Bioethics Forum Essay
Ethics at the Chocolate Factory
Recognize the scene? Lucy and Ethel at the chocolate factory is a classic episode from the 1950s television program I Love Lucy. It is also a good illustration of how people make rapid judgments in response to changing conditions at work, devising workarounds – shortcuts, fixes, patches – to bridge the gap between the rules of work and what’s actually happening. When I give talks, usually to physicians, nurses, and other health workers, about the ethics of workarounds, I often use this clip, in part because it’s fun to have four minutes of nonstop laughter during an ethics lecture, but mostly because shows how workarounds happen.
Thanks to research from cognitive neuroscience and behavioral psychology, synthesized by Daniel Kahneman and others, we now understand that “fast,” instinctive thinking and “slow,” reasoned thinking are both part of how we think, and that fast thinking occurs so quickly that we may not recognize what’s going on, or that we’re ruling out options as we make choices under pressure. When Lucy and Ethel notice that the conveyor belt has sped up and that unwrapped chocolates are sliding past them, putting them at risk of being fired, they devise a workaround: grabbing the chocolates off the belt, and eating them, or hiding them under their hats or in their bras. What options do they rule out, or fail to see? They don’t open the door marked “Kitchen,” where the chocolates are coming from, to find out if the belt is malfunctioning. They react to what is directly in front of them. There is a short-term reward for their ingenuity: when the supervisor comes back, having stopped the belt for an inspection, she praises Lucy and Ethel. Deciding that these “fine” workers are capable of even greater productivity, she orders the unseen belt operator to “speed it up a little!” Their doom is sealed.
Social psychologist Jonathan Haidt’s “social intuitionist” model of how people make fast, intuitive moral judgments and then persuade others that these judgments are correct, reinforcing the first person’s intuition, helps to explain what’s going on at the chocolate factory and in other workplaces. (See chapter two of Haidt’s book The Righteous Mind for a useful diagram of the social intuitionist model.) An event – here, the belt speeding up – triggers an intuition that the rules they’ve been given no longer work. (“Listen, Ethel, I think we’re fighting a losing game!”) Next comes a judgment about the right thing to do: devise a workaround. Lucy and Ethel never even get to the next step of Haidt’s model – coming up with post-hoc reasons to justify their quick judgment – as they persuade each other, by their actions, that what they’re doing must the right thing to do.
Health care workers frequently describe powerful moral intuitions (what we’re doing to this patient is harmful, or unfair, or simply, doing this feels wrong) that arise amid the constant pressures to manage the flow, get the job done, do more with less, and keep the customer satisfied. Peter Ubel has proposed that Haidt’s model should be applied to ethics education in medical schools; less about moral principles, more about moral psychology. Ubel, a physician and behavioral scientist, is not arguing that principles and other rules aren’t important, but rather that – like Lucy and Ethel in the chocolate factory – health care professionals will confront situations that don’t fit the rules, and will, because of how thinking works, tend to make quick judgments, devise quick fixes to accommodate problems, and look to their peers for reinforcement. Remembering that Lucy and Ethel’s fix looked fine to their boss, who rewarded them by making their job even more of a losing game, we also need to apply these insights to organizational ethics.
Nancy Berlinger is a research scholar at The Hastings Center and the author ofAre Workarounds Ethical? Managing Moral Problems in Health Care Systems, which will be published by Oxford University Press in December. This essay originally appeared on the OUP blog.
Posted by Susan Gilbert at 10/22/2015 02:57:32 PM |