CASE STUDY ETHICAL PAPER:

“The Newfound Use of the Placebo Effect”

BS CRIM 1-B
I. Gather the Facts

 A nurse in a surgical unit in a certain hospital found a new use of “PLACEBO

EFFECT”. A placebo is anything that seems to be a "real" medical treatment
but isn't. It could be a pill, a shot, or some other type of "fake" treatment.

 Nurse Lucky was a newly hired registered nurse in the surgical unit of a
hospital who’s experiencing an ethical dilemma after he discovered an
anomaly inside his workplace.

 He was hired immediately because of his brother who is a nurse supervisor for
five years of that hospital. His brother is also the one who supported his
studies to become a nurse.

 On his orientation with his senior nurse, his senior told him that some of the
patients in their floor will ask for pain medications a lot, but pain medications
are not given liberally because of its addictive properties. They sometimes
administer solutions as placebo for morphine. The senior nurse demonstrated
how placebo is carried out and administered their patients. He was instructed
to do it under the prescription of a doctor.

 One of his duty days one night, Lucky decided to do an extra effort of
cleaning the nurse’s station in line with the 5s program of the hospital. As he
begins his task, he found vials of pain relievers and IV antibiotics under the
sink. The medicines were not expired so he wondered why it was kept under
the sink. He also found out that these medicines cost P2,000 per vial. He
decided to place it back under the sink and decided to ask his senior nurse
later about it.

 One day, a patient’s relative approached him and asked where he can find
Lucky’s brother. Lucky asked him why and introduced himself as his brother.
The patient’s relative then said, “Good that he is your brother. Will you kindly
hand him over these three vials of medicines I bought from him at half the
price. My sister who is in the surgical unit would no longer use it because she
died this morning. Kindly ask him if I could get a refund because I really need
the money to arrange interment.” Lucky was in a shock when he heard the
patient’s relative. He remembered the medicines he found the other night. He
looked for it under the sink and it was no longer there.

 When he asked his senior nurse about it, his senior nurse told him to pretend
that he didn’t see a thing, it’s something everyone do in their workplace.
  He decided to investigate. He found out that there are some nurses who do not
administer these expensive medications as ordered. They administer instead a
placebo even if it was not ordered by the physician. They also charge the
patient with the medicine even though they administer placebo. These extra
vials are kept and later sold to other patients who need it at half the price. The
money is then divided among those who are involved. These occurrences are
not recorded in the medication audit being conducted by nurse supervisors
because the nurse supervisor for their floor is no other than his brother who is
also involved in the case.

 Lucky confronted his brother. His brother said that those activities enabled
him to send Lucky to college and eventually graduate as a nurse. Lucky was
dumb founded. He does not know whether he would just keep silent and join
the group to protect his brother and earn more too or make noise and make it
known to the detriment of his brother to whom he owes a lot.

II. IDENTIFY THE STAKEHOLDERS

 Lucky
A newly hired registered nurse in a certain hospital who’s having a dilemma whether
he would just keep silent about the conspiracy of the nurses to protect his brother or tell it
to the person in authority and let his brother down to whom he owes a lot.

 Lucky’s brother
A nurse supervisor for five years of that hospital who also leads and protects the
anomaly of the newfound use of placebo effect.

 Senior Nurse
One of the conspirators who told Lucky to pretend he didn’t know about the issue
and just do it too anyway.

 The patient’s relative

The one who asked where Lucky’s brother is to hand the three vials medicine
back because he won’t need it anymore as his sister in surgical unit already died.

Lucky is having trouble because he accidentally knew that there are some nurses who do
not administer these expensive medications as ordered. They administer instead a placebo even if
it was not ordered by the physician. They also charge the patient with the medicine even though
they administer placebo. These extra vials are kept and later sold to other patients who need it at
half the price. The money is then divided among those who are involved. These occurrences are
not recorded in the medication audit being conducted by nurse supervisors because the nurse
supervisor for their floor is no other than his brother who is also involved in the case.
III. ARTICULATE THE DILEMMA

a. Christian Resources-
The Christian moral life derives from the sacred books of the Old and New
Testaments, in particular from the ideas, values, and concerns of Jesus Christ. That is
to say that the moral teachings of the biblical writings should be consulted whenever
necessary.
 In this case, Lucky’s brother supervised the conspiracy of the placebo
which is against the commandment “Thou shall not steal”. Since it is
never in the knowledge of Lucky, he got stuck in a situation of whether
telling the truth or protecting his brother therefore possibly violating the
commandment “Thou shall not bear false witness against thy neighbor”.

b. Virtue-
(Prudence, Justice, Temperance, Fortitude). This theory referred to as “Ethics
of Being” as opposed to “Ethics of Doing”. It assumes that there are certain ideals
toward which we should strive, which provide for the full development of our
humanity.
 Lucky is having a hard time about what decision he will do. He doesn’t
know whether he will stay silent because keeping his mouth close will
protect his brother whom he owes a lot of things like him being able to
graduate and being hired as a nurse in the hospital where his brother also
works at or make it a noise and reveal that his brother is one of them
therefore destroying their relationship.

c. Rights-
A right is a justified claim on others, for example, if I have a right to
property, then I have a justified claim to protect my belongings against those who
might steal them.
 The patients of the hospital deserve to receive the right services from the
hospital because it is about their health that’s at stake.
 The owners of the hospital have the right to the truth. Any crimes being
committed against them must be reported to authorities concerned.

d. Utilitarianism-
This theory determines right from wrong by focusing on outcomes. This suggests
that ethical actions which provide the greatest balance of good (pleasure) over evil
(pain) for the greatest number of people.
 Lucky can’t just decide to remain silent to protect his brother because a lot
of patient’s right to truthful and quality healthcare service and especially
 their health is at stake. If the misconduct will continue to be existent, more
and more of patients will be affected.

e. Justice and Fairness-

Justice means giving every person what he or she deserves, or what his or her
due. Fairness is a just behaviour without favouritism or discrimination.
 In this case, to achieve justice, Lucky should make this crime known to the
authorities in the hospital. He should also admit that his brother was
involved in the case. Although it might destroy his relationship with his
brother, he should not forget that a crime against the patients were being
committed and as a nurse, one of his sworn duties is to put the welfare of
their patients above all.

IV. LIST OF ALTERNATIVES

Alternative no. 1:
They must terminate and lose Lucky’s brother’s job and everyone who is concerned
with the crime immediately because of what they had brought to the hospital’s reputation. They
can also raise a complaint in the court of law against the offenders taken that punishments will
remain humane.

Alternative no. 2:
They should give them a second chance of working in the hospital. In this case, they
can impose penalties or fines respective to the crime committed and let them to continue with
their work.

Alternative no. 3:
The hospital can enforce days/weeks/months of suspension while imposing
disciplinary measures to everyone who’s involved. They can also demote the employees as such.

V. COMPARE THE ALTERNATIVES WITH THE PRINCIPLES

-Alternative no. 1 and Alternative no. 3 fall under the ethical principles of Justice and
Fairness because terminating or punishing the offenders will lessen and possibly could mitigate
the issue and will save the hospital’s reputation. Both alternatives also exhibited the ethical
principle of Right wherein the hospital in Alternative no. 1 has the right to fire the offenders for
what they did.

-Both Alternative no. 2 and Alternative no. 3 fall under the ethical principle of Virtue
because these actions include prudence and care which test the virtue of those who are involved
by considering everyone’s situation.
 -Both Alternative no. 2 and Alternative no. 3 also falls under the ethical principles of
Utilitarianism because this action provides them with much bigger amount of pleasure than pain
because the employees will still have a second chance to work, giving them less pain and also for
the patients because they will receive justice and will no longer have to deal with it while not
thinking too much about the people losing their jobs despite of what happened because of the
sympathy and mercy they want to give.

VI. WEIGH THE CONSEQUENCES

Alternative no. 1

-To protect the hospital’s reputation since the offenders was out of the company
already and can finally live up to their sworn duty of providing right and just services
to its patients.
✗ The offenders have to deal with the crime they committed and let the law decide
their fate.

Alternative no. 2

-Employees can make their mistakes right and learn from it. They will also have the
second chance to finally do just what is expected from them to do adhering with the
policies of the hospital and incorporating their morals in the actions they do.
✗ The hospital’s image will still be affected and justice will not be given since they
disregarded it without proper actions to solve it.
✗ This will violate the hospital’s policies and standards, and will be questioned by
others.

Alternative no. 3
-A chance will be given to the offenders to prove themselves.
-Employees can continue with their jobs and sustain their lives.
-They will be taught by disciplinary measures that will remind them of their values in
lives.
-They might violate the company’s rules and regulations again if this decision will
not be done accordingly.

VII. MAKE A DECISION

Life will always put us into situations where our values and principles will be
tested. During times like this, we need to remind ourselves of what we really are and what we
want to impose on other people. Some of it may put them into undesirable circumstances only
because the law is telling us to do so. Unfortunately, we have to make decisions all the time in
order to reveal the truth. Sadly, there is no painless solutions in making decisions. Others have to
be negatively affected while others have to be compromised. Intuitive and reasoned factors are
the driving force of your decision-making capacities. Whatever it might be, always bear in mind
that it is the common good that we should put above all else.

In this case, I strongly believe that giving them the punishment they deserve given that
the punishment remains humane is the best decision to make. Although it might not be the best
for everyone, this falls under doing what is lawfully right while being morally mindful. It is just
right to punish them for the things they did wrong but it should not be the whole judgement
about their lives. Give them the punishment they deserve, be it in the name of the law but also
consider them being humans who naturally is expected to commit mistakes. Did justice actually
mean life imprisonment, death sentence, or giving them something equally painful to what they
made them feel to their victims or is it about correcting the sinner while giving them the chance
to reflect on themselves and finally change for the better? Because if it’s about the former, then
we are just eliminating criminals and not the crime itself.

We are all reasonable and rational beings after all. Every action constitutes to
responsibility and accountability. Punishments are corrective measures. Let it be that way. Don’t
turn it into some lifetime judgement that takes away people’s right to heading back to being
morally upright beings. No one is created in the image of evil. Some may live with it but still,
goodness is innate. Redefining our values and redirecting our actions to achieve the common
good is the first step in building a society where nobody would ever be deprived to have the
chance to live as moral agents who discern what’s right from wrong and to be held accountable
for their actions further not causing unjustified harm to people.

Justice must create peace and love, not fear and hatred.