An Issue of School Funding: A

An Issue of School Funding: A Business Case Study

Fizzell Corporation, with its Southwest headquarters in Peyton, has been in business since 1951. Its hottest-selling product is a soft drink, Fizzie, which has pushed it up to the top five beverage companies in the world. In addition to soft drinks, Fizzell produces candies and snack foods.

Yolanda Gomez has worked for Fizzell since 1982 and has been its Executive Vice President for the past five years. She has lived in Peyton most of her life. Fizzell held a senior management meeting to discuss advertising and selling its products in the Peyton school district with its 30,000 students.

The school district hasn’t passed a bond issue in 15 years and depends on funds from the state government for its increasing revenue needs. During this time, it added instructional programs for an increasing number of students who come to school with learning problems. In addition, the district’s school buildings are aging and need substantial repairs.

In order to keep up with the times, the district purchased computers and software for all its schools’ classrooms along with up-to-date- technology for the central office. This expense has been controversial in the community. The district is strapped for cash and in danger of having to reduce popular programs and even close a few schools.

The Peyton City School District enrollment has gradually declined during the past decade. Its locale has little room for further development; new businesses tend to locate outside the district. Likewise, many people have been leaving to find newer, more affordable, suburban homes. All this has reduced tax revenues to support the schools.

Fizzell’s senior management team has prepared a proposal that would give the school district much-needed funds in exchange for exclusive rights to sell their beverages and snacks in school vending machines. This deal also includes the opportunity to advertise products on the district school buses and athletic scoreboards.

Yolanda’s colleagues on the senior management team all favor the proposal. For a modest investment in the school district, the potential profit on the advertising and sale of their products could be substantial. But Yolanda had doubts about the integrity of this deal.

Yolanda has a keen interest in education and knows how important more funds are to the school district. However, she is troubled with the ethical consequences of selling to students who are a captive audience. Likewise, she heard from a parent group who argued persuasively that schools compromise their educational mission when they encourage students to be consumers.

The conflict between Yolanda’s job as an officer of Fizzell and her responsibility as a citizen of the community leaves her in a quandary.

1. Define the Problem.
a. Are commercial sales a justifiable way for schools to gain revenue?
b. Should schools be involved in the merchandising of products to students?
c. Is the Fizzell Corporation taking advantage of the situation, or is it helping the school district to solve a difficult financial problem?
d. What message does a school district sent to its constituents or voters when it raises revenue though commercial arrangements?

2. Gather the Necessary Data
a. What is the size of the Peyton School District, and how would you describe its demographics?
b. What are Yolanda’s responsibilities to the Fizzell Corporation? Her relationship to the school district?
c. What are the major reasons for the school district’s financial problems?
d. What kind of partnership does Fizzell Corporation want to create with the school district?

3. List Possible Alternative Solutions. List as many as possible.

4. Analyze the Consequences of Each Alternative. Does Yolanda’s responsibility to Fizzell override her concern as a Peyton citizen? Should Fizzell worry about the negative backlash the school district may receive from the community?

5. Recommend a Plan of Action. What would you do if you were Yolanda?

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Iwas a HackworthFellow for the Markkula Center forAppliedEthics at Santa Clara University.I was alsoa pre-medicalstudent, andam currentlyattending the Loyola University ChicagoStritchSchool of Medicine.Duringmy senioryearat Santa Clara, I led discussions onmedicalethics withstudents interestedin medicine. Thepurpose of these discussions was two-fold. First, theywere created to helpbringcurrent ethical issues ontoourcampus. Second, they wereintended tohelpstudents whowere interestedin a careerinthe healthsciences determine whether ornot medicine is their correct calling.Most of the discussions followeda simple format. One totwo cases were formulated for the students toread. Then Ipresented the students with various questionsrelatedto some of the ethicalissues containedin the situations described. The followingcases are the ones that I presentedtothe groups.Eachcase also has a short history andsummary of the ethical issues being reviewed.The questions I asked of the students are included as well.These cases and questions are public domain, and can be re-usedor modifiedfor educational purposes.I hope that youfindthem useful, andthat theyspawnthe same thoughtfulenjoyment in you as they did inme.

Note:Thecaseswere not basedon specific events. However, it ispossible that they share similarities withactualevents. Thesesimilarities were not intended.

Autonomy

Autonomy essentiallymeans “self rule,”and it is a patient’s most basic right.As such, it is a healthcare worker’s responsibility torespect the autonomy of herpatients. However, at times this can be difficult because it can conflict withthe paternalistic attitude of manyhealth care professionals. The followingtwocases address patient autonomy. The first involves the rights of anindividual todecide herownfate, even against herphysicians’ judgments.The secondcase involves the rights of a parent to care for her childinthe mannerthat she sees fit.

Case 1:

Awoman enters the emergency room with stomachpain.She undergoes a CTscanand is diagnosedwithan abdominal aortic aneurysm, a weakeningin the wallof the aorta which causes it tostretchandbulge (this is verysimilartowhat led to JohnRitter’s death). The physicians inform her that the only way to fix theproblem is surgically, and that thechances of survival are about 50/50. They alsoinform her that time is of the essence, andthat shouldthe aneurysm burst, she would be deadin a few short minutes. The womanis an erotic dancer; she worries that the surgery willleave a scar that will negatively affect herwork;therefore, she refuses any surgical treatment.Evenafter much pressuringfrom the physicians, she adamantly refuses surgery.Feeling that the woman is not in hercorrect state of mind andknowingthat timeis of the essence, the surgeonsdecide to perform the procedure without consent. They anesthetize herand surgically repairthe aneurysm. She survives, and sues the hospital formillions of dollars.

Questions for Case 1:

Doyoubelievethat thephysician’s actions canbe justified inany way?

Is there anythingelse that they could have done?

Is it ever right to take away someone’s autonomy? (Would a court ordermake the physicians’ decisions ethical?)

What wouldyoudo if you were one of the healthcare workers?

Case 2:

You are a generalpractitioner anda mothercomes intoyouroffice withherchildwhois complaining of flu-like symptoms.Uponenteringthe room, you ask the boy toremove his shirt and you notice a pattern of very distinct bruises on the boy’s torso. Youask the mother where the bruises came from, andshe tells you that theyare from a procedure she performedon him knownas “caogio,”whichisalso known as “coining.”The procedure involves rubbingwarm oils orgelsona person’s skinwitha coin orother flat metalobject. The motherexplains that caogiois usedtoraise out badblood, and improvecirculationand healing. When you touchthe boy’s back withyour stethoscope, he winces in painfrom thebruises. Youdebate whetherornot youshouldcallChild Protective Services andreport the mother.

Questions for Case 2:

Shouldwe completely discount this treatment as useless, orcould there be something gainedfrom it?

Whenshoulda physicianstepin to stop a cultural practice? (If someone answers “when it harms the child” remindthat personthat there issome pain inmany of our medical procedures, forexample, having one’s tonsils removed)

Shouldthe physicianbe concerned about alienatingthe motherandother people of her ethnicity from modern medicine?

Doyouthink that the physicianshould report the mother?

Autonomy Part2

Maintenance of patient autonomy is one of the majorethicalfocuses of physicians. Therefore, a seconddiscussionwas alsoheld that focusedprimarily onpatient autonomy. This discussion alsotook a superficiallook at euthanasia. Forthis discussion, a 58minute video, Dax’s Case (producedby Unicorn Media, for Concern for Dying;produced by Donald Pasquella, KeithBurton ;directedby Donald Pasquella New York : Filmakers Library, c1984)was used. The videotells the story of Dax Cowart, a man who wasseverely burned byan accidental propane explosion. The burns disabledDax, andthe physicians forcedtreatment onhim. Thoughhe survived the treatment, he still arguesthat he shouldhave been allowedtorefuse it sothat he could die. The videois very useful; however, the videos of Dax’s burntreatments are very graphic andthe video shouldbe reviewedbefore it is showntoa groupof students.

Questions:

Inthe video, one of the physicians says that burnpatients are incompetent to make decisionswhenthey first enter the hospitalbecausethey are in such a great dealof pain. However, patients such as Daxcanbe ina great deal of painfor a very long time. In suchcases, what should be done todetermine competence, andwhenshouldthis be done?

Doyouthink the fact that Daxcouldnot see a future forhimself should have beentaken intoaccount whendetermininghis competency? Couldthishave cloudedhis judgment? (He thought that he wouldendup onthe street corner sellingpencils)

Doyouthink that the fact that Daxwas goingtorecover, andhadthe possibility of living a happy life, made not treatingDax like suicide…or murder?What if he didnot have this possibility?

Afterhis recovery, Dax attemptedsuicide.Shouldthe physicians have let him die?Is it ever correct for a doctortoallow a patient to killhimself?

Doyoueverthinkthat it is correct fora physiciantobreak a competent patient’s autonomy? If so, is thisone of thosecases?

Doyouthink that in this case, that the ends justifiedthe means?

Oregon’s Death WithDignityAct:

Students were giventhe twoparagraphs that are foundon the following web page:http://www.nightingalealliance.org/htmdocs/iss_a_p.htm. We thendiscussed the following questionspertainingto the DeathWith DiginityAct.

DeathWith Dignity Questions:

Look at the requirements forthe request.Doyousee any problems with them? (The woman from case 1wouldnot qualify.)

Why would they put inthese guidelines?Shouldtheybethere, if they keepa competent person like the woman above from livingher autonomy? (Is it to protect the doctors so they will not have toGIVE the medication?)

Is there a moral difference betweenprescribing the drugand actually givingit tothe patient? If not, why put inthe rules?

Why do you think theywouldn’t let a personwho is terminally illandinpain with possibly more than6months receive assistance in dying?Say someone isdiagnosed with HIV?

Does the justificationof euthanasia necessarily justify the assistedsuicide of a healthy person?

Doyouthink a weakness of this law is the probability of patients beinginfluencedby familymembers? (Forexample, for financialorotherreasons?)Note: Approximately 60% of Oregonians in 2000said (before they died)that they used the prescriptionat least in some part due tofear of beinga burdenon their family.

The AMA saysthat euthanasia is fundamentally incompatible withthe physician’s role as healer. What doyouthink about this statement?Why should a physician have to be the one whodoes this?

Assisted Reproduction:

This is a difficult subject because it involves reproductive issues.Inourculture, reproductive liberty, the freedom todecide whenandwhere toconceive a childishighly protected, andthiscan make these cases muchmore difficult.

Case 1: There are twotypes of surrogacy.One type involvesa surrogate mother whouses her own eggandcarries the baby forsomeone else. The other type is a “gestational surrogacy”inwhichthe motherhas no genetic tie tothe child she carries. Inthe case presented, a gestationalsurrogate is used.

Awoman, aftera bout withuterine cancer hada hysterectomy(surgical removal of the uterus). Before, its removal, however, she hadseveraleggs removed for possible fertilizationinthe future. Now married, the womanwishes tohave a child withher husband.Obviouslyshe cannot bearthe childherself, so thecouple utilizes a company to finda surrogate mother for them. Thehusband’s sperm is usedto fertilizeone of the wife’s eggs, andis implanted inthe surrogate mother. The couple pays all of the woman’s pregnancy-related expenses and anextra $18,000as compensationforher surrogacy. Afterall expenses are takenintoaccount the couple pays the woman approximately $31,000 andthe agencyapproximately $5,000. Thoughthe surrogate passedstringent mentaltestingtoensure she was competent tocarry anothercouple’s child, after carryingthe pregnancy to term, the surrogate says that she has become too attachedto”her” child to give it up to the couple.A legal battle ensues.

Questions for Case 1:

Inthe United States it is illegaltopaya person for non-replenishable organs. The fear is that money will influence the poor to harm their bodies forthe benefit of the rich. Doyou see a parallel betweenthis case andthis law? Canallowingsurrogate mothers tobe paidfortheir troubles allow poorerwomentobeoppressed?

Does paying the surrogate harm herand/or the child’s dignity?

Is it selfish/conceitedforthis couple towant children of theirowngenetic make-up?If yes, does this changeif you can “easily” have a child? (Note:Over 100,000childrenin the U.S.are waiting tobe adopted. However, most are older, have severalsiblings, orhave specialneeds.)

Ontheirwebsite, theAMA says “that surrogacy contracts[whenthe surrogate uses her own egg], while permissible, shouldgrant the birthmotherthe right tovoidthe contract withina reasonable periodof time after the birthof the child. If the contract is voided, custody of the child shouldbe determinedaccording tothe child’s best interests.” Do yousee any problems withthis? (What’s a reasonable time? In a waycanyoustealthe surrogate’s child?)

One of the mainarguments against the use of surrogate mothers is that carryingand givingbirthtoa childis suchanemotional event that it is impossible todetermine if the surrogate willbe able togive upthe child.Though adults enter intothe contract, the childcould ultimately sufferif a longcustody battle ensues (as it couldin states where surrogacycontracts hold nolegal value, suchas Virginia).With the possibility of such battles, doyouthink it is acceptable for parents touse a surrogate mother?

Doyouthink that if the surrogateis awarded the baby, this couldcause emotionalharm to the child?

Who doyouthinkshouldreceive the child, andwhy?

Case 2:

Amarriedcouple wishes tohavea child; however, the 32year oldmotherknows that she isa carrierforHuntington’s disease (HD). HDisa genetic disorderthat begins showingsigns at anywhere from 35-45yearsof age. Its symptoms beginwithslow loss of muscle control andendinloss of speech, large muscle spasms, disorientationand emotionaloutbursts.After 15-20years of symptoms HDends indeath.HDis a dominant disorder whichmeans that her child willhave a 50% chance of contractingthe disorder.Feeling that riskingtheir baby’s health wouldbe irresponsible, the couple decides touse in vitro fertilizationtofertilize severalof thewife’s eggs.Severaleggs are harvested, and usingspecialtechnology, only eggs that do not have the defective gene are kept tobe fertilized. The physicianthenfertilizes a single egg, and transfers the embryotothe mother. Approximately 9 months later, thecouple gives birthtoa boywho does not carrythe gene for the disorder.

Is this a case of eugenics? “Eugenics”is definedas “the hereditary improvement of the humanrace controlledby selective breeding” (dictionary.com)

Wouldit be acceptable forthe parents toselect for sex as well, orshouldtheyonly select an embryo that doesnot have HD?How wouldthis be different?

Is it ethicalfor this couple tohave a baby whenthe mothercould beginshowings signs of HDwhenthe baby is just a few years old?

With this technology possible, would it be ethicalforthis couple tohave a childwithout genetically ensuring it would not have the disease?What if we didnot have this technology, would it be ethicalfor a known carriertohave a child?(If not, how farshould this carry? a carrierforcysticfibrosis ( whichisrecessive)?)

Weighingeverything we have discussed, doyoubelieve the couple acted ethically?

Universal HealthCare:

The UnitedStates is the only industrializednationthat does not offersome form of universal health care, and eachyearthe numberof uninsuredAmericansis increasing. Many people look toCanada’s healthcare system as a possible means of fixing our current woes. However, some of the fears associatedwith universal healthcare are:

Drug/medical technology companies fearthat they will not make a profit.

There will be a large tax increase.

Quality of care will decrease.

The followingcases andtheir corresponding questionsaddress some of the problems andfears.

Case 1: Amotherbrings herson intothe emergency room during anasthma attack.Though bothof his parents work, theycannot afford medical insurance forthemselves orhim. Theyalso earntoomuchmoney toqualifyfor state orfederalaid.He is treatedfor his asthma attackat the hospitalandheandhis motherleave. Two weekslater, they return to the hospitalina virtuallyidentical scenario.

Questions for Case 1:

Doyouthink that this boyis receivingadequate care?…Shouldn’t he be able tosee a primary care physician before his condition gets soacute that he must visit the ER?

Shouldeveryone be entitledtoa basic “minimum of health care”… ortothe exact same health care?

Doyouthink that healthcare is a right? If so, are we forced to honor this right?

(If studentsanswer”yes” tothe above question)Is this right relative oruniversal? Does this right exist because of the wealthof the UnitedStates, or is it applicable everywhere? Is healthcare a luxury?

Does having money entitle a person tobetter health care? (theymay have workedharder for theirgreaterwealth)

Case 2: An uppermiddle class, middleaged, Canadian manis playing racket ball when he suddenlyfeels a pop inhisknee.Inpain, he makes anappointment with his general practitionerandis seenthe next day. He is givenpainmedication, andis referredtoan orthopedic surgeon(he has no choice of whohe will see). Aftera weekwait, he is seen bythe orthopedic surgeonand is toldhe willneedsurgery.Two weeks later surgeryis performedonthe man’s knee.The physician, whois not very good, does a poorjob on the knee, andthe manwalks witha slight limp for the rest of his life.The surgery costs the man nomoney directly, however, hepays forit withhigher taxes.

Questions ForCase 2:

What doyouthink of this man’s experience in comparisontocase 1?Whichsituation seems worse, andwhy?

Does it seem like it tooktoo long for him to receive care? (The physicians will perform surgery on the more urgent patients first andthenon the less serious.)

What doyouthink about not beingable tochoose your ownphysician?(Note: In the UnitedStates, many insurance companies limit whichphysicians you choose.)

One suggestedsolutionforour current healthcare woes is that care for the elderly be decreased/eliminated. Forexample, people over the ageof 80will nolongerbe placed onlife support, which costs approximately $10,000perdayto operate. What doyou think of this?

What doyouthink could be a good middle groundsolutiontothis problem?

Response ToBio-Terrorism

The possibilityof terrorists usingbiologicalweapons on the citizens of the UnitedStates has beena majortopic inthe press forthe last severalyears. Smallpox has been speculatedtobe the perfect biological terroragent because of the potency of the virus, andbecause of the lack of herdimmunity present in the US population.The following case presents a possible way in whichthe virus couldbe releasedin the populationand a possible response. The questions followingthe case involve the ethics surrounding the government’s response.

SmallpoxFacts:

Smallpoxinitiallyhas flu-like symptoms, which are recognizable 7-19days after exposure.After 2-4days of flu-like symptoms, the fever begins todecrease, and pox will form.

An infectedpersonis contagious one day beforethe characteristic pox appear.

Approximately 30-50% of unvaccinated people exposedtosmallpoxwillcontract the disease.

The mortality rate forsmallpoxwas approximately 20-40%.

The vaccine that was used was approximately 90% effective.

It is possible that if terrorists were to use the smallpoxvirus, that they wouldgenetically modifyit.If this werethe case, then thevaccine maynot prevent all of the disease symptoms for those vaccinated.

Facts gatheredfrom:http://www.vbs.admin.ch/ls/e/current/fact_sheet/pocken/

Case:

Date: June 22, 2005. A 27-year-oldmanis brought intoa New York City emergency room witha 101-degreefever, and what he believes is chickenpox(Varicella). After a brief examination, the 35-year-old physician is puzzled because the pox donot appear to be typical of the varicella-zostervirus.Worried, he calls inanother physician forher opinion.She takes one lookat the patient, determines he has smallpox, and immediately orders him tobe quarantined.She notifies the Centers forDisease Control andPrevention(CDC)and asks them what shouldbe done. While doing backgroundon the patient, he tells the physicians that he is a flight attendant and that he has flowntoOrlando, FL, Los Angeles, CA, Chicago, IL, and Seattle, WA in the past few weeks while working. Thoughhe is given excellent treatment, and hadbeen inperfect healtha few days earlier, the patient dies7 hours after admittance to the hospital.

The CDC decides that mandatory smallpoxvaccines willbe administeredto allworkers inthe NYC hospital, and toall patients whowere inthe ER.His co-workers are allgiven mandatoryvaccines as well, as are all people livingin his apartment complex. They also shipstored quantities of the vaccine to allof the cities where the manhadflown to for work. The vaccines are offered tocitizens of these cities. Finally, allpeople, alongwith their families whohad beenonthe man’s flights in the weeks preceding the appearance of the disease are forced toreceive the vaccine.

Questions: Note:Theflight attendant was most likelygivensmall pox bya bioterrorist who flew on his plane sometime during the past week/week and a half.The terrorist would have been contagious but would not have shown symptoms.Virtually everyperson theman came intocontact withwould have gottenthe virus.

Is it ethicalfor the CDC to force people to get the vaccine?

An LA womanonthe flight is religiouslyopposed tovaccines.Under California law she can normally refuse vaccines on religious orpersonal grounds. However, the government says she must receive the vaccine orface mandatory quarantine. What do youthink of this?

Doyouthink that formore common diseases, for example measles, that it is ethical for the state toallow people torefuse vaccines(even forreligious grounds)? What if their refusalcanharm others whocannot have thevaccine, suchas people who are immunocompromised like AIDS patients?

Is it ethicalfor someone to refuse the vaccine?

You haddrivendown to Los Angeles 5 days ago to visit a friendforthe weekend. While intown, youvisited manytourist attractions. Youare worried andyoutry toget the vaccine, but are deniedit because of limitedresources.What do you think of this?

Citizens begincallingfor the mandatoryquarantining of people directly exposedto the victim, i.e those livingin his apartment complex, those workinginthe ER, those who flew onthe plane inthe prior week.What do you think of this?

The smallpox vaccine, like many othervaccines (example: oralpoliovaccine) can actuallytransmit the virus to others. In light of this, is it ethicalfor people toget the vaccine? (Note: they are vaccinatingthose whomaynot want tobe vaccinated)

Today, shouldhealth care workers be allowed/forced to get the smallpox vaccine?What about non-health care workercitizens?