Q: I am an anesthesiologist. A few of my patients are children undergoing their first surgery — understandably nervous, sometimes in tears. Medications can calm them; developing a rapport with them also helps. One way I do that is to propose a contest. If they can pop the “balloon” (the bag an anesthetized patient uses to breathe), they will win a fabulous prize — a pony, a puppy, a motorcycle. This task is effectively impossible (but their deep breathing puts them to sleep faster). Some nurses complain that children in the recovery room are very disappointed when told they did not win a prize. Should I suspend the contest? — Mark Isaac, Mansfield, Ohio
A: Wait a second: I’m not getting a pony?
Fine. I knew we were only playing. Some young patients, unfortunately, do not, as their post-op responses confirm. Your admirable efforts to ease their fears, although effective in the short term, can soon disappoint these kids and, worse still, undermine their trust in doctors, rendering them yet more anxious the next time they’re in a hospital. Thus, while you need not suspend your contest, you should revise it.
It is fine to engage children in a calming game, but there is a difference between a game and a lie. In the former, all participants know they are playing; in the latter, some do not. Age is a big factor. Older kids can often understand what younger kids cannot. You might try less-competitive games with younger patients or promise more modest prizes that you can actually deliver — inexpensive toys or games, for example.
Q: I teach in a public high school, usually Advanced Placement English, but last semester I taught a film class to second-semester seniors, a notoriously disengaged group I found hard to reach. I suggested to a colleague and friend who’d taught film that we swap: I’d take his sophomore English class. The switch was approved, but within a week I discovered that many of the sophomores had severe difficulties — some were on medication, some were being treated by psychiatrists — and should be taught by a specialist. Shouldn’t my colleague have alerted me in advance? — L.H., New York
A: Absolutely. By withholding information he knew to be relevant, he injured both you and the students in that English class, apparently landing them with a teacher untrained to meet their needs. And while you should have better investigated the situation before making the switch, that is a failure of competence; his was a failure of ethics.
If he were selling you a house in August with a basement that flooded each April, he’d have both an ethical and (in some jurisdictions) a legal duty to clue you in. We can make a truly free choice only if we have all salient information. As bad as it is to tacitly gull someone in a financial transaction, it is worse in your situation, a betrayal of your colleague’s professional obligation to his students and the duties of friendship he owes to you.
There is another polecat in this moral bayou: your principal. If those English students had learning disabilities or emotional or psychological problems that required expert assistance, your principal should have made sure they got it and not allowed them to be fobbed off on someone without the specialized training required to educate them effectively.
Send questions and comments for Randy Cohen to Universal Press Syndicate, 4520 Main St., Kansas City, MO 64111, or ethicist@nytimes.com.
