The Ethical Dilemma of John Q

Ethical Analysis: John Q

The film John Q (2002) depicts the struggle of a father whose 9-year-old child needs a heart transplant the family cannot afford, and who lacks the insurance coverage to ensure his child can have this lifesaving surgery. John Q. Archibald holds an entire hospital staff hostage (including its administrator, physicians, patients, as well as the ER staff) to demand Michael is put back on the transplant list and continues to receive the care he needs to survive. This paper will analyze the extreme choice Archibald makes to preserve his child’s life from the paradigm of virtue ethics.

Ethical Analysis

Virtue ethics is one of the three major ethical paradigms in philosophy. In contrast to utilitarianism or consequentialism (which emphasizes that ethical decisions should be analyzed from the perspective out outcomes) or deontology (which emphasizes following ethical norms or rules) virtue ethics stresses the need to honor moral virtues in ethical decision-making (Hursthouse & Pettigrove, 2022). Virtue ethics stresses the need to uphold the correct virtues when undertaking specific moral actions.

The film highlights the ethical quagmire that is for-profit American medicine. On one hand, as a parent, Archibald is upholding the moral action of preserving his son’s life at all costs. He is standing against a system which is putting profits ahead of helping people. On the other hand, the virtue of preserving life and showing benevolence to patients is not upheld by putting hospital staff and other patients at risk. Although Archibald is depicting as releasing some hostages who are very sick, this does not discount the significant trauma to which he subjects the entire ER, not just the persons responsible for his situation. The fact he prevents other individuals from receiving care, as well as does psychological damage to them, cannot be overlooked.

On the part of the physicians themselves, medical ethics specifically holds that they must honor ethical virtues of fairness, honesty, judgement, kindness, leadership, and teamwork (Kotzee, Ignatowicz, & Thomas, 2017). In this scenario, the physicians must not just consider the fate of Archibald’s son Mickey, but of all patients. Even if the system of medical insurance and funding patient surgeries is not what they necessarily believe in, they cannot treat each patient with the same love and care as they might if that patient was their own child. They are honest with Archibald regarding his son’s prognosis.

On the other hand, not all the actors Archibald holds hostage are seemingly so blameless. For example, administrator Rebecca Payne puts profits over people in her statement that if Archibald cannot put down a $75,0000 payment towards his son’s surgery, she is willing to allow the child to die. From Payne’s utilitarian perspective, the hospital must stay in business and help the maximum number of people possible, versus focusing on the life of one child (Dimmock & Fisher, 2017). Payne also insists that patients must honor financial obligations, or use insurance (even if the Archibald’s lack of insurance is due to an oversight, rather than deliberate), as the hospital could not be solvent for long in doing so. Even if the American system of for-profit medicine may not be fair or uphold higher virtues such as benevolence to a sick child, there is a finite limit to the extent to which hospitals can offer unquestioning charity to all for such expensive medical procedures.

Further questioning the virtuous moral underpinnings of Archibald’s actions is the fact that he does not undertake other potential actions that might be less injurious to others. For example, he could take his case to the news media, given how sympathetic his position might be. He could try to fundraise, asking charities to offer him financial assistance. Furthermore, given that taking an entire hospital hostage does not necessarily mean, even if they agree to his terms, that his son will be cared for properly afterwards, this does not necessarily promote the virtuous ideals of what is known as eudaimonia, or well-being for either his son, his family, or society (Hursthouse & Pettigrove, 2022). Even from the child’s own perspective, knowing that his survival required his father to be imprisoned and to give up his own life does not necessarily promote long-term happiness.

Judged in terms of the extent to which it promotes happiness, the father’s judgement seems flawed. On the other hand, so is the hospital’s, given that they too must be found lacking in their lack of meaningful attempts to help a family in need afford a life-saving surgery. The hospital could have worked with the Archibald family, and offered more extensive advice about insurance that would have enabled them to afford their son’s surgery and care. For example, the Children’s health insurance program (CHIP) (2022) offers funding to families for children’s healthcare which do not qualify for Medicaid, the federal poverty health insurance program, which still lack adequate coverage.

The hospital clearly fails in its virtuous obligation to do due diligence and act as an agent of preserving health, and one of the ways in which values are judged under the umbrella of virtue ethics is the intention behind the action. In this, Archibald’s actions seem far more virtuous, given he is motivated by a desire to help his son, even if virtue ethics would still question his relative lack of regard for preserving the lives of others. Both parties thus fail considering virtue ethics underlines the value of allowing human life to flourish, even though Archibald does show occasional compassion to others not in his family, including releasing the sickest prisoners (Hursthouse & Pettigrove, 2020). The film’s great plot revelation depicts Archibald’s true moral underpinnings by stating that he ultimately was not going to kill anyone except himself, if the hospital did not perform the surgery, and would donate his heart to his son in such an action. Still, this does not fully erase the harms done to patients (both psychological as well as physical).

Consider this from yet another virtue ethical perspective, that of a Rawlsian one: “…principles, famously, are derived from an ‘original position’ in which (very roughly) rational contractors under a ‘veil of ignorance’ decide how they wish to commit themselves to being governed in their actual lives,” in other words, rules should be determined as if the rule-setters had no idea what roles they would eventually play in the ethical scenarios, as they played out (LeBar, 2020, par. 3). Archibald would likely not justify every single person holding an entire hospital hostage if they did not like the financial and ethical decisions of their insurance companies and the hospital administrators.

On the other hand, the administrators would likely not have taken such a cold, ethical calculus in determining whether to perform a surgery or not or set a deadline for a down payment for a life-saving surgery, if one of their own family members’ lives was at stake. The film suggests this perspective finally gains some validity in the eyes of the administration, as Payne agrees to add the child’s name to the transplant list, despite Archibald’s inability to come up with the $75,000 immediately. The film ultimately suggests that there is room for compassion and virtue in offering mercy to others, even if it does not validate Archibald’s violence. Utilitarian calculus is not a way to govern society anymore than pure emotionalism (LeBar, 2020).