As a computer programmer employed by a hospital with a very large organ transplant program, I have the task of computing the life-table statistics on our transplant patients. The surgeons who do these operations are very competitive, and are as anxious as athletes to have good numbers, because good numbers mean professional prestige and money. Moreover, the success of the transplant program is judged not only by the United Network for Organ Sharing—the agency that matches available organs with patients waiting for them—but by the health insurance companies, which direct patients into one program or another.
Wanting to be conscientious about my work, I studied the relevant federal guidelines on statistical reporting. On a number of key points the methods of reporting the surgeons have been using do not conform. There are many ways to “sandpaper” statistics, and while the surgeons are not exactly lying, they are hardly being candid. As a result, the statistical reports I generate are deceptive—they make the hospital’s program look more successful than it is.
At a meeting yesterday afternoon with the surgeons and the hospital administrator, I brought this matter up. Everybody admitted that the methods used diverge from the guidelines and result in deceptive reports, but they were unanimously against changing. The surgeons’ response, basically, was: It is our business to provide the data and yours to compile the reports; don’t worry about the guidelines and mind your own business. The hospital administrator argued that competing programs at other hospitals also diverge from the guidelines. I do not have any firsthand knowledge about that, but have no trouble believing it, since there must be similar motivations and opportunities to deceive everywhere.
May I do as I have been told and go on compiling these deceptive reports? If I refuse, I am sure to be fired, probably for insubordination, and given a negative recommendation. Even so, there is a lot of demand for programmers, and my previous record is good enough that I could expect rather quickly to get another job without these problems, though probably with fewer benefits than I have now. Also, the hospital administrator will have no trouble finding a programmer to do things his way, since most programmers have no qualms about using whatever data are given them, just as most secretaries do not hesitate to type up whatever the boss dictates.
This question concerns cooperation in deception. The administrator’s argument that reporting by other programs also diverges from the guidelines at best claims that diverging from the universal practice in reporting would make the hospital’s transplant program appear comparatively less effective than it really is. But even so, life-table statistics on transplants as a whole would seriously mislead potential recipients, referring physicians, and others unaware of the practice. If the questioner must intend to bring about the deception or certify that the methodology conforms to the guidelines, he or she formally cooperates in the wrong and must refuse to continue doing so. Otherwise, the cooperation is only material and under certain conditions would be morally acceptable. However, since the questioner expects to get another adequate job very easily, he or she almost certainly ought not to continue following orders and, in my judgment, should try to bring an end to the deception.
In answering your question, I first shall explain why programmers sometimes should have qualms about using the data supplied them. Then I shall clarify the reality and gravity of the surgeons’ deception, discuss your involvement, and suggest what you should or might do.
At the Last Supper, Jesus said to his apostles: “You are my friends if you do what I command you. I do not call you servants any longer, because the servant does not know what the master is doing; but I have called you friends, because I have made known to you everything that I have heard from my Father” (Jn 15.14–15). While Jesus’ work and his apostles’ cooperation in it were unique in their character and importance, the relationship Jesus established with his apostles provides a model for the relationships between superiors and subordinate workers in any situation. When workers and superiors are “friends,” their community can realize human and Christian values that would be impeded or entirely blocked by a master-servant relationship.
The computer programmer and secretary who know what their “master” is about can look toward the ulterior end of their work. Provided the enterprise is morally sound, they can intend the benefits not only of their personal contribution but of the enterprise as a whole for the people it serves. Understanding and intending these benefits, workers who are their superiors’ “friends” need not follow orders blindly but are able to adjust their work when necessary so that it effectively serves its real purpose. The work then has more meaning for those who do it, and gives them greater personal fulfillment and psychological satisfaction. Most important, however, is that such workers, their superiors, and the people the enterprise serves can form a true community pursuing a common good and willing one another’s benefits through sharing in it.
Friendship, of course, depends on mutual good will; workers cannot unilaterally establish it. In conscientiously studying the federal guidelines for statistical reporting, you looked beyond the technical goal of programming to the real benefits to which it should contribute; you were not thinking as a mere servant. From what you say, it seems that, when the surgeons told you to mind your own business and forget about the guidelines, they were telling you to be a mere servant. Christians, however, finding themselves involved in injustices to others, should resist and try to overcome them, not simply resign themselves to them. You rightly have qualms, since your work should serve the survival and health of transplant patients.
The hospital administrator’s argument that reporting by competing programs at other hospitals also diverges from the guidelines can be interpreted in two ways.
He might be granting that the life-table statistics on the hospital’s transplant program really are deceptive but assuming a patently false premise—for example, “A common practice cannot be wrong” or “Competitors need be fair only to one another.” Such an attempt at justification obviously fails.
However, he might be making a more interesting claim: that the common practice in reporting, not that specified in the guidelines, must be followed in order to provide an accurate statement of the comparative success of the hospital’s program; otherwise, it would be measured by higher standards than those used to measure other hospitals’ programs. The result very likely would be that both the United Network for Organ Sharing and the insurance companies that direct patients into programs—not to mention potential financial supporters—would at times mistakenly prefer other hospitals’ programs. If this is the administrator’s argument, it attempts to show that the life-table statistics accurately assert the success of the hospital’s transplant program relative to competing programs.
However, the argument depends on the premise that reporting by all the other competing programs diverges from the guidelines to the same extent this hos~pital’s does. It is hard to imagine how the administrator could know that, though he may well have anecdotal evidence about similar deception by some other places. More important, even if the argument is sound, it fails to justify a practice that makes all transplant programs seem more successful than they really are. For choices are made, not only among transplant programs, but between seeking a transplant and not seeking it. Potential patients and the physicians who refer people to transplant programs compare the burdens and benefits of such treatment with those of alternatives, including palliative care until the death that even the most successful transplant can only postpone. Consequently, overly optimistic statistical reports seriously mislead at least some people who are considering transplants and their referring physicians, as well as the programs’ supporters. This deception is gravely evil. It defrauds at least a few patients of the alternatives they would have preferred had they and their physicians been accurately informed, and imposes the very substantial costs of transplants that otherwise would not be chosen on those who ultimately pay them, namely, others paying insurance premiums and/or the taxpayers.
How are you involved in this gravely evil deception? If you had to adjust your procedure in order to make the hospital’s program seem more successful than it is, you would have to intend the deception. Likewise, if you asserted that the guidelines were followed in gathering the material for the statistical reports you generate, as an auditor certifies that appropriate accounting procedures have been followed in auditing a financial statement, you would make a false assertion. In either case, while not sharing all of the surgeons’ and/or hospital administrator’s purposes, you would share their immediate purpose of deceiving, and so participate fully, even if reluctantly, in the deception. If so, you would be obliged to refuse to do your job, regardless of the consequences.
However, your statement of the problem suggests that, even knowing what you do, you need not share the purpose of deceiving. You do your work, I take it, just as you would if the surgeons were entirely candid. I assume you are not expected to certify the accuracy of your reports. On these assumptions, it seems to me that, while your work helps bring about the deception, you do not intend it or choose to do anything so as to bring it about, and you might rightly do as you have been told and continue compiling the deceptive reports. That surely would be so, I believe, only if three conditions were met: (1) you needed your job to fulfill your responsibility to support yourself and your dependents; (2) your refusal would result in your being fired; and (3) the deception with all its bad effects on patients most likely would continue even if you gave up the job.
You say, though, that you expect to get another job quickly, even if you are discharged for insubordination and given a negative recommendation. This prospect certainly requires you to consider alternatives to doing as you have been told. Indeed, I believe that you almost certainly should adopt an alternative. I shall sketch out some, though you very likely will think of variations.
First, you might simply resign and take another job where you could use your talents to provide people with real benefits and there would be a better prospect of being your superiors’ friend rather than their servant. This would minimize your personal sacrifice, since it would be unlikely to provoke your present employer and would free you from trying to end the deception.
However, if you think there is even a remote chance of persuading the hospital administrator and/or the surgeons to change their minds, I think you should take that chance out of concern for their souls and fairness toward those the deception harms. In that case, a second alternative seems the least you should do: Tell the hospital administrator you have decided not to continue compiling deceptive reports, explain your reasons, and ask him to cooperate with you in ending the deception. The focus of your argument should be on the deception’s unfairness to patients and those who pay for transplants, the real harms they suffer, and the betrayal of professional responsibility by both him and the surgeons in preferring their own interests to the interests of those they promised to serve in undertaking their professional roles. In making it clear to the administrator that his attempted justification fails, you need not question his claim that competing hospitals do the same. Rather, you can challenge him to use the information he has to work for broad reform by demanding that his counterparts in other hospitals cooperate in ending the deceptive practice. You might communicate with the administrator along these lines without resigning. But if you judge that such an appeal almost certainly would result in your dismissal, you might consider it preferable to resign, using the occasion to bear witness to the truth about the deception and exhort those responsible to reform.
If the deception is not ended, you probably should bring it to the attention of outsiders. Doing that probably should be your last resort, unless it appears that first speaking directly with those responsible would hurt its chances of succeeding or involve serious risks to you. Various outsiders could be approached. You might urge the relevant federal authorities to investigate the practice of deceptive reporting and take steps to correct it, ask federal and state prosecutors to explore the possibility that those responsible for the deception are violating criminal laws, inform at least the major insurance companies concerned and the United Network for Organ Sharing, and/or inform relevant consumer groups or the public media.
While pursuing such alternatives no doubt would be burdensome to you, you would be carrying out your responsibility as a Christian to bear witness to the truth and share in Jesus’ struggle against the Father of Lies. If your efforts succeeded, those wronged by the deception would be benefited. Even if they failed, your love for those neighbors would not be pointless, since it would contribute to your own sanctification and prepare material for the kingdom (see GS 38–39).