John Q

I had to watch John Q for another class and saw that the movie embraced a huge
ethical dilemma. For those who are not familiar with the movie. It is the story of a
working class family (The Archibalds) whose life is about to change with an
unexpected health tragedy. The son of the Archibalds is about 9 years old and while
playing baseball one day he collapsed. He was taken to the hospital and the family
was told that he needed a heart transplant but his insurance was not going to cover
it. The heart transplant would cost $250,000 but in order to place the son on the list
to receive a heart the family would have to pay $30,000 cash. The son did not have
long to live and after coming up short on the deposit, the hospital decided to
release the son.

Situations like this occur everyday in the United States. Families are not able to pay
for health care and they are placed in situations such as this. Ethics is questioned
when asking a family to make a cash payment to save the life of a child. This was a
working class family who did not have the $30,000 to pay for the heart transplant
deposit. They sold almost everything they had and still was not able to come up
with the money. To add to the turmoil the hospital tried to release the child knowing
he was not in good condition and would not live much longer without the transplant.
The hospital should have had more alternatives for the family besides telling them
to make a cash payment. I feel it is the responsibility of the hospital to help
everyone especially those who need life saving treatment. One of the principles of
ethics is beneficience which stands for the act of doing good. In this case, the
hospital was not acting on this principle of ethics. In my opinion, asking a family to
pay $30,000 and trying to release a dying child is not beneficience.

The principle of human dignity was also questioned in this dilemma. Human life is
very significant and sending someone home to die does not constitute the right of
human life. The hospital took away the child's right to live by refusing to place him
on the list to receive a heart and trying to release him to go home. If the child only
had a short time to live with the help of the hospital, imagine what would have
happened if he would have went home without any medical treatment or support.
The hospital did not consider this because receiving money seemed to be most
important.

In the movie, the Archibalds had an HMO and one of the employees said that HMO
receive incentives for not offering treatments to patients which raises another
ethical dilemma. The father said that the child receives a check up every year and
no doctor every said that he was healthy and had no conditions. The dilemma here
is clear, if the doctors would have ran tests prior to the incident, they could have
seen that the child did not have a healthy heart and could have possibly treated
him. There have been many speculations that HMOs do not offer treatments and in
return receive incentives at the end of the year. This is unethical because the job of
the physician is to maintain the health of the patient. If the physician does not give
all of the treatments they are reducing the quality of care as well as the health of
the patient.

These were two ethical dilemmas in the movie John Q that I felt should be pointed
out. It is important for health facilities to realize their responsibilites and react
ethically and lawfully. It is unfortunate that these events do occur often. Which is
why ethics and law play significant roles in regards to the care of patients and
health care organizations.
Introduction

This movie shamelessly delivers a potent tale of parental love and sacrifice
smothered by a deafening cacophony of ethical dilemma. Each major character
confronts excruciating decisions and must appeal to a code of morals in order to
justify his or her actions. Rarely are these choices clear cut and something precious
must be sacrificed in each outcome. The father and protagonist, John Archibald
(played by Denzel Washington) traverses through the most vexing moral
quandaries, pitting his overwhelming duty as a parent against the "greater good" for
society. This movie came out in 2002 and continues to cause us to question what is
right and what is wrong. John Archibald's example makes us wonder what we
would do in the situation and what is truly important to us. We learn how difficult it is
to judge the morality of the actions of others.

John does whatever it takes to save his son

See all 3 photos
John does whatever it takes to save his son
Role as a father

As a father, John has a moral obligation to do all that he can for the welfare of his
son. Duty demands that he provide a better life for Mike than he had for himself.
John, a Christian man, understands this and does his best to secure enough hours
at his plant in order to adequately provide for his family. He drives Mike to school,
visits his little league baseball games, and does his best to support him emotionally
and financially. Those needs are drastically increased when Mike's medical
condition is discovered; however, John's deontological imperative remains the
same: to love, support, and take care of his son.

In this respect, John responds ethically to his moral responsibilities. He takes no

thought to consequence and proceeds with motives driven purely by filial obligation.
He values his role as a parent and the sanctity of human life above all else. His
selfless decision to donate his heart to his son demonstrates that he even values
this above a "right" to one's organs. This decision is the only rational (and
subsequently condonable) action under these circumstances. As deontology
necessitates, actions and laws must be universally applicable. All adherents must
be willing to both give and receive. John required no less from others than he was
willing to give.
See all 3 photos
Utilitarianism Viewpoint

John's actions affected much more than just Mike, however. Utilitarianism requires
individuals to make choices that will provide the greatest amount of good or
pleasure for the greatest number of people. There is no feasible way for John
Archibald and his family to ever pay enough taxes on his limited income or enough
in insurance premiums to close to covering the necessary costs for Mike's
procedure. It would be unjust for them to receive a treatment that they had not paid
for. Furthermore, the $250,000 allocated from the private health care facility's funds
certainly could be redistributed among hundreds or thousands of other patients.
This reallocation of limited resources could allow many other individuals to receive
minor procedures for free or reduced costs. They could hire more nurses to shorten
wait times or install better medical technology. From this utilitarian viewpoint, it is
unjust and immoral for Mike's parents to demand that he be the beneficiary of such
an expensive procedure when that money could produce more collective happiness
dispersed among the other patients that pass through the hospital.

From this ethical standpoint, John acts irrationally and selfishly. His decisions show
a clear inability to see "the greater good". His choices effectively rob the other
patients of the ability to have lower costs, better treatment and shorter waits. The
borrowed money from friends and neighbors could have also provided much good
in their respective lives. His cost/benefit analysis also seems to neglect the distinct
possibility that his son will never return to full health.

John Q
John Q
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Conclusion

Ultimately, John act ethically. Corrupt practices within the health care insurance
industry eventually led to the violations of many individual's inherent rights. These
subtle changes switched the onus of these companies from beneficence to one of
maleficence. This blatant disregard of Kant Ethics and duty naturally compels other
rational and moral individuals to take more extreme measures to uphold their
personal beliefs and live in accordance to their ethical stances.In today’s American
society, our health care insurance dilemma is outrageous, and “John Q” had the
potential to make not one moviegoer unaware of how serious this problem really is.

The film, directed by Nick Cassevetes, begins with a shot of an open highway. The
shot ends with a horrific car accident where a beautiful woman is killed—and it is
obvious then this woman will be instrumental in making everything good and well at
the end of the film. We then jump to the lives of John Q. Archibald (Denzel
Washington), his wife Kimberly, and his son Michael. One morning, the family car is
seized by Michael’s insurance company. John, it seems, has been reduced to
twenty hours a week in the factory where he works. As of then, the family is
completely uncertain about how their financial situation will stand.

They do, however, try to go back to their normal lives, which consist of attending
their community church and Michael’s baseball games. Things take a sudden turn,
though, when the seemingly healthy boy collapses while running to second base
one Sunday afternoon. He is rushed to a quality Chicago hospital, where it is
determined that Michael’s heart will soon be useless, as it is already three times
normal size. Hospital administrators (James Woods and Anne Heche) give the
family two choices: either pay for a heart transplant which may or may not succeed,
or try to make Michael’s life as quality as possible during the months or weeks he
has left to live.

As most families would, the Archibald’s decide within seconds that a transplant is
their ONLY option, but are then hit with the hard reality that because of John’s lack
of work, his insurance has been dropped from full-time to part time. The hospital
“does everything in their power” to help Michael and his family. Neighbors help the
family raise $22,000, but this figure is nowhere near the down payment of $75,000
necessary to get Michael’s name on a donor’s list. John has exhausted all of his
options by the morning when the hospital is going to release Michael from
treatment. His wife’s pleas for John to “do something!” cause him to buy a gun, lock
down the hospital, kill the elevator power, and hold everybody hostage, threatening
to hostage situation negotiator Frank Grimes (Robert Duvall, who makes even the
worst movies watchable) that there will “be some dead bodies in here” if Michael
has not been issued a new heart by 5:15 that evening.

All the while I kept thinking, “Is this really what a father would do?” and “John Q”
almost made me believe it, until the film took on your standard plot for any movie
about a hostage situation. When the movie was solely about a father’s love, I
almost bought it; when it came time for the first gunshot opportunity on the gunman,
I thought “Maybe not.” When a computer genius hacked into an emotional
telephone call between John and his wife and broadcast it live over television, this
movie had turned from us rooting from Michael to rooting for John Q. When comic
relief started to take its toll in the form of conversations between John and the
eclectic mix of hostages he has taken under his belt, I wish I would have walked
out. Even the final climactic minutes, where John debates whether he should kill
himself and give his heart to Michael do not undo everything else thrown in
unnecessarily.

Again, this movie had the potential to say something that would hit medical
insurance companies deep, but instead it turns into a laughable, completely
unplausable film. If the intention of the filmmakers, who incidently spent eight years
writing the script (it seemed like it was eight days), was to send a message to
insurance companies, they would have done well to skip the entire hostage
situation and make this into a heart-breaking courtroom drama. I get the sickening
feeling that the hostage crisis might have just been created as a draw to teenage
audiences.

From a Christian standpoint, I suppose the film glorifies violence as a means of

solving a problem. There also is plenty of strong profanity, including two “F” words,
10 “s” words, and many, many uses of the Lord’s name in vain by many of the
hostages. There is also a side plot that in no uncertain terms establishes a hostage
as a wife-beater.

However, I did like how in the final waning moments of the situation, John realized
that a miracle from God was his last hope.

But, in retrospect, this film does not have the potential to offend simply because of
certain anti-Christian elements, but also because it takes a very serious issue and
through the usage of unneeded material and plot lines, makes it into a farce. The
sad thing is that intelligent filmmakers won’t want to touch this worthy material for
some time now.

John Q; From an Ethical Standpoint

As human beings, we will all experience some type of ethical dilemma sometime in
our lives. Committing an act of “evil” for the sake of someone else’s well-being may
be one of these dilemmas we face. The concept of an acceptable or necessary evil
is one that is highly debatable. When is evil justifiable? According certain ethical
schools, at times the ultimate goal is independent of the means to reach it. In such
ethical schools, the evil act may be justified if it is the course taken to ultimately do
something good for the benefit of others.

The movie “John Q” deals with the issue of “necessary evil”. This movie Denzel
Washington stars as John Quincy Archibald, a husband and father whose son is
diagnosed with an enlarged heart. The hospital informs them that his son needs a
heart transplant in order to survive. However, due to insufficient health insurance,
the hospital refuses to put his name on the transplant list or agree to do the surgery.
Therefore, he decides to take a hospital full of patients hostage until the hospital
puts his son’s name on the recipient’s list. John also actually considers sacrificing
his own life in order to save is son.

Necessary evil as something that is unpleasant or undesirable but is needed to

achieve a result. This film deems John’s actions necessary to meet his ultimate
goal. Although John’s assault on the hospital and threat to kill hostages would be
considered evil, it was done with the intention of saving his son’s life. John used
every other possible option, before he actually considered such an extreme
measure. Therefore his choice to assault the hospital was a last resort, and was
necessary to meet his goal. This is what the textbook may consider a necessary
evil.

The ethical school of Consequentialism determines right and wrong on the basis of
the consequences. This school is based on 3 premises: ends are independent of
the means; “cost benefit analysis” and right or wrong determined by consequences.
Under this branch of ethical theories, a “necessary evil” may or may not be justified.
Being that the term “necessary” implies intent is to reach a commendable goal; the
actual evil act may be taken into account separate from the goal itself.

In addition, in order to look at this dilemma from a consequential point of view, one
would need to take the cost benefit analysis into consideration. A cost benefit
analysis is done to assess the issue and determine how well, or how poorly, a
planned action will turn out. A person must find, quantify, and add all the positive
and negative factors, and base the decision on the difference between the two. In
John’s case, the positive factor would be saving his son’s life. The negative factors
would be jail time or being killed in the process. Most parents that I know would
agree that any of the above would be worth saving their child’s life. In the movie,
John was willing to give his life and his freedom in exchange for his son’s.
Therefore, in his case, the positive outweighs the negative.

Natural Rights is another theory under the school of consequentialism that would
support John’s decision in the movie. Naturals rights is the belief that all human
beings are endowed by their Creator (God or nature) with certain rights. This is
based on the philosophy of John Locke, who said that we are all born with the
inalienable rights of life, liberty and property. In John Q’s case, the hospital had the
means to save his son’s life, but chose to deny him that right because of a
monetary issue. In addition, being that this theory is teleological ethical approach, it
determines right and wrong on the basis of a goal. John Q’s goal was honest and
admirable, which justified his “evil act”.

Although some ethical consequentialist theories may support John Q’s actions,
Rule Utilitarianism does not. The utilitarian ethical approach determines the action
by what can produce the greatest utility. However rule utilitarianism maintains that
we should look at the consequences of an action in relation to particular rules of
conduct. In order to apply this theory to a dilemma, you must consider how an
action can affect the overall rules of society. In this case, condoning John’s
extremist actions would completely change the rules of society. If this were to
become okay, people would continue to wield guns and threaten hospitals every
time they are denied health care. It is true that everyone has a right to preserve life,
if everyone such extreme actions against hospitals and or other medical agencies
would create total chaos.
In this movie, John Q’s actions are the “necessary evil” needed to not only save his
son’s life, but also expose the injustice of this country health system. Although
John’s actions may be considered evil, some would actually consider it evil for him
to have done nothing, and allow his son to die. So, in retrospect, he committed the
lesser of two evils. At the end of the day, sometimes we have to do unfavorable
things in order to achieve a favorable.
ETHICAL ANALYSIS OF "JOHN Q" MOVIE
The movie “John Q” is filled with ethical and moral dilemmas throughout its course.
It gives us a clear notion of the duties of public servants, and private administrators
with regards to ethical decision they face in the daily execution of duties in
communities they represent. In this analysis, I will explore the ethical and moral
values of the main characters in the movie in performing their various official
capacities. I will also elaborate on health insurance coverage by defining and
reviewing the difference and similarities of PPO and HMO. Below is an ethical
analysis of the characters in the movie “John Q.”:
First of all let me explain what the movie is about before touching on the moral and
ethical dilemmas of the characters. The director of this movie Nick Cassavetes
reveals a social issue in the health care industry. He explains the ordeals of John
Archibald, whose son has a serious cardiac condition that requires urgent surgery.
John did not have an appropriate health insurance policy to cover the cost of the
operation; the hospital chooses not to take the Good Samaritan route, and refuse to
proceed with the operation.
Therefore, John Q is confronted with a moral dilemma to accept fate and prepare
for his son’s funeral as the Hope Memorial Hospital administrator, Rebecca Payne
have suggested, or raise funds for the cardiac operation, which is a daunting task
considering the time and emergency nature of the situation his son is in. John
decided to take the hospital staff and other patients at the emergency room
hostage. In the Geuras, Dean, and Charles Garoralo text for this course have
discussed the four sub groups of absolutism which will be discussed in this
analysis. It talks about philosophers like Aristotle, Kant, and Mills who have
developed their ethical opinions and philosophies. By reviewing events throughout
the movie, we can compare them as to how they would be viewed under these
different philosophies to determine if they were morally right, or wrong in relation to
Public Administration.
One would wonder why a hospital will refuse to offer free operation to save the life
of a twelve year old boy. Well the answer is simple, unlike public administrations,
Hope Memorial Hospital (HMH) is a private entity, and private cooperation’s were
established to make a profit. This what academicians described as the “real world”
or functional world? A world of budget, deadlines to meet, accountability, and
compliance (Garofalo and Gueras p, 1.) Rebecca Payne acted in a utilitarian way;
by thinking that assisting John Q’s son for free treatment will not do society any
good due to millions of HIV patients facing the same problem. John Q’s son is only
a modicum of the health care problem faced by many. Utilitarian believes that the
outcome of any action has to be for the happiness of many. Rebecca Payne may
be a pariah to her community for refusing to offer free treatment to John’s son, but
her action may be justified by a utilitarian.
While John is espousing the emergency room (ER) with his hostages, he was also
faced with an ethical dilemma; he has a pregnant woman who needs treatment at
another facility and another lady who can’t speak English in the ER. When
Lieutenant Frank ask him to release some of the hostages during the negotiation,
John’s dilemma tears him between leaving the women in the ER where they will die
and giving in to the police by releasing the women. One outcome emphasizes his
desire to find a heart for his son while the other saves the lives of hostages and
expose his weakness. In the end, he shows his reverence for humanity and
releases the hostages that need serious help to save them.
This act of John Q will resonate well to a jury that has passion with the “virtue
theory” of Aristotle which focuses on good intents of an action. By releasing the
most vulnerable patients during the hostage negotiation for their own good, divulge
a good side of John. John Q may have portray a poor character traits for using the
gun to commandeer the hospital staff, but for the very fact that he was brandishing
an empty gun on his victims, and his consistency in freeing hostages as promise, is
a clear indication of being a man of integrity. Since virtual theory is concern with
the significance of the whole person, (Garofalo and Gueras p, 59.) John’s actions,
his ran some demand and the treatment of his hostages shows his frivolous
intensions of hurting no one, rather than an attempt to save his son’s life after
everything else saves. His case brings awareness to his community who can relate
to its plight, of part time employment, and lack of health insurance. This fact makes
his actions very virtuous and utilitarian despite his action initially gear towards his
son’s well being, it’s magnitude after being publicized has a theme of struggle to
achieve happiness beyond his community. His slogan,” sick! Help! Is welcome by
sympathizers, and that is a remuneration for his virtues.
Furthermore, the movie also brings to mind the question of loyalty which is one of
the six pillars of characters. How much can one be loyal to his employer or
organization? One has a moral duty to protect his organization, but when a
person’s moral standards are being threaten, they usually resigns, or stay and
become “whistle blowers.”[1] The whistle blowers often fall under intuitionism, a
pragmatic theory which indicates that our intuition can determine if an action or act
is good or evil. There are certain individuals in the ER whose morals conflict with
those of the ‘Hope Memorial Hospital’. For instance one of the nurses gives John
Q several options for funding of his son’s operation including an altruistic statement
of “just don’t take no for an answer.” A statement which John Q reminded her of
when she asks him what he thinks he is doing. John answer that, “I am doing what
you advise me, not to take no for an answer.” During the course of the hostage
taking in the ER, both John and the hospital staff were discussing insurance
coverage for Health Maintenance Organization (HMO.)[2] “HMO” Merriam-
Webster’s Medical Dictionary. Merriam- Webster, Inc. 21 Aug.2011. <
Dictionary.com http://dictionary.reference.com/brouse/HMO>.
One of the ER male nurses reveals that HMO physicians receives annual
Christmas bonus for not checking their patients for costly illness to avoid paying
hospitals for costly procedures. This is reveal after John asks why his son’s
physicians didn’t find out about his illness earlier during their visits. The heart
surgeon amongst the hostage is reluctant in accepting this claim which I think is the
exercise of his loyalty to the hospital. The candor this male nurse in further
attacking the surgeon by revealing that in their hospital, they tend to get around the
law by stabilizing the patients, and then send them home to die if they do not have
a good health insurance carrier to cover the cost of the treatment.
The male nurse’s claims sounds infallible, but the question is what is the ethics in
whistle blowing? In their analyses of whistle blowing, both Bowie (1982) and Bok
(1980) indicate that an employee has a significant obligation of loyalty to the
organization they belong. Bok, for example, comment that the “whistleblower
hopes to stop the game; but since he is neither referee nor coach, and since he
blows the whistle on his own team, his act is seen as a violation of loyalty.” For
both, however, the duty of loyalty is not absolute; it is a prima facie duty that can be
overridden in certain circumstances.
However, Duska (1997) reject this theory in which whistle blowing is categorize as
an act of sell out, one needs justification or can be pursued only under special
circumstances. Duska says “ it is as if the act of a good Samaritan is being
condemn as an act of interference, as if the prevention of a suicide needs to be
justified” (p.355). The flaw, for Duska, is found in the notion that individuals should
be loyal to a company. Simply put, a company is not a person and not, therefore,
deserving of loyalty. While a company typically consists of people, it is not a group
of people with a purpose that transcends self-interest. Loyalty, according to Duska,
exists in the context of human relationships and entails a readiness to engage in
sacrificial behavior. “A company is...an instrument with a specific purpose, the
making of profit. To treat an instrument as an end in itself...does give the instrument
a moral status it does not deserve” (p. 338). Thus whistle blowing is a prominent
instrument in virtue theory, intuitionism and teleology.
Another ethical aspect that comes to light in the movie is dishonesty. The human
resource (HR) department change John Q’s insurance from PPO (Preferred
Provider Organization)[3] “PPO” Merriam- Webster’s Medical Dictionary. Merriam-
Webster, Inc. 21 Aug.2011.< Dictionary.com http://dictionary.reference.com/brouse/
PPO> to HMO without explaining the implication of the change to his health
benefits. Not until the day he visits the HR to discuss his health benefits that he is
aware of the kind of coverage his has. Health insurance and other employee
benefits are very esoteric, and should be thoroughly explained to employees before
making changes in their plan.
Another aspect of dishonesty is portrayed by Rebecca Payne, Hope Hospital
Senior Supervisor in lying to John Q’s wife that her son’s name has been added to
the donor list. This unethical lie would have cost John Q his life as he is made to
believe that his son’s name has been added to the organ recipient list. As he is
talking on the phone with his wife, a conspiracy to murder him during the act is
unsuccessful, as the sniper misses his target (John Q). As John Q lie inanimate
after the shot is fired faking to be decease to play his move. He rise up and
overpower his assassin to fulfill his moral obligations to his wife and son whom he
promised to do something, and to find his son a new heart.
This action of John Q, to deceive the sniper, and the entire police force in his locale
on live television also resonates with the six pillars of character (W& B p.13, 14) of
reliability and responsibility. John Q is reliable due to his determination to keep the
promises he made to both his wife and son. West and Evan write that “when we
make promises or other commitments which creates a legitimate basis for another
person to rely on us to perform the task (p.13). They further write that people with
ethics should avoid bad faith excuses. This clause reveals the dishonesty of the
hospital administration, and the HR department of John Q’s employer, who uses
cover up to conceal their motives of murder, and paying less health coverage for
their employees respectively without explaining benefits and cost to their
employees for them to make an informed decision.
The reliability character pillar also warns individuals to avoid unwise commitments,
and also to avoid unclear commitments. These two clauses put John Q in a moral
dilemma for promising his loved ones to get things done by taking the law into his
own hands as a vigilante to fulfill his promise at all cost to save his son’s life. As he
put it “I will not bury my son, my son will bury me.” This brings another pillar of
character to mind, ‘responsibility’. As the economist’s says, human wants are
many, but the need to satisfy them are limited (Adam Smith- wealth of a nation)
which brings to scarcity and choice. John has chosen to threaten the hospital to
save his son which is considering as a moral responsibility for every parent. He is
aware of the consequences of his action, as West and Berman indicates “beyond
having the responsibility to be trustworthy, respectful, fair and caring, ethical people
show responsibility by being accountable, pursuing excellence, and exercising self
restraints” (W & B p, 14). All this traits can be trace in John Q’s actions and
decision making throughout the movie, on to the end when he decided to sacrifice
his heart for his son when he has explore all means, but his son’s condition keeps
deteriorating by the hour.
Despite this colorful picture I have painted on John Q’s to morally, and ethical justify
his actions, I will be unjust to discredit Rebecca Payne for lying to John Q’s wife. In
fact, she is not the one that suggested initially lying to John Q’s wife about their
son’s name being added to the organ recipient list, it is Sergeant Moody’s idea.
Regardless, a deontologist would argue in her favor due to the principle nature of
the situation. A deontological ethical theory celebrates an action not base on its
outcome, but on a remarkable feature of the act itself (G& G p.53). Most popular of
these views are followers of Emanuel Kant (1959), the father of Kantianism. They
believe in consistency and in this case, they will support Hope Memorial Hospital’s
stand of continue its policy of “cash case” for all patient without health coverage.
Any action contrary to the hospital’s billing tradition with creates contradiction, and
lying to John’s wife is ethical. This is because, deontologist believes any true
statement meant to deceive others would not be a lie (G& G p,53).
Another example of lying can be justified by deontologist and Utilitarians alike is
doing undercover work by police officers. They often dress in plain clothes and
change their identity to get information from the public. Such action can be
consider as unethical by some, but since such disguise is for the general good to
create a happy society, the utilitarian would support such an act, and so is the
deontologist. For the very fact that Rebecca Payne lie to end the hostage ordeals
in her organization to save the hostages, her organization, and cooperation with
authorities, makes her decision ethical.
In the final analysis, we will examine the role of the Police Officials and the media in
the movie, and the impact of their involvement ethically. Unlike private organization
that operates for profit, public officials such as police officers operate to provide
public safety to maximize happiness for people to roam freely in their communities
without fear for their lives or properties. They are empowered with the moral and
ethical powers to carry out their duties without fear and favor. On the other hand,
the new outlets that are considered by political scientists as the fourth arm of the
government encourage transparency and accountability and exposes corrupt
practices in the community.