Sunday, August 28, 2011

ETHICAL ANALYSIS OF "JOHN Q" MOVIE

The movie “John Q” is filled with ethical and moral dilemmas throughout its course.  It gives us a clear notion of the duties of public servants, and private administrators with regards to ethical decision they face in the daily execution of duties in communities they represent.  In this analysis, I will explore the ethical and moral values of the main characters in the movie in performing their various official capacities.  I will also elaborate on health insurance coverage by defining and reviewing the difference and similarities of PPO and HMO.  Below is an ethical analysis of the characters in the movie “John Q.”:
First of all let me explain what the movie is about before touching on the moral and ethical dilemmas of the characters.  The director of this movie Nick Cassavetes reveals a social issue in the health care industry.  He explains the ordeals of John Archibald, whose son has a serious cardiac condition that requires urgent surgery.  John did not have an appropriate health insurance policy to cover the cost of the operation; the hospital chooses not to take the Good Samaritan route, and refuse to proceed with the operation.
Therefore, John Q is confronted with a moral dilemma to accept fate and prepare for his son’s funeral as the Hope Memorial Hospital administrator, Rebecca Payne have suggested, or raise funds for the cardiac operation, which is a daunting task considering the time and emergency nature of the situation his son is in.  John decided to take the hospital staff and other patients at the emergency room hostage.  In the Geuras, Dean, and Charles Garoralo text for this course have discussed the four sub groups of absolutism which will be discussed in this analysis.  It talks about philosophers like Aristotle, Kant, and Mills who have developed their ethical opinions and philosophies.  By reviewing events throughout the movie, we can compare them as to how they would be viewed under these different philosophies to determine if they were morally right, or wrong in relation to Public Administration.
One would wonder why a hospital will refuse to offer free operation to save the life of a twelve year old boy.  Well the answer is simple, unlike public administrations, Hope Memorial Hospital (HMH) is a private entity, and private cooperation’s were established to make a profit.  This what academicians described as the “real world” or functional world?  A world of budget, deadlines to meet, accountability, and compliance (Garofalo and Gueras p, 1.)  Rebecca Payne acted in a utilitarian way; by thinking that assisting John Q’s son for free treatment will not do society any good due to millions of HIV patients facing the same problem.  John Q’s son is only a modicum of the health care problem faced by many.  Utilitarian believes that the outcome of any action has to be for the happiness of many.  Rebecca Payne may be a pariah to her community for refusing to offer free treatment to John’s son, but her action may be justified by a utilitarian.
While John is espousing the emergency room (ER) with his hostages, he was also faced with an ethical dilemma; he has a pregnant woman who needs treatment at another facility and another lady who can’t speak English in the ER.  When Lieutenant Frank ask him to release some of the hostages during the negotiation, John’s dilemma tears him between leaving the women in the ER where they will die and giving in to the police by releasing the women.  One outcome emphasizes his desire to find a heart for his son while the other saves the lives of hostages and expose his weakness.  In the end, he shows his reverence for humanity and releases the hostages that need serious help to save them.
This act of John Q will resonate well to a jury that has passion with the “virtue theory” of Aristotle which focuses on good intents of an action.  By releasing the most vulnerable patients during the hostage negotiation for their own good, divulge a good side of John.  John Q may have portray a poor character traits for using the gun to commandeer the hospital staff, but for the very fact that he was brandishing an empty gun on his victims, and his consistency in freeing hostages as promise, is a clear indication of being a man of integrity.  Since virtual theory is concern with the significance of the whole person, (Garofalo and Gueras p, 59.)  John’s actions, his ran some demand and the treatment of his hostages shows his frivolous intensions of hurting no one, rather than an attempt to save his son’s life after everything else saves.  His case brings awareness to his community who can relate to its plight, of part time employment, and lack of health insurance.  This fact makes his actions very virtuous and utilitarian despite his action initially gear towards his son’s well being, it’s magnitude after being publicized has a theme of struggle to achieve happiness beyond his community.  His slogan,” sick! Help! Is welcome by sympathizers, and that is a remuneration for his virtues. 
Furthermore, the movie also brings to mind the question of loyalty which is one of the six pillars of characters.  How much can one be loyal to his employer or organization?  One has a moral duty to protect his organization, but when a person’s moral standards are being threaten, they usually resigns, or stay and become “whistle blowers.”[1]  The whistle blowers often fall under intuitionism, a pragmatic theory which indicates that our intuition can determine if an action or act is good or evil.  There are certain individuals in the ER whose morals conflict with those of the ‘Hope Memorial Hospital’.  For instance one of the nurses gives John Q several options for funding of his son’s operation including an altruistic statement of “just don’t take no for an answer.” A statement which John Q reminded her of when she asks him what he thinks he is doing.  John answer that, “I am doing what you advise me, not to take no for an answer.”  During the course of the hostage taking in the ER, both John and the hospital staff were discussing insurance coverage for Health Maintenance Organization (HMO.)[2]  “HMO” Merriam- Webster’s Medical Dictionary.  Merriam- Webster, Inc. 21 Aug.2011.               < Dictionary.com http://dictionary.reference.com/brouse/HMO>.
One of the ER male nurses reveals that HMO physicians receives annual Christmas bonus for not checking their patients for costly illness to avoid paying hospitals for costly procedures.  This is reveal after John asks why his son’s physicians didn’t find out about his illness earlier during their visits.  The heart surgeon amongst the hostage is reluctant in accepting this claim which I think is the exercise of his loyalty to the hospital. The candor this male nurse in further attacking the surgeon by revealing that in their hospital, they tend to get around the law by stabilizing the patients, and then send them home to die if they do not have a good health insurance carrier to cover the cost of the treatment.
The male nurse’s claims sounds infallible, but the question is what is the ethics in whistle blowing?  In their analyses of whistle blowing, both Bowie (1982) and Bok (1980) indicate that an employee has a significant obligation of loyalty to the organization they belong.  Bok, for example, comment that the “whistleblower hopes to stop the game; but since he is neither referee nor coach, and since he blows the whistle on his own team, his act is seen as a violation of loyalty.”  For both, however, the duty of loyalty is not absolute; it is a prima facie duty that can be overridden in certain circumstances. 
However, Duska (1997) reject this theory in which whistle blowing is categorize as an act of sell out, one needs justification or can be pursued only under special circumstances.  Duska says “ it is as if the act of a good Samaritan is being condemn as an act of interference, as if the prevention of a suicide needs to be justified” (p.355).  The flaw, for Duska, is found in the notion that individuals should be loyal to a company. Simply put, a company is not a person and not, therefore, deserving of loyalty. While a company typically consists of people, it is not a group of people with a purpose that transcends self-interest. Loyalty, according to Duska, exists in the context of human relationships and entails a readiness to engage in sacrificial behavior. “A company is...an instrument with a specific purpose, the making of profit. To treat an instrument as an end in itself...does give the instrument a moral status it does not deserve” (p. 338).  Thus whistle blowing is a prominent instrument in virtue theory, intuitionism and teleology.
Another ethical aspect that comes to light in the movie is dishonesty.  The human resource (HR) department change John Q’s insurance from PPO (Preferred Provider Organization)[3]  “PPO” Merriam- Webster’s Medical Dictionary.  Merriam- Webster, Inc. 21 Aug.2011.< Dictionary.com http://dictionary.reference.com/brouse/PPO>  to HMO without explaining the implication of the change to his health benefits.  Not until the day he visits the HR to discuss his health benefits that he is aware of the kind of coverage his has.  Health insurance and other employee benefits are very esoteric, and should be thoroughly explained to employees before making changes in their plan.
Another aspect of dishonesty is portrayed by Rebecca Payne, Hope Hospital Senior Supervisor in lying to John Q’s wife that her son’s name has been added to the donor list.  This unethical lie would have cost John Q his life as he is made to believe that his son’s name has been added to the organ recipient list.  As he is talking on the phone with his wife, a conspiracy to murder him during the act is unsuccessful, as the sniper misses his target (John Q).  As John Q lie inanimate after the shot is fired faking to be decease to play his move.  He rise up and overpower his assassin to fulfill his moral obligations to his wife and son whom he promised to do something, and to find his son a new heart.
This action of John Q, to deceive the sniper, and the entire police force in his locale on live television also resonates with the six pillars of character (W& B p.13, 14) of reliability and responsibility.  John Q is reliable due to his determination to keep the promises he made to both his wife and son.  West and Evan write that “when we make promises or other commitments which creates a legitimate basis for another person to rely on us to perform the task (p.13).  They further write that people with ethics should avoid bad faith excuses.  This clause reveals the dishonesty of the hospital administration, and the HR department of John Q’s employer, who uses cover up to conceal their motives of murder, and paying less health coverage for their employees respectively without explaining benefits and cost to their employees for them to make an informed decision.
The reliability character pillar also warns individuals to avoid unwise commitments, and also to avoid unclear commitments.  These two clauses put John Q in a moral dilemma for promising his loved ones to get things done by taking the law into his own hands as a vigilante to fulfill his promise at all cost to save his son’s life.  As he put it “I will not bury my son, my son will bury me.”   This brings another pillar of character to mind, ‘responsibility’.  As the economist’s says, human wants are many, but the need to satisfy them are limited (Adam Smith- wealth of a nation) which brings to scarcity and choice.  John has chosen to threaten the hospital to save his son which is considering as a moral responsibility for every parent.  He is aware of the consequences of his action, as West and Berman indicates “beyond having the responsibility to be trustworthy, respectful, fair and caring, ethical people show responsibility by being accountable, pursuing excellence, and exercising self restraints” (W & B p, 14).  All this traits can be trace in John Q’s actions and decision making throughout the movie, on to the end when he decided to sacrifice his heart for his son when he has explore all means, but his son’s condition keeps deteriorating by the hour.
Despite this colorful picture I have painted on John Q’s to morally, and ethical justify his actions, I will be unjust to discredit Rebecca Payne for lying to John Q’s wife.  In fact, she is not the one that suggested initially lying to John Q’s wife about their son’s name being added to the organ recipient list, it is Sergeant Moody’s idea.  Regardless, a deontologist would argue in her favor due to the principle nature of the situation.  A deontological ethical theory celebrates an action not base on its outcome, but on a remarkable feature of the act itself (G& G p.53).  Most popular of these views are followers of Emanuel Kant (1959), the father of Kantianism.  They believe in consistency and in this case, they will support Hope Memorial Hospital’s stand of continue its policy of “cash case” for all patient without health coverage.  Any action contrary to the hospital’s billing tradition with creates contradiction, and lying to John’s wife is ethical.  This is because, deontologist believes any true statement meant to deceive others would not be a lie (G& G p,53).
Another example of lying can be justified by deontologist and Utilitarians alike is doing undercover work by police officers.  They often dress in plain clothes and change their identity to get information from the public.  Such action can be consider as unethical by some, but since such disguise is for the general good to create a happy society, the utilitarian would support such an act, and so is the deontologist.  For the very fact that Rebecca Payne lie to end the hostage ordeals in her organization to save the hostages, her organization, and cooperation with authorities, makes her decision ethical.
In the final analysis, we will examine the role of the Police Officials and the media in the movie, and the impact of their involvement ethically.  Unlike private organization that operates for profit, public officials such as police officers operate to provide public safety to maximize happiness for people to roam freely in their communities without fear for their lives or properties.  They are empowered with the moral and ethical powers to carry out their duties without fear and favor.  On the other hand, the new outlets that are considered by political scientists as the fourth arm of the government encourage transparency and accountability and exposes corrupt practices in the community.

By: Gershon Bai-Lama Bangura
copyright2011- all rights reserved

Bibliographies
Bok, S.: 1980, “Whistleblowing and Professional Responsibility,” New York University Education Quarterly, 11, 2-7.
Bowie, N.: 1982, Business Ethics. (Prentice-Hall, Englewood Cliffs, NJ).
Duska, R.: 1997, “Whistleblowing and Employee Loyalty,” in Ethic Theory and Business , T. Beauchamp and N. Bowie, Eds. (Prentice-Hall, Upper Saddle Rive, NJ).
Geuras, Dean, and Charles Garofalo, Practical ethics in Public Administration 3rd Edition (Management Concepts: Vienna, Virginia, 2011).

“HMO” Merriam- Webster’s Medical Dictionary.  Merriam- Webster, Inc. 21 Aug.2011.  < Dictionary.com http://dictionary.reference.com/brouse/HMO>.

“PPO” Merriam- Webster’s Medical Dictionary.  Merriam- Webster, Inc. 21 Aug.2011.  < Dictionary.com http://dictionary.reference.com/brouse/PPO>.

West, Jonathan and Evan M. Berman, The Ethics Edge 2nd Edition (ICMA Press, Washington D.C. 2006).







[1] a person who informs on another or makes public disclosure of corruption or wrongdoing.
[2]  an organization that provides comprehensive health care to voluntarily enrolled individuals and families in a particular geographic area by member physicians with limited referral to outside specialists and that is financed by fixed periodic payments determined in advance called also health maintenance organization compare
[3] A preferred provider organization (PPO) enters into contractual agreements with health care providers and creates a "provider network." But unlike HMOs, PPO health insurance will cover some – but not all – of the cost of care administered by out-of-network providers.  If you select a PPO, you will have low co-payments as long as you see in-network physicians. Another advantage of PPO insurance is that unlike an HMO, you do not need a primary care physician's permission to see a specialist (as long as the specialist is in network).

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