and a sanatorium. The number of people she infected during this time is unknown. She was eventually found and returned to North Brother, where she spent the final twenty-three years of her life.

Mary never believed she was an asymptomatic carrier of typhoid, for she never showed any symptoms of the disease herself. But stool samples repeatedly showed she continued to produce typhoid bacilli her whole life, most likely in her gallbladder. She maintained she had been falsely imprisoned, without ever having been tried or even accused of a crime. Her lawyer sued to get her released from quarantine, but the suit was thrown out, partly on the strength of Jacobson v. Massachusetts, 197 U.S. 11, in which Chief Justice Harlan wrote, “The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good… The possession and enjoyment of all rights are subject to such reasonable conditions as may be deemed by the governing authority of the country essential to the safety, health, peace, good order and morals of the community.” In Mary Mallon’s case, the Department of Health took away her career and her freedom of movement for life, without a trial or even a hearing. But, in fact, all she had to do was wash her hands.

Case Three: “Able” To Practice Medicine?

A large body of evidence reveals race-based health disparities in the United States. The data also shows a dearth of physicians who identify as Black or African American, American Indian or Alaska Native, or Hispanic. These two facts seem connected in an interesting way. Health researchers have found a positive correlation between patient satisfaction and health outcomes. That correlation isn’t very surprising. Interestingly, though, health researchers have also found a connection, at least for women and for underrepresented minorities, between patient satisfaction and outcomes on the one hand and, on the other hand, whether the patients and health care workers identify as being part of the same group. Simply put, members of marginalized groups seem to have better health outcomes when they can identify with their healthcare providers.

In the last few decades, US medical schools have made strides toward attracting and graduating female and minority students. In fact, female medical students outnumber male medical students in application

rates, matriculation rates, and total medical school attendance. Students of color have had mixed success at gaining admission into medical schools and also in graduation rates. A handful of historically black colleges and universities (HBCUs), Hispanic-serving institutions (HSIs), and minority-serving institutions (MSIs) are taking the lead in graduating physicians from underrepresented groups. But the members of one sizable group in the United States, people with disabilities, still experience great health disparities, compounded by race, and yet are largely absent from the ranks of physicians and medical students. Only a very few physicians identify as having a disability, relative to the population as a whole. (The CDC estimates that one of every four American adults have some type of disability, whereas fewer than 3 percent of medical students and around 2 percent of physicians identify as a person with a disability. About a third of the medical students who self-identify report they are ADHD.)

There are many factors that could be preventing persons with disabilities from becoming medical students and physicians. Perhaps the numbers are underreported because of a bias against identifying as a person with disability, especially in such an emotionally and physically demanding profession. Perhaps medical schools are not complying with the Americans with Disabilities Act (ADA). Perhaps the medical school entrance requirements themselves don’t comply with the ADA. One such hurdle for would-be physicians might be the Medical College Admission Test or MCAT. Numerous rules for taking the MCAT effectively dissuade test takers from requesting needed accommodations, while other rules are simply not in compliance with the ADA. (The required documentation policies of the Association of American Medical Colleges for reviewing requests for disability accommodations do not appear compliant with the DOJ guidelines for accommodated testing under the ADA, for example.)

Many disabilities are not immediately obvious to others, while some physical disabilities, like deafness or blindness or conditions requiring a wheelchair, are hard to miss. Women who use a wheelchair have worse health outcomes for conditions like breast cancer, for example. Given that over 40 percent of OB/GYN practices fail to be accessible to wheelchair users, this particular statistic isn’t surprising. If a physician in such a practice had a physical disability, one could assume the office would necessarily be accessible.

A few recent hints in the popular culture suggest that persons with disabilities could be becoming more widely accepted as physicians. One example might be the television show, The Good Doctor, even though disability rights advocates have objected that the lead character is not representative of the overwhelming majority of people with autism.

Discriminating against people can be warranted if the reasons for exclusion are relevant. The schedules of residents and physicians are physically and emotionally grueling, to say the least, and certain disabilities could make it difficult, if not impossible, for a student to succeed in medical school or as a practicing physician. However, certain other types of disabilities should be no barrier to practicing some medical specializations. In fact, certain traits often listed as disabilities may even be a benefit to some medical students and physicians. (For example, being overly attentive to seemingly minor details can be beneficial in diagnosing a patient’s symptoms, especially in cases where a patient’s general symptoms can indicate numerous potential causes.) It is unclear whether the conditions for administering the MCAT is a proper place to set up hurdles for persons with disabilities.

Note: This case is adapted from the 2018 honors thesis of National Ethics Bowl alum student Mimosa Thomas, who passed away in 2020 at the age of twenty-four and who identified as a person with a disability.

Case Four: Putting Animals Out to Pasture.

Currently there are more than 100,000 primates in public, private, and government research facilities across the United States. These animals are being used for biomedical, clinical, and behavioral research studies across various disciplines. Many of these primates have been bred and born in captivity and have spent their entire lives living in research labs. Having been born in captivity, most of these animals have strong bonds with their human caretakers/researchers, and have never experienced sunlight, rain, or basic intraspecies socialization.

Traditionally, once animals have no more value as research specimens, they are humanely euthanized. Currently, euthanizing is considered a “best practice”; however, animal rights activists (and some researchers) argue that these animals, primates in particular, should instead be sent to a retirement sanctuary.

After two years of searching for a suitable retirement sanctuary for Bush, one of their primates, researchers at Princeton University were lucky enough to find one. He is now living out his days at an annual cost to the University of $2,500. While $2,500 is not an exorbitant amount, euthanizing would be more cost effective and the money saved could go towards other research, such as cancer trials.

Some researchers have other reasons to oppose retirement sanctuaries. The United States Department of Agriculture does not require animal sanctuaries to register with them, so there is little if any oversight of the living conditions. For this reason, adoption by the right persons might seem to be a better option than retirement sanctuaries. But there is no system in place for monitoring those conditions either.

Case Five: All the Opinions Fit to Print?

Every day for more than a century, the New York Times masthead has proudly proclaimed, “All the News Fit to Print,” reminding readers, sources, advertisers, and employees of the news organization’s commitment to impartiality, balance, and fairness. In early June, 2020, editorial page editor James Bennett was forced to resign, and deputy editorial page editor Jim Dao was reassigned to the newsroom, leaving some people to wonder if all opinions were fit to print.

An opinion piece written by Senator Tom Cotton (R-Arkansas), published in the June 3 issue of the Times, had sparked the controversy leading to Bennett’s resignation. Cotton expressed his view that the US military should be deployed to quiet the civil unrest in the country at that time. Protesters were demanding federal and state response to the newest wave of police killings of black men. Cotton accused radicals, rioters, and Antifa for promoting anarchy among the Black Lives Matter protesters. Senator Cotton encouraged President Trump to invoke the Insurrection Act and send in the military to deal with US civilian citizens. “One thing above all else will restore order to our streets: an overwhelming show of force to disperse, detain and ultimately deter lawbreakers.” Some readers and many NYT employees were horrified by the op-ed piece, claiming that the Senator’s language was overly-dramatic

and dangerous. Some felt that publishing such opinions could lead to further violent outcry among citizens who felt unheard and vulnerable. Times employees signed a letter which said, in part, “We believe [Senator Cotton’s] message undermines the work we do, in the newsroom and in opinion, and violates our standards for ethical and accurate reporting for the public’s interest.”

The New York Times’ apology for publishing the essay appeared within days of the op-ed’s publication and continues to be attached to the piece that can be found on the news organization’s website. The newspaper took responsibility for not challenging overstatements and for writing a provocative headline to accompany the piece.

Critics of the Times say that the news organization caved in to reader and employee backlash. They point out that the newsroom, which indeed is dedicated to balanced and accurate reporting, is different from the editorial offices, which has the responsibility of providing a diversity of opinion on timely matters. They think that readers of the New York Times should know the positions that their elected officials hold, even if a position is not popular or trades more on emotion than fact. The critics charge that leadership’s response reveals the news organization’s liberal bias.

After reading and researching your case, compose an initial posting that includes the following:

Interpretation:

Identify the central issue in the case study.
Identify the relevant perspectives involved in the issue.

Analysis:

Provide a summary of the case study in your own words that includes the essential information of the case. Include additional information you may have gleaned based on the additional research you have completed, and identify any additional information you do not have but would like to know order to better understand it.

Identify at least two ethical concepts that are relevant to the case study. Define these terms, and explain how they apply to the case.

Evaluation:

Propose a solution that best resolves the issue in an ethical manner based on your own judgment. Be sure to provide a thorough explanation of your solution.

Apply at least two normative ethical theories we have covered in the class to the case study. Be sure to define the basic idea of the theories and explain how they relate to your resolution of the ethical question at issue.

Identify or develop at least one principle that is relevant to the case study. State your principle clearly, being sure to explain how it relates to your resolution of the ethical question at issue.

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