An examination of the ethics of MD-reporter involvement in Haiti

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I know that some people may not see any ethical conflict in physician-reporters like CNN’s Sanjay Gupta, CBS’ Jennifer Ashton and ABC’s Richard Besser reporting on their own delivery of health care in Haiti. Screen shot 2010-01-18 at 9.36.53 AM.png

But people who think a lot about these issues DO have concerns.

Media ethics guru Bob Steele of the Poynter Institute and DePauw University told the Los Angeles Times: “It clouds the lens in terms of the independent observation and reporting.” Given that Gupta’s story involved a child who – in the end had a cut but no head injury – Steele said, “Frankly, it isn’t much of a story. You can’t help but look at this and worry there is a marketing element in it.” Los Angeles Times media columnist James Rainey referred to it as “self-promotion.” That’s from a journalism ethics perspective.

ahc_75463.jpgPhysician-ethicist Steve Miles, MD, of the University of Minnesota Center for Bioethics wrote to me:

“The reporters who have been practicing well-televised drive-by medical care in Haiti are demonstrating an appalling abuse of medical and journalistic ethics.” He feels the decisions on what to broadcast are based on what presents itself as a “telegenic case.”

Miles served as medical director for the American Refugee Committee for 25 years, including service as chief medical officer for 45,000 refugees on the Thai?Cambodian border and projects in Sudan, Croatia, Bosnia-Herzogovina, Indonesia, and the Thai-Burmese border. He is on the Board of the Center for Victims of Torture. He wrote:

“They justify this form of self-aggrandizement by its effect in mobilizing response for the larger disaster. The added value of their self promotion largely goes unchallenged.”

Dr. Carl Elliott, also on the faculty of the UMN Center for Bioethics, wrote to me:

“It’s worse than self-promotion. It’s exploiting the suffering of Haitians for the PR goals of their employers. They should not be reporting on their own work. That’s a classic PR tactic: using humanitarian aid as a public relations device, in order to drive up ratings for their network.”

Allow me to drop back and apply an ethics tool to the situation. For years I’ve trained undergraduate journalism students in the use of the Potter Box, named after Ralph Potter, an emeritus professor of social ethics at Harvard Divinity School.

The box has four quadrants, which you can step through in this fashion.

Screen shot 2010-01-18 at 2.44.13 PM.png

The facts of the situation are that these MD-reporters are in Haiti where there are overwhelming health care needs.

What are the different values at play? Clearly, the moral value of helping a person in need is a dominant value.

What ethical principles may apply to the situation? Again, the “persons as ends” or “do unto others” principle could dominate the decision-making. But Aristotle’s or Confucius’ golden mean might call for a middle grounds of practical wisdom – an appropriate decision between two extremes. So, rather than doing nothing to help, or – at the other extreme – rather than reporting on one’s own involvement in helping, a middle ground might be to help – but with the cameras off. In his media ethics workshops, Bob Steele always asks journalists to think about alternative pathways for telling a story – alternatives that might eliminate or minimize ethical conflicts.

To whom does the journalist have loyalties? This is probably the most essential quadrant of the Potter Box in this situation. Is this a journalist with loyalties to journalism principles? Or this is a physician with loyalties to his/her medical professional oath? It is difficult to be both. Time-honored journalism principles would dictate that a journalist should not be part of the story, that the “lens of independent observation and reporting” might be clouded if the reporter becomes part of the story. If an MD-reporter is guided by his/her sense of physician responsibility to care, look at how one citizen observer commented on the LA Times blog:

Screen shot 2010-01-18 at 2.36.52 PM.png

“With people dying around him every minute as he should not waste a single minute serving as a reporter. He’s a doctor and it seems unethical to me that he is not spending every waking moment of his time providing medical care to the thousands that desperately need it. Can’t CNN find any other reporters and spare him for a few weeks so he can save some lives? I appreciate the fact that he helped that baby, but he could help SO many more if he would just put down his microphone.”

One could apply both the “values” and the “loyalties” questions to the news value of the stories. Why, exactly, were these episodes that Gupta, Ashton and Besser featured in, deemed to be newsworthy? Because they were outstanding news stories? Or because it was a way to feature a CNN, CBS, or ABC employee in an active, care-giving role?

The code of ethics of the Radio-Television News Directors Association states: “Resist any self-interest or peer pressure that might erode journalistic duty and service to the public.”

The Potter Box demonstrates the complexity of the ethical decision-making involved. The first two quadrants might seem like a slam-dunk in favor of the MD-reporters doing whatever they could to lend a hand of help. But the last two quadrants raise considerable complexities.

So the comments that media ethicist Bob Steele and media columnist James Rainey made were not just trivial comments made by people in the Ivory Tower or sitting on the sidelines of journalism – as I’ve seen some online comments charge. They raise legitimate journalism ethics concerns which are worthy of greater thought and consideration.

Screen shot 2010-01-18 at 9.39.44 AM.pngBefore getting on a plane to Haiti, each of these MD-reporters and their news organizations knew what they were getting into. Such journalism ethics discussions need to take place in newsrooms before events take place – not during or after. What discussions took place? Or was it a matter of: “Go down there. Jump into action as soon as you can and we’ll put it on the air?”

Ivan Oransky, a journalist who earned his MD, responded to my request for a reaction:

“When you’re the only specialist — or even doctor — around for miles, treating victims of wars and natural disasters you come across is the natural human inclination. I actually think it’s both understandable and justifiable, and probably even commendable.

But where these episodes start to worry me is when networks start making their doctors’ heroics into the story, and then pound viewers with clips repeatedly. That’s what all the networks are doing now. What I’m not in favor of is the reporter becoming the story, and the episode turning into marketing. It smacks of all kinds of exploitation, and it throws independence and skepticism into serious question. There are already enough forces eroding those principles.”

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January 18, 2010 at 3:24 pm

It would be much better if Dr. Gupta, et. al. stepped out of their journalistic roles and actually tended to the needs of the population if they thought they could be of real assistance. Instead we get what appears to be almost staged episodes of them tending to injured victims with the cameras rolling. There are obviously plenty of news crews running around getting the story out, almost to the point that it must stir anger in the Haitian population that is being actively filmed while awaiting real aid. The argument for the need of this to rally concern is not beleivable.
It is a sad state of affairs when we can get Dr. Gupta into Haiti from almost day one, but not some real doctors doing real medicine.

John Towriss

January 19, 2010 at 10:05 am

Thought provoking Gary and no easy answers. Good to read your stuff. John


January 19, 2010 at 12:05 pm

Gary, thanks for posting. I have also been interested in what seems to be a lack of boundaries regarding the visuals broadcast from Haiti as well.

Andrew Holtz

January 19, 2010 at 3:05 pm

There are two questions:
#1 – Does someone need urgent help and is the reporter the only one who can provide it?
If yes, then certainly the first duty of any person is to provide aid.
But don’t forget #2 – Is it a story?
If the news crew came across someone providing exactly the same aid, how much air time would they give that event? I’m not bothered much by a reporter mentioning what he or she did. However, if they give more attention to themselves than then would to another person doing the same thing, then it becomes self-aggrandizement… exploiting suffering for personal and professional gain.
Oh, there is a third question: How do they justify leaving the scene to go do their live shot or writing or other tasks? Does the urgent need magically disappear when the show open rolls?
Just think how many more people these physicians could help if they took a leave of absence from their network jobs in order to provide care full-time… and left the reporting to journalists.


January 19, 2010 at 3:44 pm

When a human risks their life to go into an unstable situation and report what is going on to the broader world, that is a force for good which has intrinsic value, however it is interpreted. The Irish documentary which aired in 2008 about Haiti would be something worth watching. This situation in Haiti has been around for awhile…maybe now that it’s on the radar of the celebrity doctors someone will pay attention.


January 19, 2010 at 4:42 pm

I have been stewing over CNN’s coverage of a few stories coming out of Haiti, including the transformation of reporters into entertainers.
Anderson Cooper traded his tailored suit for a black T-shirt and inserted himself into a street brawl to pull a young man out of the fray. That’s okay, but when (with cameras rolling) he tries to lead the bleeding boy around the corner, and then just picks him up and carries him — well, what are we watching here? A reporter or an action hero? If the urgency of the situation demands that the boy be carried to help or safety, great — stop rolling film and help get him to safety. This may be entertainment, but it isn’t news. News would have been an explanation of what the fighting was about and who the participants were, or why no one seems to be in control on the streets of Port-au-Prince.
Another reporter sheds light on the inefficiencies in getting medical relief articles from the port to the areas where they’re needed. A shipment of corneas ready for emergency transplantation didn’t get to surgical units in time, so they expired and are no longer viable. But then the reporter says, “Here, I’ll show you,” and proceeds to open up the package on camera and show the now worthless corneas. Gratuituous, unnecessary, unprofessional, and not news. News would have been an explanation of the breakdowns in logistical and transportation arrangements, what steps are being taken by whom to correct them, what it takes to transplant a cornea and whether or not such capability exists in the midst of the crisis, and whether donors are making arrangements with people on the ground to receive donated items before sending them on.
Wolf Blitzer interviews the U.S. Ambassador to Haiti shortly after Bill Clinton’s walk-through and receives clarifications about the U.S. response to the crisis. Great. But then he ambushes the ambassador by putting on the air the parents of a U.S. student who is presumed to be trapped in a collapsed building. Blitzer invites them to make their pleas for rescue efforts directly to the ambassador on the air, which they fervently do. The ambassador explains what he knows about the situation and promises to respond to the parents’ requests as soon as he’s off the air. Okay. But instead of letting him go and do just that, Blitzer keeps him and the parents on the air so that they can work themselves up even more and browbeat the ambassador with increasingly more emotional pleas and harangues for immediate action. Despite the ambassador’s assurances that he would do just that as soon as he was off the air, the parents and the reporter kept him from doing so. They was no further point to make, just an escalation of the emotional temperature. The parents were being exploited and the ambassador was highjacked for the sake of the network’s ratings. Gratuitous, unprofessional, sickening excuses for journalism. Jon Stewart would have done a more responsible job of identifying the salient issues and getting an appropriate response from the relevant parties.
At least Dr. Gupta actually performed surgery on someone who (presumably) needed his help, and says the right things about when to play doctor and when to play reporter.
I’m concerned that it appears that no one is doing the job of reporting anymore (with its attendant roles of editing, balancing, fact-checking, and synthesizing). Even more importantly, are there no editors out there?? Someone out there still knows what journalistic ethics are, right?
I’d trade hours of CNN’s entertainment approach for some good old fashioned reportage any day. And if humanity demands that they put down their camers and notepads for a moment and pitch in, then so be it — my need for news can wait awhile, and I can see an action movie anytime if I want to be entertained.
Thank you for taking this subject on.

Eve Harris

January 20, 2010 at 11:27 pm

I, too, appreciate that you’re asking the hard questions. Thanks to Tivo and NPR and online news sources like BBC I wasn’t aware of what CNN was doing — until I tuned in to Oprah today! She just magnified the hell out of it, of course.
I’m afraid it’s going to get worse before it gets better.


January 21, 2010 at 10:27 pm

Isn’t it our fault as the audience demanding to see the whole story and demanding more from our reporters. If Anderson Cooper had stopped filming the minute he realized the child couldn’t walk, wouldn’t we as a viewer demand he turn it back on so we can see what happened. And if he had just continued to film as the child stumbled down the street, we the viewers demand his intervention.
Maybe from our own demands of what makes the world a better place involves our own involvement in it especially during a crisis. And when we cannot, we want those who are there to do it for us.
There needs to be a change to the ideas of ethics that reflect the reality of the situation. The people are there. They have the ability to help and sometimes possess special skills. They have the tools to report that not only brings the story to the world, but brings aid and more help to where it is needed. No privacy was invaded. No unwilling participant complains later that the provided help was falsely given.
So why is it unethical to provide help and report it, to inform others to also provide help when it is needed.
If you found out that Dr. Sanjay Gupta preformed surgery in Iraq on a soldier who had been pronounced dead. And yet, because he was there, and because he was a neurosurgeon. He was able to provide a life saving operation. But no one reported it because he turned the camera off. You would want to know. So who would be better to tell the story than the person who is there. Who is going to provide the best critical information.
Maybe it is the ethics that need to be reviewed and not the people who are helping what little they can during difficult times.

Gary Schwitzer

January 22, 2010 at 7:33 am

Thanks for your note.
But I don’t agree with your premise that the audience is “demanding” this kind of coverage from MD-reporters.
No one in the audience “demanded” MD-reporter involvement in their own stories.
In fact, quite to the contrary. Commenters – many of them journalists – have spoken against these practices this week. The first piece I saw Dr. Nancy Snyderman file was one in which she was NOT the focus of the story. Rather, she profiled a physician-volunteer who flew to Haiti to help. The physician-reporter stayed in the background. And for that reason it was one of the better pieces that I’ve seen any of the network TV MD-reporters file from Haiti.
I agree that ethical decision-making needs to adjust to the realities of the situation. But there is nothing about this situation that made it necessary for the MD-reporters to report on themselves delivering care. Of the thousands of cases of need in Haiti, how were these stories chosen to profile other than the fact that the MD-reporter was involved in the case? That is – and will always be in any situation – a troublesome journalism ethics case. As I’ve written and said repeatedly this week – Provide care but don’t report on yourself doing so – and then much of this discussion would end.
You may not be troubled by these events. But as evidenced by comments from others on this blog and elsewhere, many journalists – who care a great deal about the erosion in public confidence in journalism – are very concerned about what they’ve seen.

Angela Gill

January 22, 2010 at 11:58 pm

Now may not be the time to mention this, but those of us sickened by the erosion in the quality of mass-media journalism aren’t just realizing it now with the plight of Haiti – this problem has been a recurring theme all through the presidential election coverage and bailout coverage as well. Uninterpreted news has become almost nonexistent as “experts” posing as reporters spout endless opinions in place of unbiased journalism. That is the real reason blogging has seen unprecedented growth as an interactive phenomenon – people are actively searching for real news by dedicated professionals who refuse to suck the Murdoch or Turner teats.


January 23, 2010 at 6:19 pm

Sanjay’s Gupta’s behavior is appalling. He is essentially using the Haitians as props for his self aggrandizement. Turn off the camera, put down the mike and help. Or just report and don’t make your self the central character in the story. CNN should be ashamed.


January 24, 2010 at 10:29 am

Dr. Sanjay Gupta is providing an invaluable service as a physician reporting from Haiti: he is getting the word out to doctors and other medical professionals worldwide regarding the details of the public health crisis as it unfolds.
Perhaps on-air reportage should stop when he is called to treat a victim in an emergency; I am conflicted about this issue. But by viewing a bit of that medical treatment as Dr. Gupta provides it, the viewers can see that that the doctor is sometimes called away from his duties as a reporter to deliver the care of a physician. He cannot ethically be a bystander in some cases, and viewers watch him make that choice.

Stephanie Knight

January 26, 2010 at 4:50 am

A medically trained person whether it be an MD, RN, etc… will naturally react to a medical crisis to help someone in need. My sense is that Dr. Gupta and other physician or nurse reporters have the genuine nature to help those in need. It just so happen that they are in the media with cameras constantly rolling around them. Therefore, any acts from the heart that occur in a critically depress and crisis area such as Hati tend to become a media showcase to the public.