Morality of the Code for the Pharmaceutical Quiz

In this case analysis, we review the article The Code I’m Still Ashamed Of, by Bill Sourour. Bill started coding at a very young age and was mentored by his father. At the age of 21, Bill found himself coding full-time for an interactive marketing firm in Canada founded by a doctor. Not only was it founded by a doctor, but many of its clients were pharmaceutical companies. Canada has strict laws about advertising prescription drugs; therefore, websites with general drug information are created, and companies get creative about how they market-specific drugs to a target audience (Sourour, 2019).

Sourour was hired to code a quiz that directly targeted teenage girls. The girls would answer questions, and the site would recommend a specific drug or type of drug based on their answers. Unfortunately, no matter the answers, the quiz was coded so that the client’s (pharmaceutical company) drug would always be the recommended drug. This particular drug had side effects which included suicidal thoughts, and Bill would later find out that there had been teenage suicides, which may have been linked to the drug. Sourour later resigned from that job after realizing the company’s unethical ways and looking inward at his ethical responsibilities (Sourour, 2019).

In this Case Analysis, I will argue that Confucianism shows us that the code was morally problematic because it targeted a specific group of individuals, used deceptive and misleading marketing, which led to harm or potential harm to the user; therefore, Sourour should have questioned the coding project further because of the potential harm to the general public.

Codes of Ethics

In a review of three different Codes of Ethics, the National Society of Professional Engineers (NSPE), the Institute of Electrical and Electronics Engineers (IEEE), and the Association of Computing Machinery (ACM), it is noteworthy that they all have many codes of ethics in common. I will focus on ethical codes relating to safety and welfare for this assignment. The members of IEEE commit themselves to high ethical standards, with the first one being to “hold paramount the safety, health, and welfare of the public to disclose promptly factors that might endanger the public or environment” (IEEE).

Similarly, NSPE’s first ethical code is also to “hold paramount the public’s safety, health, and welfare.” NSPE goes further by saying that if an engineer reports to their employer or client, their judgment of a job/contract to be risky or “endanger life or property, and they are told to complete the job regardless, then it is the ethical duty of the engineer to notify employer/client and other authority deemed appropriate (NSPE).

ACM also highlights health and safety in their first two general moral imperatives. In section 1.1, “contribute to society and human well-being,” members must “minimize negative consequences of computing systems.” Those negative consequences include threats to health and safety. Section 1.2, Avoid harm to others, further elaborates on the first section; however, it concentrates on “harm” relating to negative consequences, such as loss of property, environmental harm, or property damage (ACM, 2018).

Professionals must make all attempts to avoid potential negative consequences. Even if harm is unintentionally caused, the responsible parties must do everything they can to fix the problem or mitigate the problem, causing negative consequences. While this section mainly focuses on “harm” being related to everything but personal injury, it narrowly includes one sentence that references the words “resulting injury” when explaining the responsibility of professionals not misrepresenting system features to users, coworkers, etc. In this same section, the imperative indicates that the computing professional must report any possible system dangers that may potentially lead to “serious personal or social damage.” If supervisors or higher-ups do not act accordingly, whistleblowing may be necessary to avoid or reduce risks; however, one must be extremely careful when reporting violations, as they could also be harmful if a full assessment of the risk is not conducted (ACM, 2018).

When thinking about the Codes of Ethics from each of the three membership associations, they include the prevention of harm to the health, safety, and welfare of users, the general public, employees, or employers. Some may allude to the fact that a marketing company founded by a medical doctor, who is working with large pharmaceutical companies, should have been a red flag from the start if the coder’s work involved medication; however, this would probably be considered biased based on societal opinions of the doctor/prescription drug industry.

As for computing professionals, ethical code 1.2 in the ACM’s Code of Ethics, it is their job to assess whether a system feature, such as the quiz and all answers leading back to the same drug, is misrepresented to the user, primarily since they would be held responsible should there be injuries resulting from their work. In that same ethical code, 1.2 also references that computing professionals are “obligated” to report potential risks or harm. Sourour did question the quiz requirements, and his project manager questioned the quiz itself; however, Sourour, at that time, stated that it was the requirements he was given, and he left it at that.

Although Sourour was completing his assignment or contract and making sure it worked accordingly, which is part of the ACM code 2.6, Honoring contracts, agreements, and assigned responsibilities, I believe that Sourour should have questioned the quiz results leading to the same recommendation, further with the client bringing up “what-if’s” concerning the marketing of the same drug despite the answers given. This possibly may have led him to look at the side effects. Suppose this was done, and his superiors did not attempt to undo or change the quiz features.

In that case, it may have been a moment where whistleblowing may have been needed if he believed the drug’s main side effect, which was suicidal thoughts, was a significant risk to the public. I also think that going to dinner with the client went against ethical code 2 in the IEEE’s guidelines, which states that members should “avoid real or perceived conflicts of interest whenever possible.” This pharmaceutical client took him to dinner for a job well done, but the job was geared entirely in their favor and did not consider the user’s health, safety, and welfare. It was as if they were thanking him for making them rich while they knew the dangers of the side effects.

Armstrong

Mary Beth Armstrong researched and wrote a comparison of confidentiality across several professions, including accounting, engineering, and medicine. In this paper, the author examines the importance of ethical confidentiality codes vs. public safety and welfare. Armstrong explains how professional knowledge and monopoly in specific fields lend themselves to having too much power, leading to possible harm to others (Armstrong, 1994). Armstrong is adamant that professionals should be using their knowledge to protect or benefit society instead of causing harm (Armstrong, 1994).

Decades ago, keeping a client’s secrets and upholding one’s confidentiality were considered the highest ethical standards for professionals. Some believed that confidentiality and loyalty were in the public’s interest because the public would know that professionals could be trusted. Prima facie duty recognizes utmost confidentiality among clients/patients; however, when and if the prima facie is challenged, it is usually due to the notion that keeping confidentiality may harm others. Although confidentiality is looked like a prima facie, it is not and cannot be upheld no matter the circumstances. Armstrong examines several cases under the law which helped slowly change the code of ethics in certain professions and lean more toward protecting the health and safety of the general public as the top priority of a professional’s responsibility (Armstrong, 1994).

When looking at the engineering profession, Armstrong noted the change in the code of ethics over the years. In 1912, the first official ethical guidelines noted, “protecting a client’s or employer’s interests his first professional obligation” (Armstrong 1994, p. 80). In 1947, a small change was made to add “public” in the wording of ethical guidelines, which said that professionals had a duty to include public interests when carrying out their interests; however, it was not until 1974 when the ECPD Canons of Ethics stated this specific wording in their guidelines, “Engineers shall hold paramount the safety, health, and welfare of the public in the performance of their professional duties,” (Armstrong, 1994 p. 81). This is the language noted in several of the codes of Ethics studied in the first part of this assignment.

Similarly, the American Association of Engineering Societies (AAES) noted that engineering professionals should first alert their client/employer of any risks (now or future). If they did not mitigate, the engineering professional should “consider” alerting those higher up. This was left open for the engineer to decide if they should and whom the higher-ups may entail (board members, police, etc.). Though more protected than in previous years, whistleblowing is still dodgy for some professionals because they may lose their jobs, depending on the situation. They may be vindicated publicly but still have a hard time finding work in their field as client’s/companies may look down upon them as not being loyal, despite their ethical responsibilities (Armstrong, 1994).

When applying these concepts to the Sourour article for our case analysis, we must make certain assumptions. The article did not include details of whether the client knew that deaths had already been occurring and what, if anything, he did Sourour do, other than resigning his position. Given the concepts discussed in the Armstrong article, I will discuss his ethical obligation to include possible whistleblowing. Sourour knew that the quiz was coded and rigged to send users the same drug marketing information despite their answers. This should have raised an ethical red flag or at least a reason for him to question the assignment further. Upon finding out about the death of the teenage girl and his sister being on the medication, according to the concepts in the article, he was bound by ethical principles to express his concern for public health, safety, and welfare, to his client, giving them the change to mitigate such harm. If they did not attempt to mitigate, or if it was not done in a fashion that Sourour felt was protecting the public from harm, he should have taken it further. This could have been to the board if the company had one, the ethical associations he may have belonged to, or possibly even the authorities.

When looking at Confucianism, Sourour displayed aspects of following directions in his job, just the way his father was brought up to do, when he was being taught code from such an early age. He was following through on the work ethic of completing his coding assignments. However, as he matured into adulthood and learned the world’s ways (this is my assumption based on my approach from working in computers from my younger years to now being 22), he started to question situations that felt morally not right. He questioned the lack of requirements about what to do with the quiz answers. This was the right thing to do; however, he did not question all users’ answers defaulting to the same drug. I realize he is not a doctor and may not have known the side effects of the drug but based on the Armstrong concepts and Confucianism (the path he was on at that time), he should have looked at the immediate and future harm of the project and been ethically bound both to question and report the potential harm/dangers. Following through on the assignment could be considered Confucianism because that is the work ethic taught by his father from a young age. However, now that he is a professional, he is bound by ethical codes to look at it further if it could harm others. In the end, he did get his sister to stop taking the medication, and he did resign his position, which I believe would both fall under doing the right thing based on that moment or that path he took; however, I believe he should have done more (unless he did, and it was not highlighted in the article).

Conclusion

In conclusion, the client and subsequent quiz were problematic because it targeted a specific population and defaulted to the marketed drug, no matter the answers given by the user. The drug’s significant side effects were suicidal thoughts in users, thus should have been looked at as a risk because it led all users to this drug website. Although Sourour resigned his position after he had finished and learned of the teenager’s death, I feel Sourour should have questioned the quiz answers leading back to one single product and the possible harm that may have on the public. If his client did not attempt to mitigate the possible harm to the users, then Sourour may have had to take it further, possibly a whistleblowing situation.

One could argue that he is not a medical professional and did not understand the side effects or know the side effects. When researching the ethical guidelines, I admit that I thought of this as a possible excuse or reason; however, I also take medication and am aware of side effects; therefore, I feel one can connect possible conflict of interest just by knowing the quiz leads back to only one drug. It may, at very least, make Sourour question it further. From reading the Code of Ethics, I am also aware that he would have to have almost certain proof that it may have caused harm to others before taking his concerns further, such as whistleblowing. I agree with this; however, if he had first questioned the quiz further, that may have led him to research on his own the medication, which may have led to further knowledge coming to light about side effects and deaths related to the medication.

References

ACM. (2018). ACM Code of Ethics and Professional Conduct. Code of Ethics. Retrieved March 20, 2022, from https://www.acm.org/code-of-ethics

Armstrong, M. B. (1994). Confidentiality: A Comparison across the Professions of Medicine, Engineering and Accounting. Professional Ethics, 3(1), 71–88. https://doi.org/https://odu.voicethread.com/lti-student/1145492/

IEEE. (n.d.). IEEE Code of Ethics. IEEE. Retrieved March 20, 2022, from https://www.ieee.org/about/corporate/governance/p7-8.html

NSPE. (n.d.). NSPE Code of Ethics for Engineers. Code of Ethics | National Society of Professional Engineers. Retrieved March 20, 2022, from https://www.nspe.org/resources/ethics/code-ethics?gclid=CjwKCAjwoduRBhA4EiwACL5RPw23nYLJ__Gw4hEnkI27R7WeRVU2EhsNytUsNZ91nXFa4RmInmcrTxoC0_0QAvD_BwE

Sourour, B. (2019, June 3). The code I’m still ashamed of. freeCodeCamp.org. Retrieved March 20, 2022, from https://www.freecodecamp.org/news/the-code-im-still-ashamed-of-e4c021dff55e