Ethics Case Studies

Answer:
The case involves the adoption of unethical practices by the pharmaceutical companies and their representatives to influence the sale of their medicines by providing gifts and other benefits to the doctors, who prescribe the medicines to their patients. In the absence of strict enforcement, such practices are rampant in India.
(a) Ethical dilemmas faced by me as the Regional Sales Manager of a pharmaceutical company include:

• Clash between personal integrity and professional obligations: 1 personally want to conduct business in an ethical manner. At the same time, being the Regional Sales Manager, it is my responsibility to ensure better sales and growth for my company. However, if I give primacy to my personal values, my professional obligations are compromised and vice-versa.
• Short-term vs long-term interests: I can focus on the short-term interests of my company by competing with other companies and keeping my sales up. However, there is a real possibility that the sustainability of the company, its values, and the work culture get threatened if I forgo the long-term interests.
• People’s health vs company’s interests: It is morally wrong to influence doctors to prescribe medicines of a particular brand and company, as it would affect their decision- making in choosing the right kind of medicine for individual patients. However, if I do not provide such incentives to the doctors, there is a high chance that some other company will. This would affect the sale of the company.

(b) As the Regional Sales Manager, three options are available to me. The options and their respective merits and demerits include:

• Option 1: Instruct the Area Sales Managers to follow all means to meet their respective targets.
  • Merits:
    • It would be financially beneficial for the company, the managers and employees at all levels.
    • The company’s share in the market could increase, which would benefit the shareholders.
  • Demerits:
    • The end is achieved through wrongful means and by violating the current laws.
    • It will lead to degradation of moral values in the society at large and the unethical practice will continue unhindered.
    • It could lead to cognitive dissonance, as I am working against my conscience.
• Option 2: Refuse to accept the new sales targets with unethical practices.
  • Merits:
    • This will lead me to have a clear conscience.
    • It would be in accordance with the deontological principle that means in themselves are the end.
    • Values of self-regulation would be propagated in the industry.
  • Demerits:
    • This would most likely result in a loss for the company in comparison to its competitors.
    • Long-term profitability and sustainability of the company may be threatened.
    • It may lead to demotion or job loss for me.
• Option 3: Report the industry-wide malpractices to the regulatory authorities while trying to meet the sales targets in an ethical manner.
  • Merits:
    • This would ensure that unethical practices are brought on record and the complaints can be investigated by the authorities.
    • I would be doing my duty as a conscientious and responsible member of the industry by highlighting the wrongdoings and promoting ethical business practices. I would be contributing towards better corporate governance.
    • By exploring new avenues of growth in sales, I would be ensuring a better sales outcome for the company.
  • Demerits:
    • In the absence of mandatory adherence to the Uniform Code of Pharmaceuticals Marketing Practices, other competitors might continue to indulge in unethical practices and move ahead in the competition.
    • My own company’s sales targets might not be achieved and the company might go in distress, which could lead to layoffs.
    • The company may come to know about my role in approaching the regulatory authorities and may demote me or terminate my employment.

In the given situation, I would choose Option 3 due to the following reasons:

• Personal gains: I would have adhered to my conscience. Even if I get demoted or lose my job, my honesty and ethical work style would make me an attractive candidate for other companies who engage in ethical business practices.
• Social gains: The unethical practices by doctors would come to a halt and more choices would be available to the general public. Further, lower operating expenses could even reduce the prices of medicines.
• Sectoral gains: With improved regulations, companies would bring more sustainable and innovative ideas to increase their sales. Also, companies engaged in ethical business practices tend to succeed in the long-term.

(c) The following alternatives can be considered by the pharmaceutical companies to increase their sales and growth:
Exploring alternative markets: Indian pharmaceutical companies are known for their cost-benefit and high quality of medicines. The companies should actively explore other markets such as East Asia, Latin America, Africa, etc. for potential business opportunities. The government can extend support through market information and by facilitating better trading relations with countries in the regions. Associating themselves with certain causes: For instance, shifting CSR towards women empowerment, rural development or towards people with disabilities, sourcing raw materials from nations which procure them ethically, etc. Reducing the cost of medicines: The companies can reduce the price of medicines by adopting better technology or by giving up a share of their profit margins. Lesser price would enhance the competitiveness of the companies.
Pharmaceutical companies are trusted partners in the healthcare system in the country and have played a tremendous role in ensuring access to affordable and quality medicines not only in India but across the world. Such unethical practices by the marketing branch of the companies should be dealt with a strict hand.

Answer: The given case pertains to the continued practice of defecating in the open by many people despite the availability of sanitary latrines in a district, which has already been declared as ‘Open Defecation Free’ (ODF). It reflects the fact that behavioral change is difficult to achieve and it requires the will of officers, continuous monitoring, and emotional intelligence to ensure that the status is maintained in perpetuity. (a) Reasons behind the unceasing practice of open defecation despite the availability of sanitary latrines:

• Socialization and physical activity: People consider defecation in open fields as an activity undertaken with friends that allows socialization, an opportunity for morning walks, a visit to their fields, and access to fresh air in the morning.
• Religious belief and hygiene: Defecation in houses is considered against the religious and spiritual norms by some, as their gods reside in the houses. Bad odor from the latrine, its maintenance, and associated pollution, force people to avoid usage.
• Household norms for latrine use:
  • Toilets are to be used by special guests, the elderly, or only during the night-time.
  • Females of the house do not share toilets with the males, due to associated privacy and honour issues in joint families.
• Issues with queuing: Public toilets are time-consuming. People find it uncomfortable to defecate in a dark room with an unpleasant smell.

(b) As the Sub-Divisional Magistrate (SDM), I have the following options along with their merits and demerits:

• Ignore the issue
  • The ODF status given to the district will not be questioned due to my actions. My predecessors and other officials of the district who might have furnished wrong data to claim ODF status will remain aloof from any inquiry that may be ordered. And, I will remain in the good books of the District Magistrate.
  • However, the protection of ODF status will only be temporary. If some media persons highlight this issue, the ODF status will still be in danger.
• Take official action by writing an official inquiry
  • This will help in identifying the areas where open defecation is still being practiced and taking suitable and targeted actions to change the attitude of people in those areas towards the use of sanitary latrines. This will also help in identifying the lapses in the administration, which led to furnishing misleading data to claim ODF status.
  • However, this may endanger ODF status besides disobeying my District Magistrate (DM) who happens to be my senior in the department. The DM may create hurdles in my career.
• Increase vigilance and awareness, so that when verification is done, the ODF status is earned again in the real sense.
  • This will not only help ensure that people change their attitude towards open defecation but also, I will remain in the good books of the DM.
  • There is no demerit attached to this step.

(c) As the SDM, I will take the following course of action in order to serve the public interest:

• Social audit: The issue of ODF sustainability will be raised in the Gram Sabha meetings. There, they would be made to understand that several centrally sponsored schemes have been prioritized to their area, simply because of ODF status. In the absence of maintenance of that status, such funds will go away. So, a careful social audit and ODF sustainability needs to be maintained.
• Vigilance: The Nigrani Samiti in villages and the municipal administration in the cities will be asked to ensure morning and evening vigilances so that nobody goes for open defecation. I would also plan a surprise visit at dawn/dusk in the villages/cities where behavioral changes are not reflected.
• Awareness generation: Involvement of the entire community, especially women and children, PRIs, and key opinion makers such as social workers, doctors, leaders, etc. would be used to spread awareness about the usage of toilets, as well as demerits of defecating in the open. For learning and cross-sharing of information, I would arrange the sessions of key stakeholders with the districts/states that are doing exceptionally well in this regard.
• Incentive mechanism for motivators/swachhagrahis: The role of motivators/coordinators would be reworked in tune with the activities required for the sustainability of ODF status, and an incentive mechanism/reward would be attached to their performance.

The issue highlighted in this case study is a real issue in many areas of our country, which requires high emotional intelligence besides effective persuasion to change people’s attitudes.