Noah S. Weaver

Ethical Decision Making:

Problem: HIV transmission through breastmilk is much more likely as children are breastfed over a longer period of time from an HIV+ mother. The proposed solution, however, makes HIV transmission much less likely but also utilizes crops that are treated with pesticides and potentially harmful to children.

Ethical Issue: Is it ethical to enable the use of pesticide-sprayed crops in the nutrition of children in order to minimize risk to another health condition (HIV)?

Facts:

• Stunted growth of 35% of children in a region of East Africa due to poor nutrition
• Gruel is fed to infants at 2 months of age to supplement breastfeeding nutrition
• Children are breastfed until 24 months of age
• WHO recommends exclusive breastfeeding until 6 months of age
• There is a high prevalence of HIV/AIDS in this region: the longer an HIV+ mother breastfeeds, the higher the chances of transmission
• Donor has donated money to establish a woman’s cooperative in the region
• The donor wants to establish shelf-stable and nutritious porridge from locally-grown produce to begin weaning children off of breast milk at 6 months of age
• 500 women in the area are interested in joining the cooperative
• Crops grown in the area are contaminated by pesticides
• High likelihood of pesticides ending up in the food of children

Stakeholders:

1. Children
   1. Motivated by hunger
2. Mothers of the children
   1. Motivated to feed their children
   2. provide the best care within their reach to the children
   3. a better livelihood for their families
3. Farmers
   1. Motivated to provide nutrition to their community
   2. Motivated by money for themselves to survive
4. Donor (Secondary)
   1. Positive impact on the lives of women and children in the region
   2. Increased reputation for themselves
   3. Motivated for success because they might be able to expand their operation to other areas using the same model
5. Researcher/Designer (Secondary)
   1. Motivated to make the most positive impact on the lives of women and children
   2. Enhanced reputation

3. Solutions:

Solution A: continue as originally planned by the women’s cooperative/donor.

• Ethical Code: risk of HIV exposure to children is minimized with the resources at hand.
• Pros:
  • lower likelihood of HIV transmission when children are weaned off of breastmilk at 6 months of age (instead of 2 years)
  • affordable nutrition that provides the necessary nutrients that the gruel is missing
  • shelf-stability and affordability makes it accessible to virtually anyone who may need it
• Cons:
  • High likelihood of pesticide contamination of food that can lead to negative/unintended health consequences
  • Unintended health consequences may lead to more harm than good (in some cases, probably not all of them)
  • This could be seen as taking advantage of a vulnerable population: i.e. a wealthy donor who comes in with knowledge beyond the community will likely be trusted blindly by community members and that donor’s decisions directly impact the lives of a lot of people who might not necessarily be able to fend for themselves

Solution B: Invest in HIV eradication techniques

• Ethical Code: Provides a multi-pronged approach that will have a deeply beneficial impact from both a social, humanitarian, and health perspective.
• Pros:
  • Solves the original problem indirectly (HIV+ transmission to babies through breastmilk)
  • Improves the health of both children and the mothers (not just the children)
  • Nutrition (by itself) will continue to be affordable as the diet will not necessarily need to be changed if children are continued to be breastfed until 2 years of age as usual
• Cons:
  • Extremely expensive problem to fix: this method will undoubtedly cost much, much more upfront than simply changing nutritional methods for the children
  • Incredibly time-consuming: HIV/AIDS eradication takes a sustained, long-term effort by every stakeholder involved. It will already be difficult enough to get every stakeholder to buy into this solution, and it will be even more difficult to get the stakeholder to sustain efforts as they will likely not see results in the near- or medium-term future
  • The complexity of technique: HIV transmission is spread through several different methods (mostly bodily fluids, IV drug use, etc.) and this will take a multi-pronged approach. The multiple methods that are required to genuinely eradicate HIV/AIDS require a lot of manpower from well-educated people: unfortunately, there is only so much manpower in the world that one can utilize to solve this issue.

Solution C: Continue breastfeeding children until 2 years of age, but redirect funding for porridge into supplementing nutrients that are left out of the gruel

• Ethical code: this allows for minimal outside influence and maintains the independence of the people in the region
• Pros:
  • The existing system is left completely intact with minimal invasion of outside influences
  • Minimal effort is required by the researcher or donor
  • Children are given all nutrients as required through their diet
• Cons:
  • HIV transmission is highly likely from mother to child due to extended period of breastfeeding
  • Depending on which nutrients are missing, this could potentially be expensive and/or difficult to integrate into the gruel
  • The donor’s original intent will likely not be as impactful as hoped

Chosen Solution: Solution A.

Solution A is the most realistically achievable solution that balances the short-term and long-term needs of the community and ensures financial feasibility without the loss of quality nutrition. Perhaps most importantly, this solution lowers the likelihood of HIV transmission from nursing mothers to their children. The porridge is affordable under these circumstances. The porridge will also be accessible to the entire community due to its shelf stability and affordability. This solution satisfies the highest set of ethical values because of its affordability, accessibility, and health-centered approach aimed at minimizing the risk of HIV exposure to children. Although this solution involves the risk of pesticide contamination, this method is still ethical because the crops grown in the area are already supplemented into the gruel under the existing methods of nutrition. As such, the children are not necessarily changing their risk to pesticide exposure, but they are lowering their HIV risk- the net outcome is positive.

Positive implications: this solution ensures the financial sustainability of the venture, assuming the venture is able to recover enough to cover the cost of producing and distributing the porridge. The farmers who provide the crops will have more money in their pockets and this will allow them to continue benefitting their communities through nutrition, enhancing the reputability of the venture. Finally, the reduced risk of HIV transmission due to less time breastfeeding is the socially responsible route to choose, and the time/effort put into providing affordable nutrition will increase the community’s trust in the venture as this shows the thoughtfulness of the venture’s stakeholders.

Negative Implications: this solution is not perfect. Long-term complications experienced by the children as they grow older (e.g. cancer) may have been caused by pesticide exposure (social/health issue), and although the venture is not changing the fact that children will be exposed to pesticides through cash/subsistence crops, they could be seen as a scapegoat and damage their reputation as a result. This solution can also be seen as environmentally irresponsible because the venture is actively encouraging the use of pesticides on crops by purchasing such products, and this could also be damaging to their reputation (e.g. if an environmental activist group began demanding a boycott of the porridge, all the good the venture accomplished may evaporate to a certain extent). This method also depends on the people buying into the product. It is very difficult to get people to buy into anything new (usually), and there might be some resistance to acceptance of the porridge. As a result, it will take more work upfront to implement.

Grassroots Diplomacy

Ethical Issue: how do we ensure that the money earned by the women working for the cooperative is used for needed purposes (e.g. feeding one’s family)?

Facts:

• The cooperative is thriving
• The women like their jobs and earn money while making a difference in their community
• The men of the families waste the money earned by their household’s women on unnecessary expenses like alcohol
• You are one of seven committee members on the leadership team that oversees the cooperative’s operations
• You only have six months left in your current term and will likely leave the cooperative completely after finishing the term
• The other six people on the leadership committee are women that fully understand the scope of this issue
• the women on the committee, like many others, are convinced that this is “just the way it is” and nothing can be done to prevent the men of their households from spending money on unnecessary expenses

 

Problem: the men of each woman’s household is spending money earned while working for the cooperative is spent on unneeded items

 

Stakeholders:

• women of the cooperative:
  • Personal motivations: want to feed their children, maintain familial relationships
  • Professional motivations: ensure the sustainability of the cooperative, make a positive impact in the community as a whole by doing so
• Children
  • Personal motivations: have enough food to be satisfied and healthy
  • Professional motivations: N/A
• Men in the community:
  • Personal motivations: use as much money as possible for unnecessary expenses such as alcohol
  • Professional motivations: N/A
• Farmers:
  • Personal motivations: sell as much crop as possible in order to sustain themselves
  • Professional motivations: Help the cooperative in order to feed nutritious meals to children of the community
• Researcher:
  • Personal: improve children nutrition, increase your own notoriety in this area of research
  • Professional: use increased notoriety to expand funding access to the cooperative, accomplish the original goal of the cooperative
• Donor (secondary):
  • Personal motivation: make a positive impact on the community through better nutrition of children and simultaneously increase their own notoriety/reputability in order to continue doing so
  • Professional motivation: accomplish the original goal of the cooperative and feed nutritious meals to children

Solution:

Ethical code: provide all stakeholders with a sort of middle-ground that ensures resources are equitably distributed.

• Establish a gift card system for the payment of the women exclusively for children’s food at the local markets. Provide a small cash payment for the women to take home to the men of the family.
  • Pros: women can feed the children of the community as originally intended, everyone is given a “slice of the pie” (men are given alcohol money, children are fed, etc.), and the women of the cooperative can continue socializing with each other
  • Cons: It may be difficult to integrate the credit system initially (assuming something of the kind is not already in place at the local markets), this does not keep all of the money to be used exclusively towards essential nutrition needs, it’s not the perfect solution, either.
• How does it save face?
  • This allows the men to spend money on things they want without feeling like they don’t get something in return by allowing the women to continue working in the cooperative (without making a fuss about doing so), this allows the women to also maintain the peace, and it makes the researcher/donor feel accomplished as this will allow them to accomplish the original goals of the venture
• Relationship implications:
  • Short-term: men will not be as satisfied with less money brought home, but will still be happy with the extra money for alcohol
  • Long-term: the family units of the community will maintain long-term peace as everyone is given something in return for their time, efforts, (or in the case of the men, “allowing” women to do their work)
• Venture implications:
  • Short-term: more porridge might be readily used by the community since this is the best nutritional option available
  • Long-term: the cooperative might be able to expand this model to other areas of East Africa in order to provide nutrition for more people
• Positive implications: This solution is the best way forward because it ensures that the original goal of the cooperative is accomplished (feeding the children), the women are able to feel good about themselves for feeding the children and continue to socialize with each other, the men are still happy (but maybe not as much as they were previously) for being given “free” money for alcohol and other frivolous things, and the researcher and donor also accomplish their goals by accomplishing the goals of the cooperative. The venture’s success may also be used to expand operations to other areas, as the success of the cooperative can be used as evidence to other governments to integrate the same thing into their existing systems (relationships-long term).
• Saves face: This also saves face for those involved because it maintains the general peace of each family unit and maintains the look of everyone doing their part to make a positive impact on the community by feeding their children with appropriate nutrition. This solution was chosen over other solutions because it is the only way to ensure accountability without overly-burdening any one stakeholder over the other (e.g. receipts will not be used as proof of purchase because they will be difficult for the cooperative to track in terms workload and reliability, cash is not given out for the entire pay since it will continue to be used inappropriately). This maintains the general peace and preserves relationships in both the short-term and long-term futures.
• Negative implications: from a social standpoint, not all of the money is used towards its originally intended purpose and this could be seen as enabling bad habits. This also is using up valuable resources that could be better spent on more nutrition or other necessities.  This solution will change the technology of the venture in terms of how they operate their cooperative model. The environment will see no net impact as crops with pesticides will be used regardless of whether or not this solution is chosen. Finally, this could lead to reliability issues with the gift card system’s use (e.g. a merchant refuses to accept it because they might not immediately see the cash) and this might cause the community members to blame the cooperative for starting trouble. 

Sequence of events:

• Ask the women why they believe nothing can be done about the problem (and truly listen to them: this will allow them to be more receptive to your proposed solution).
• Propose the solution to the women on the leadership of the cooperative.
• Assuming everyone is on board with it, we can begin by individually messaging the merchants in the area of the plan
  • The merchants can be reimbursed in cash by the venture for all credits received from women who purchased goods from their market
  • If merchants ask “what’s in it for me?” you will tell them that they will see increased sales since the women of the cooperative are only able to spend money on necessary food items for their children
  • Increased sales will be more than enough incentive to get them to cooperate
• Appoint one person of the leadership committee to be the “go-to person” for the oversight related to the credit system. This person might not necessarily have authority over anyone else, but they will be responsible for understanding and reporting on any future issues related to the credit system.