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12

COMMUNICATION ETHICS FOR RISK, CRISES, AND PUBLIC HEALTH CONTEXTS

Shannon A. Bowen and Jo-Yun Li

By way of introduction, I had defined ethics as a science that teaches, not how we are to achieve happiness, but how we are to become worthy of happiness.

—Immanuel Kant in his work On the Old Proverb: That May Be Right in Theory but It Won’t Work in Practice (1974, Reprint, p. 45).

The Intersection of Ethical Communication, Risk, Crises, and Public Health

In the modern world, we are surrounded by risk of all kinds. Many of those risks result in crises, and a plethora of health outcomes often follow. For example, the 2016 earthquakes in Japan were a relatively known risk after the 2011 earthquakes and tsunamis that killed tens of thousands. When the 2016 earthquakes hit, that resulted in a public health crisis—not only for first responders and those killed or injured, but for businesses and organizations of all kinds. They had to deal with the resulting lack of electricity, food supplies, transportation, water, and other basic services, along with numerous other implications for survivors.

During and after crises, the number one commodity demanded is communication and the information supplied by that communication. In situations where risk materializes to crisis, people instinctively ask: “What is happening? How bad is it going to get? How long is it going to last? Are my loved ones well?” Whether the crisis is an infectious outbreak or a natural disaster, communication plays the central role and ethical communication is a must.

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Theories and principles in risk management and crisis management have been studied from public relations, rhetorical, business, governmental, and financial perspectives. Outgrowths of that study are the specialized fields of risk communication and crisis communication, employed to enhance the effectiveness of communication between publics and the organizations or governments upon which they depend in exigent times. Lives may be at stake during crises, so the goals of ethical communication need to be defined clearly.

Ethical communication can be viewed as providing forthright, candid, honest information (Bowen, 2016). It also entails the concept of contextual disclosure, meaning that relevant information and facts are not withheld, but are provided in a context that helps people make fully informed choices (Bowen, 2016). To provide information that is less than this standard of honesty is unethical, and this chapter explains why. First, we offer a literature review of the current state of research on ethics in risk, crisis, and emergency contexts. Then, we offer an examination of that literature in terms of the evolving media and social media. This chapter then provides an overview of three schools of ethics: utilitarianism, deontology, and virtue ethics. We offer a new, integrated decision-making guideline in which all three of those perspectives are used to examine a risk, crisis, or health problem. A short case study of SARS is offered at the conclusion of the chapter as a means for using the questions in the ethical guideline presented in Figure 12.1. This chapter seeks to offer an understanding of how to use rigorous ethical frameworks to determine the correct course of communication in the face of risk, crises, or public health contingencies.

The State of Risk, Crisis, and Emergency Communication Research Related to Ethics

Risk management entails the collective management and reduction of risk of many kinds, and risk communication facilitates knowledge about that risk. Risk communication in public health has been associated with messages provided by health professionals regarding the potential risks of specific behaviors (Freimuth, Linnan, & Potter, 2000; Witte, Meyer, & Martell, 2001). The messages are expected to alert target audiences to the risks of certain behaviors, such as an unhealthy diet or unsafe sex, and persuade them to adjust their behaviors accordingly.

Crisis communication, on the other hand, is frequently referred to as crisis and disaster management (Barton, 2001; Coombs, 1995). It allows corporations and organizations to follow principles and strategies to repair a damaged reputation after crises and disasters.

Although differences have been recognized, risk communication and crisis communication typically interact at various points (Reynolds & Seeger, 2005) depending upon the issue at hand. Thus, in order to provide comprehensive communication guidelines, the public health community has merged the two traditions into an integrated approach known as Crisis and Emergency Risk Communication, developed by the Centers for Disease Control and Prevention (Reynolds, Galdo & Sokler, 2002). This five-stage framework includes risk, eruption, clean up, recovery, and evaluation, and it is used to address both risks and urgency of crises or disasters to stakeholders and the general public. Communication challenges can only be overcome when both crisis and risk are covered in the plans. The consideration of ethics is also key to successful communication plans while dealing with crisis and risk, an essential factor in the development and implementation of public health communication (Guttman & Salmon, 2004). From plan purposes to target populations, from message development to effectiveness assessment, and from content consistency to message accuracy, the demands for ethics in public health communication often outweigh their consideration in strategic planning (Guttman & Salmon, 2004).

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Findings from emergency communication on ethics. In recent decades, research has focused on the effectiveness and ethical principles of emergency public information (Glik, 2007), as well as the warning messages receivers need in order to receive the words, to understand the words, to realize that the information is related to them, to understand that they need to adopt protective action in order to avoid the risks and, finally, to adopt the assigned action (Mileti & Fitzpatrick, 1991; Mileti & Sorensen, 1990). Transparency, accuracy, and consistency of warning messages play extremely crucial roles in the process of information delivery (WHO, 2003). Transparent public communication allows the public health community and authorities to communicate guidance and suggested protective action effectively; at the same time, it also establishes the authority and credibility of responding sectors (O’Malley, Rainford, & Thompson, 2009).

In 2010, when dealing with one of the largest oil spill crises in the United States, BP management and the local government each drew criticism over a lack of transparency, including delayed disclosure of information and restrictions on media access. The negative perceptions regarding the oil company, reinforced by the outpouring of media reports, reflected a complete failure of private sector crisis management (Kimberly, 2010). Lessons learned from the BP oil spill crisis and similar crises: Rapid, full, and contextual disclosure with honesty and candor are now considered an organization’s ethical responsibility, as well as a strategic approach of minimizing the influence of hostile media coverage and fostering relations with customers and stakeholders (Bowen, 2016).

These ethical principles not only apply to crisis and risk management of corporations and organizations but also to the trust-building process between governments, public health professionals, and their publics (Bowen, Hung-Baesecke, & Chen, 2016). While communicable diseases may spread widely, candid, honest, and full communication by the public health community allows authorities to make appropriate decisions and provides sufficient information that targets the audiences that need to adopt protective action. Moreover, transparency is an effective strategy for public health professionals to establish public trust (O’Malley et al., 2009). Particularly when emergencies such as epidemics break out, the effectiveness of restricting individuals’ freedom of choices to comply with instructions directly influences public health professionals’ crisis and emergency management (Menon & Goh, 2005). The level of mutual trust between authorities and the many involved publics determines individuals’ behaviors about whether or not to cooperate with the instructions.

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Message consistency, honesty, and public compliance. A lack of ethical public communication could destroy public trust and undermine all phases of emergency management. One infamous example is the management of the 2014 Ebola crisis (Ratzan & Moritsugu, 2014). A day after New York doctor Craig Spencer (who was not required to quarantine himself after returning from treating Ebola patients in Guinea) tested positive for the virus, the New York authorities enforced mandatory quarantines for all travelers from infected areas. However, the policy was revised a few days later to allow home quarantines with monitoring from health professionals. The ambiguous information aroused controversy that greatly damaged public trust and contributed to a national panic about the disease.

In addition to transparency during information delivery, message consistency and accuracy are also key determinants of message recipients’ perception and behavior (WHO, 2003). Consistent messages over time are believed to be more effective than inconsistent messages, especially on individuals’ understanding and belief regarding risks (Mileti & Sorensen, 1990; Perry, Greene, & Lindell, 1980). For example, inconsistent information from the Centers for Diseases Control and Prevention (CDC) about who were at higher risk of contracting or spreading the Ebola virus caused a serious panic in the United States (Begley, 2014). This lesson was learned not only from Ebola but also from Mad Cow disease, SARS, H1N1, and, more recently, MERS (Middle East Respiratory Syndrome). To communicate with clarity is a crucial ethical obligation for the public health community (Ratzan, 2013). Communication with publics may be significantly different from communication with policy makers and medical professionals. In an era of information overload, consistent information for at-risk publics becomes particularly important.

Moreover, accuracy and certainty of messages can determine peoples’ response behavior to the warning messages (Glik, 2007). When an emergency breaks out, the public is eager to know every piece of information that the authorities know. During a public health crisis, every single word counts, whether it is accurate or not (Reynolds & Seeger, 2005). In order to enhance warning efficacy and to persuade the target population to comply with the messages, public health practitioners, authorities, and media often adopt strong motivating appeals (e.g., fear appeals) and attempts to intensify risk (Guttman & Salmon, 2004). Inaccurate and exaggerated information could contribute to unintended adverse effects that negatively influence individual psychological behaviors or cultural beliefs. Unintended negative effects frequently result from such public health interventions (Cho & Salmon, 2007).

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The distribution of health or warning messages, particularly messages that limit individual liberty, may motivate message receivers to choose the opposite behaviors that the messages advocate (Dillard & Shen, 2005). Examples include anti-smoking messages, which may trigger an impulse for smokers who are attempting to quit (Stewart & Martin, 1994). Today, media communication may be more persuasive and influential on individuals’ behavior than that of medical professionals (Ratzan, 2013), but only when the public health community and authorities disseminate accurate and evidence-based messages, ones where the intended desirable effects and unintended adverse effects are balanced. Overall, public health communication plans that are sensitive to ethical principles are believed to be better implemented and to be more trusted by the public (Guttman & Salmon, 2004).

The Role of a Rapidly Evolving Media in Risk, Crises, and Emergencies

In the era of continual media exposure, the ease of access to information has increased individuals’ expectations of instant news reports, particularly when public health crises and emergencies emerge. In the process of information delivery, mass media plays an increasingly decisive role in communicating risks and emergency public information to the public (Bennett, 2010; Reese, Gandy, & Grant, 2001; Stryker, 2003; Stryker, Emmons, & Viswanath, 2007).

In an evolving media environment, messages are ever more fragmented, often poorly sourced, and rapidly moving. These dynamics have given rise to the recent epidemic of “fake news”—essentially misinformation and disinformation that is successful because it is quickly disseminated, rapidly moving, and often difficult to trace or source. As a response to the fake news epidemic, and resulting distrust of information, the implications are heightened for ethical communication. Offering ethical, honest information with transparent sources is more important than ever to help create credibility, trust, and belief among stakeholders and publics.

This is especially true with information about health. More than half of Americans indicate that national, local, and cable television news are their main sources for receiving relevant health information (Kaiser Family Foundation/Harvard School of Public Health, 2001; Newport, 2002). In addition to receiving information passively, individuals have started seeking health information actively and paying more attention to relevant coverage in the news media. Health news trails weather, crime, and sports news in coverage, but has obtained the highest interest (average of 7.8 score) from audiences, using a 0–10 point scale to rate Americans’ interest in six issues such as health, science, economy, and politics (National Science Board, 2014).

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During health crises or emergencies, the public relies heavily on media and the Internet for updated information (Glik, 2007). Research shows that Internet usage and news website visits after the September 11 attacks were twice as great as the days before the crisis (Glass, 2002). The number of unique visitors to the CNN online news sites increased 23 percent, to 17 million, from the previous week. The Red Cross also received about 400,000 unique visitors every day during the week after the terrorist attacks. The use of media and the Internet by the general public for health information suggested that the public health community must be better prepared for communication with mass media during crises. Otherwise, public health professionals and authorities may fail due to a lack of control of the message during continuous media coverage of the crisis.

Perceptions and frames of issue importance. One aspect of risk management is the relationship between media coverage and individuals’ perceptions of issue importance (e.g., McCombs’s and Shaw’s agenda setting theory, 1972). Previous research shows that there is a high degree of similarity between a prominent agenda in the media and the audiences’ priorities (Kim, Scheufele, & Shanahan, 2002). Merely through the amount of coverage, the media tells people what to think about and what to pay attention to (Scheufele, Shanahan, & Kim, 2002). Even though individuals may not understand the specific contents regarding certain issues, they do believe that some are more important than others simply because they see them covered by the media. Thus, the exaggeration and amplification of issues by media may contribute to unintended adverse effects and impede communication plans of the public health community.

Another key idea is media framing of messages. Framing theory says that how the media frames an issue influences how individuals think about an issue (Scheufele, 1999, 2000). The different presentations and frames of the same information can generate different responses. In particular, the media and the public health community possess different perspectives on news relevance during crises (Shoaf & Rottman, 2000). Journalists tend to emphasize conflicts, consequences of crises and emergencies, and attribution of responsibility, while public health professionals attempt to minimize the conflicts and consequences of an issue (Barnes et al., 2008). “The reporter is drawn to the danger and drama, while health professionals emphasize prevention, reassurance and recovery” (Anzur, 2000, p. 197). As a result of the polarizing perspectives of news agenda when crises break out, an ongoing and effective relationship with mass media helps a public health community manage the problem.

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Interactivity. Traditional media (i.e., newspapers and television) are still important sources of information between the public health community and the public. But in the past decade, the Internet and social media have become the main sources of information for the general public during health crises (Jones & Salathe, 2009). The user-generated content on the Internet has significantly changed the format of public health communication. The public no longer receives messages passively, but actively participates in the stages of knowledge translation as message generators, transmitters, and sometimes “exaggerators” (Chew & Eysenbach, 2010). Picard (2010) explained:

In the era of the 24-hour news cycle, the traditional once-a-day press conference featuring talking heads with a bunch of fancy titles has to be revamped and supplemented with Twitter posts, YouTube videos and the like. The public needs to be engaged in conversations and debate about issues of public health, they don't need to be lectured to.

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Given the new interactive format of public health communication, developing effective communication plans is considered just the first stage of crisis and emergency risk communication. In the days before high penetration of the Internet, public health professionals employed traditional evaluation techniques such as surveys and focus groups to measure a target population’s perceptions and behavioral responses, in order to examine the success of interventions or communication plans. Now, immediate responses and public expressions on the Internet during crises can be a significant factor in the effectiveness of public health communication. Thus, immediately and consistently assessing information on the Internet and social media is necessary for public health agencies while dealing with emergencies.

Message fluidity and dynamism. When a public health crisis erupts, uncertainty and issue severity usually trigger fast and wide information dissemination that causes anxiety, misinformation, confusion, or even panic. Widespread speculation and rumors occur in the early stage of emergency situations (Samaan et al., 2005; Smith, 2006; Tai & Sun, 2011). Rumors and fake news circulate even faster in the era of participatory social media, which underlines the importance of candid, accurate, factual, clear, transparent public communication. Crisis and emergency information are particularly prone to poorly sourced and exaggerated reporting due to time pressure, fear, and lack of accurate information. Therefore, public health professionals must monitor information and public reaction on the Internet to address problems and speculations carefully.

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One example of the influence of social media in crisis and emergency communication is the Ebola quarantine controversy in New York City in 2014. After the New York authorities enforced mandatory quarantines for all travelers from the infected areas, news spread rapidly on Twitter, and promptly drew opposition from some public, who called the policy “inhumane.” Under the pressure of public opinion, local governments in New York and New Jersey revised the controversial policy a few days later. The policy change on Ebola quarantines could be considered a demonstration of social media power: attracting attention, mediating the coverage of traditional media, and effectively leading to actual policy changes.

Social media is an increasingly popular forum for the public to obtain information to understand a public health crisis or emergency (Vos & Buckner, 2016). It has the power to clarify incorrect information and stop the message distribution, complying with the requirements in the framework of Crisis and Emergency Risk Communication (Veil, Reynolds, Sellnow, & Seeger, 2008). However, a large proportion of information on social media does not mobilize individuals to adopt protective action, and a great many damaging rumors can be widely disseminated (Vos & Buckner, 2016).

In the 21st century, the evolving media is a double-edged sword. Appropriate coverage and discussion may help public health professionals enhance the public’s awareness of crises and emergencies; on the other hand, exaggeration and amplification in the mass media and social media may contribute to negative consequences such as unnecessary anxiety. How to communicate with the public effectively and ethically through media during crises and emergencies has become a primary challenge.

Demands for Ethical Accountability

Ethics is not an optional concern for public and private sector organizations (De George, 2010). Readily available social media channels lead to rising criticism (Li, 2015) and growing public demands for accountability and social responsibility. Infamous cases of governmental wrongdoing, corporate scandals, and failures of ethics have created widespread cynicism. This has resulted in a distrust of corporations, a suspicion of governing bodies, and a dislike for elected officials or leaders. Public trust in both business and government is at an all-time low on a global level (Edelman Trust Barometer, 2015). However, the upside of rapidly evolving media means that organizations can now speak directly to stakeholders and publics to counter rumors, fake news, or inaccurate reports. Doing so with attention to ethics is vital.

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To create long-term relationships with stakeholders and publics, both internal and external, organizations must be their own best ethical voice, both inside the organization and externally. Employees are exceptionally important to an organization. It has been argued that employees are the most important asset of an organization, giving a competitive advantage when other factors are equal and even acting as ambassadors during times of organizational need. But in order to offer both of those advantages to their employer, employees must have a sense of trust that the organization will treat them with good intent. Ethics builds trust: attention to fairness and integrity builds ethical awareness and creates ethical behavior, and in turn ethical behavior enhances trust.

Research shows that ethics is a vital part of strategic management and organizational decision-making (Bowen, 2008, 2009). Some research perspectives talk about character, others integrity, and others talk about honesty and moral principle. Some perspectives talk about the greater good or public welfare and social justice, while others talk about corporate social responsibility (CSR). When organizations do not attend to creating their own set of ethical values, someone else’s values will be imposed upon them. To maintain autonomy and independent decision-making, responsibility seems to be the most morally aware, strategic, and efficient means of creating an ethical framework.

Defining Ethics

Ethical communication requires attention to numerous concerns. Much confusion exists around the terminology of ethics in professional practice (Bowen, 2016), so a concrete definition was sought from moral philosophy. The literature of moral philosophy is the natural place to turn when one seeks to understand ethics. Moral philosophy, or the study of ethics and how we should make decisions, is a discipline that dates back to the beginning of civilization. As an old, rigorous, and formalized study, moral philosophy has much to offer to a younger, applied field such as public affairs or public health. Ethics is defined as rules, principles, or ways of thinking that guide actions, or “systematic study of reasoning about how we ought to act” (Singer, 1994, p. 4). Applied ethics can be defined as determining right from wrong actions.

Ethics is the study of what standards and moral principles apply, and should apply, to our actions or potential actions. The ethical is determined by its intrinsic value in terms of duty, happiness, responsibility, truth, and the ability of the decision to further or to uphold virtues such as integrity. There are three broad schools of normative ethics: utilitarian ethics, virtue ethics, and deontology. Each approach defines what is ethical slightly differently, and each approach has strengths and weaknesses. Therefore, this chapter combines the three classic approaches to normative ethics into a modern, imminently practical decision test offered later in the chapter. A brief review of each type of philosophy offers a basis of understanding that can enhance ethical decision-making on the parts of governmental entities, businesses, NGOs, and citizens.

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Utilitarian Ethics

The utilitarian school of ethics, refined and popularized by John Stuart Mill (1861/1957) defined the ethical as that which creates the greatest good for the greatest number of people, while minimizing harm. Although what constitutes “good” may be debatable, the utilitarian ethical framework is applicable in a public health context because the framework seeks to operate in the public interest. In fact, utilitarianism is the basis of the US legal system and is commonly employed in public health contexts (e.g., school vaccination requirements are based on a utilitarian ethos).

Utilitarianism is a consequence-based paradigm, meaning the outcomes, or potential outcomes, of a situation determine the ethical course of action. This framework stands in opposition to other schools of ethics, which consider moral principle, truth, or character as the determinants of ethical behavior. With utilitarianism, consequences carry the day. One must be astute at predicting consequences for the aggregate good, as well as evaluating the potential outcomes of actions.

Utilitarianism begins by requiring a “dispassionate objectivity” in which the decision-maker is “truly impartial” with regard to personal interest and the interests of others (Elliott, 2007, p. 101). Most moral philosophies begin with rationality, requiring objectivity, lack of bias, and an abrogation of selfishness and self-interested concerns that could taint a decision. Engaging in a moral philosophy-based analysis is a rigorous intellectual exercise in logic.

The utilitarian calculus is an estimation of the aggregate number of people who will be positively benefited, in the communitarian sense, by potential action minus the number of negative outcomes or harms created by the action. In other words, decision alternatives and their consequences are weighed against one another. The decision creating the most good and the fewest negatives is the ethical course of action. However, utilitarianism is very specific that rights and justice must be upheld even for those potentially harmed by a decision. Getting to a greater good through unethical actions is specifically forbidden. In other words, one cannot sacrifice ethics in order to create a more ethical consequence in the end. To do so would be illogical and selfish.

Mill believed happiness to be the greater good that should be maximized. He wrote: “The creed which accepts as the foundation of morals, Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness” (1991, p. 137). Mill maintained that his philosophy must be used to uphold individual rights and to build community, as happiness was found in community and ethic of care, or what is modernly called communitarianism (French & Weis, 2000).

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Utilitarianism is a useful theory to help determine what consequences of an action might be in the public interest. However, utilitarianism is often misunderstood and thus has several limitations. The tyranny of the majority can ensue, meaning that minority voices of smaller publics may not be heard. Although Mill was against simply using arithmetic to determine the ethics of actions, that is often how the theory is implemented. Other philosophers protest that human beings and moral ideas cannot be reduced to numbers. In that light, utilitarianism is reductionist in that it measures the outcomes of actions rather than the moral principle of the actions involved. Finally, utilitarianism requires the ability to predict future outcomes, yet we know that many outcomes are unpredictable or even unknowable (e.g., natural disasters, accidents, and so on).

The risks we face in daily living pose challenge enough; predicting potential outcomes of complex situations of risk, crisis, or public health is an intimidating prospect. Some scholars worry that the misapplication of utilitarianism can justify bad behaviors in seeking some greater good outcome. But even when undertaken with the best intentions, to communicate with anything less than honest, full, and contextual disclosure may actually increase the risks people face in the long term. For these reasons, utilitarianism is best used in a combined analysis with other forms of philosophy, as suggested later in this chapter. Combining the relatively common philosophy of utilitarianism with different forms of reasoning allows us to focus on its strength in examining the public interest while compensating for the weaknesses of the philosophy.

Deontological Ethics

Deontology is widely regarded as the most rigorous form of ethical analysis. This approach was developed in the 18th century by the Prussian philosopher Immanuel Kant, who is regarded as the most renowned of the enlightenment philosophers for his masterworks on ethics (1785/1964). He based his work on virtue ethics from ancient Greece but sought to make it more specific and practical. The resulting paradigm of ethics is known as deontology, quite literally the study of duty. Deontology has been studied extensively and applied in professional practice of numerous fields.

Deontology begins with rationality, but perhaps in an even more rigorous form than other moral philosophy. Kantian rationality is based on the equality of all people by virtue of their ability to engage in a rational analysis that is logical rather than aristocratic, well educated, or otherwise privileged (Kant, 1785/1948). One could argue that Kant is the premier philosopher of equality.

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Unlike utilitarianism, deontology is not based on consequences; they are simply one factor in a decision no more or less important than other factors. This form of ethics is based on moral principle rather than potential outcomes. It requires a thorough examination of obligations, rights, and duties to a universal moral law that requires all rational people to make decisions without bias. This theory is said to be universal because it is based on equality: it obligates all people to follow moral law through reason alone (Sullivan, 1989).

Deontology also requires a high degree of moral autonomy, meaning independence, objective moral analysis, and decision-making (Kant, 1793/1974). Kant acknowledged that the duty to do something also implies that you can actually implement the change, so some degree of authority to implement an ethical decision may be required. This means that Kantian ethics may be of limited help to those without authority (Bowen, 2004a). Moral autonomy is a form of objectivity that also rules out self-interest, selfishness, societal convention or norms, greed, and other means of introducing bias into an analysis.

Deontology uses three decision tests to guide a moral analysis. Kant termed them categorical imperatives because they are obligations without exception and are not hypothetical, subjective, or conditional, but apply categorically to all rational people. In order to be considered ethical, a decision option needs an affirmative answer to all three tests (Kant, 1785/1948):

Kant offered the categorical imperative, with its three tests, to help examine a potential decision from multiple viewpoints, such as the perspectives of stakeholders and publics. Kant intended to minimize bias and selfishness with these decision tests. Further, the universal nature of the first test emphasizes the enduring nature of ethical decisions. When competing obligations arise, Kant offered that a deciding factor should guide the decision. The deciding factor is the most important moral principle to be upheld, again speaking to the universal and cross-cultural power of this paradigm. Although it requires a great deal of information or research to understand multiple perspectives, deontology is based on moral principle rather than predicted consequences. Though conducting a deontological ethical analysis is not easy, the outcome is worth the time and effort. Because of the rigorous nature of a deontological analysis, it is thought to create more thorough, defensible, consistent, and enduring ethical decisions than other frameworks (Bowen, 2004b).

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Virtue Ethics

The progenitor of deontological ethics, Immanuel Kant, wrote: “I had defined ethics as a science that teaches, not how we are to achieve happiness, but how we are to become worthy of happiness” (Kant, 1793/1974, #357, p. 45). Kant’s idea is that worthiness is the ultimate goal, and his definition is derived from virtue ethics. It also shows a eudaimonistic approach, meaning that it accords value to human well-being or a life well lived. The eudiamonistic value of ethics is a tradition established by the ancient Greek philosophers and derived from the Greek term for happiness (Annas, 1993). But ethics cannot be defined through an over-simplified understanding of happiness as self-gratification. Rather, ancient philosophers such as Socrates, Plato, and Aristotle viewed ethics in terms of a life well lived in accordance with achieving the highest or supreme good, based on questioning our conception of what is good through rational examination. This eudaimonistic approach in virtue ethics equates happiness with self-reflection, inner knowledge, truth, peace, and satisfaction from living a life of character, all achieved through practice and rational examination.

Virtue ethics requires reflecting on one’s own actions and how they measure up to the ideals of integrity, questioning, arguing for truth, and virtuous moral character, in seeking the life well lived. Virtue ethicists often focus on what they have contributed through living, how they introduced happiness, or how they will be remembered. Modern virtue ethicists (Foot, 2003) have termed these complex goals the pursuit of “human flourishing,” enhancing the ability of ourselves and those around us to thrive through the seeking and attainment of high ethical standards. However, this method implies that such judgments require reflection over time and a great deal of life experience, rendering virtue ethics highly impractical. Most issues of risk, crises, and public health emergencies offer little time for reflection, and most of us do not have experience with all of the innumerable possibilities. To make virtue ethics easier to implement, it has been incorporated alongside the supporting deontological theory and utilitarian concepts presented below. When combined with other moral philosophies, the conceptual strengths of virtue ethics can be maintained while compensating for its deficits.

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An Integrated Approach to Ethics

Ethics helps to determine the best solution to a dilemma as well as helping to create new options for resolution of complex dilemmas through the analysis of a specific situation. When based on rational analyses, a rigorous consideration of multiple perspectives occurs, resulting in defensible conclusions and well-researched arguments. The more powerful the analysis, the better; so, the three primary forms of moral philosophy have been integrated in this chapter to guide an ethical analysis. Please refer to the Integrated Question Analysis of Ethics in Figure 12.1.

Utilitarian philosophy has a primary strength of considering the effect of actions on publics, pondering the consequences of risk, crises, and public health problems. It is particularly useful for government as it exists to organize and prioritize public interest, but can be employed from any perspective. The shortcomings of utilitarianism are countered by incorporating a powerful principle-based analysis through deontology. That way, public interest is considered as a primary goal, yet tyranny of the majority is not possible because of the rigorous reliance on dignity, respect, and equality for all people.

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Deontology is used to introduce a duty-based principled form of ethical decision-making. It maintains a universal perspective, requires dignity and respect for all involved publics, and uses good intention or a morally good will as the ultimate test of an action. A decision is thought to be ethical if it can pass these tests, so all three tests are present in the integrated approach offered here. The concepts of virtue ethics are introduced to enhance ethical goals and fortitude of the analysis while reducing its reliance on hindsight through the more practical questions of utilitarianism and deontology.

Integrating utilitarianism, deontology, and virtue ethics means that multiple definitions of good, duties, rights, and intentions can be examined. Using multiple viewpoints strengthens the intellectual rigor of analysis. Although each of these philosophies may have a different way of defining ethics, they all have in common a reliance on rationality and moral autonomy. That means that these philosophies can be used in conjunction to form an integrated analysis.

The integrated analysis offered below takes the form of questions that are applicable to any situation. These questions can be asked of individuals, groups, or organizations. The beauty of asking questions is that even though answers may not be readily available, decisions are certain to be better analyzed than those undertaken without scrutiny. As many scholars have noted, we grow wise by asking questions. Even questions that remain unanswered may offer insight and fertile new ideas for consideration.

An ethical examination fosters the understanding of complex problems from multiple viewpoints and creates reasoned analyses of difficult situations with numerous implications and competing priorities. Simple yes or no questions rarely need a full ethical analysis to determine the best course of action. The questions presented below are in the chronological order necessary to guide an ethical analysis, and are those best suited to conducting an ethical analysis from each of the three paradigms discussed earlier in this chapter.

SARS Case

Use the following case example to walk through the integrated question analysis.

The Severe Acute Respiratory Syndrome (SARS) epidemic of 2002–2004 offers an excellent case for ethical analysis including elements of risk, crisis, and public health. Interspecies transmission of the SARS virus led to competing narratives from the numerous organizations and countries that were involved. Misinformation resulted from the competing narratives, and insufficient information about the origin of the disease and its modes of transmission were troubling to many. A lack of honesty and candor from the Chinese government were especially troubling. Regional and national health groups in China offered no specifics about the virus outbreak (Bowen & Heath, 2007). The origin and transmission of SARS remained “shrouded in mystery” and exacerbated the health crisis (Bowen & Heath, 2007, p. 74).

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The SARS epidemic spread to other countries and concerns of a pandemic of the potentially fatal disease were high. Understanding the origin of the disease was essential to developing a containment protocol and treating cases of SARS. Epidemiologists at the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) were heavily involved in researching the SARS virus. The Chinese government remained silent but authorities began to slaughter household pets: dogs and cats were suspected of carrying the SARS virus, but that information was incorrect.

Media coverage of the epidemic was prohibited by the Chinese government after some news reports began to criticize its emergency management (Huang, 2004). Moreover, Chinese authorities avoided communicating with the World Health Organization until a very late stage of the outbreak. The continued information blackout seriously hindered the public from receiving up-to-date information and deterred the authorities from addressing the chaos (Huang, 2004).

In May 2003, Hong Kong researchers identified a wild rodent-like creature called a civet as the source of the coronavirus that led to SARS. Food was scarce in the Guangdong province where SARS originated, so locals had turned to the wild rodent as a food source, resulting in the inter-species contamination that created the SARS epidemic. The Chinese government found this explanation embarrassing and actively worked to suppress information about the source of the disease. It also continued to promote tourism by issuing statements saying that it was safe to visit and tour China. The Chinese government did not recognize any authority of the WHO or CDC. Yet when the Ministry of Public Health quarantined 10,000 Chinese in Nanjing in late May 2003, the crisis could no longer be denied.

Valuable months had been wasted by the Chinese government in an epidemic that caused 8,100 illnesses and 800 documented deaths (Bowen & Heath, 2007).

Where did the Chinese government go wrong? What were their priorities in decision-making? How were the publics, both sick and healthy, considered? Most importantly, what would an ethical analysis using the integrated questioning model have indicated as an ethical resolution to the SARS crisis? What would using the integrated question analysis have you do differently?

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[For a detailed discussion and ethical analysis of the SARS case, see Bowen & Heath, 2007.]

Implications

The theoretical implications going forward are many. Using an integrated approach to ethics of virtue, utilitarianism, and deontology offers a robust means of analysis—perhaps stronger than each philosophical approach alone. There are many benefits to using a three-philosophy approach, but also three times more risk. One must be aware of the pitfalls of each philosophy and guard against those entering the analysis: the hindsight and experience needed in virtue ethics can be a hindrance to fast-moving problems in a rapid media landscape. The tyranny of the majority, reducing people’s concerns to numbers, and difficulty in predicting future consequences, all inherent in utilitarianism, should be guarded against. The difficulty of finding a universal moral principle that maintains respect for all parties in deontology requires volumes of unbiased research including multiple perspectives.

This process is time-consuming and challenging, involving higher-order reasoning, logic, and critical thinking. This combined moral approach is a new avenue of thought with solid theoretical backing yet scant empirical testing. Combining these forms of moral analysis can offer solid decisions with ethical implications that are based on the most unassailable moral principles. Decisions made in this manner from a basis of good intention should survive the turmoil of a rapidly moving and changing communicative context, assaults from fake news, and challenges from biased opponents. They are defensible based on the most rigorous types of moral analyses yet developed.

In implications for practice, unforeseen hurdles to implementing an integrated virtue-utilitarian-deontological analysis may arise. Decisions are only as good as the data on which they are based, and access to accurate and complete data could be an impediment. The time pressure to communicate during crises, disasters, and public health scares can lead to missteps. Future research could test and study the implementation of this combined moral analysis in various professional settings and situations to refine the theory for practical implementation.

Conclusions

In confronting public mistrust of government and media outlets, organizations now need to be the best and most accurate source of information for stakeholders and publics. That standard requires a high degree of ethical expertise, multiple forms of research and vetted sourcing, and insightful, critical analysis. But in a media environment with accusations of insider collusion and fake news a daily occurrence, organizations face a vacuum of credibility.

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Where can stakeholders and publics now turn for truthful, accurate, full, objective, and trustworthy information? The rigorous combined and integrated ethical analysis of virtue-utilitarianism-deontology presented in this chapter offers a means through which that vacuum of credibility can be filled by organizations offering honest and ethical information. The integrated three-philosophy question guide presented in this chapter offers a theoretically strong and analytically insightful way to create better organizations and better communications, one decision at a time.

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