A subtle shift of a dilemma
EVERYONE is capable of an ethical dilemma, with a little flexibility of definition.
This dilemma arose in a man recently released from prison. His crime had been violent -though, he said, the fault of the other guy. Few of his problems were his fault, including his years of substance abuse. Now he was living in the prison release sober house; a state program that provided three months reacclimatization to the heady air of freedom. The arrangement, though without bars was not without constraint: It required him to submit urine toxic screens every week. Positive results for alcohol or drugs were cause for holding weekend passes. This is reasonable to anyone who has been a parent; when the state is paying to house you, dad wants to make a few rules.
He had a daughter, she was turning 7, living with her mother. She was the heart of his heart - though the mother was a complainer - and lately, only one thing had been on the girl's little mind: her birthday party. A pony seemed to be involved, and time in the pool. Hubbub and anticipation. She wanted him there, and he was going. He wouldn't disappoint her.
A few days before the date, he dropped by the clinic. There was a problem. He had gone to an Emergency Room for an enigmatic back condition the night before; they had given him medication. He didn't realize what was in the painkillers, he said, until after swallowing them. The pills hadn't helped, and now there were opiates in his system.
If the weekly toxic screen tested positive, his pass to the party would be pulled and the heart of his heart would be broken. If he left for the party without giving any toxic screen, he would be violating house rules, which risked eviction. If he refused to give a toxic screen altogether, his pass would be pulled without question.
To be honest, he said, the crux of the matter was this: He was unsure how long these opiates stayed in the bloodstream (we were not about to tell him). They might be gone, but he couldn't count on that. He was at the mercy of pain, it wasn't his fault, but already a few disagreements with staff since moving in had caused them unfair vigilance towards him. They would never believe his story (neither did we). He had come for advice. This was a mental health clinic, wasn't it? Well, he was going crazy.
It was an interesting dilemma. Here was someone struggling, manifestly, with matters of truthfulness, disclosure, and priority-setting. But of course - sociopathically speaking - he was struggling with what he could get away with. It was not subtle. A classic sociopath makes you weep for his poverty while he is easing the wallet from your pocket. The best practitioners are almost impossible to recognize in their handsome sincerity and belief in themselves. He was not one of the best practitioners; we did not feel at all badly about his poverty. He knew what he was doing when he swallowed the pills.
But as the meeting went on, we started to feel badly for his little girl, who wanted him pony-side. Why should she suffer? We found ourselves preoccupied with the drama this was about to create for her. His motives were murky, while hers were straightforward. There had to be a way to make everything come out cleanly, for her happiness. We began to think about it.
And thus, without any seeming transfer of weight, the dilemma shifted from his shoulders, off and onto ours. While we pondered how to resolve the problem in an honest yet ethical way, he stretched his legs in front of him.
He looked relaxed. He was a professional, after all.
Elissa Ely is a psychiatrist.
