I was finishing loading my groceries into the car last week when I was presented with the regular challenge for any suburban grocery shopper. Do I leave the basket near the car or do I return it to the designated basket area 75 feet away? Those who have read my previous columns may recall that grocery stores are of particular interest to me for elucidating complex ethical dilemmas. Earlier, when there were many discussions about how to fairly allocate vital resources like intensive care beds and ventilators, I wrote about how grocery stores’ use of priority queues to some clients could shed light on the principles of equitable resource allocation frameworks: who has first access to a scarce resource and why.
The shopping cart question may be less loaded, but when faced with this challenge, it always asks the question, what is the right thing to do?1 The answer to this question is particularly important because if we can understand more clearly what drives us to do the right thing in a low-stakes setting like a grocery store parking lot, it can provide useful information for deciding questions. more important in health care. professional.
The easy, “cocktail party” answer to this question is to simply flip the basket because it’s the pro-social thing to do. There are no laws that require us to return the cart, we will not be arrested if we choose not to. However, we are social beings who live in communities that require people to cooperate with each other. When we shop in stores, convention, not rules, may require us to return the cart to its receptacle area. So even if we were to return the cart, anyone who’s ever walked through a parking lot knows that a lot of people don’t meet that standard.
Is it just that people are selfish and choose not to be helpful? We’re probably more likely to feel this when a cart is blocking the parking space we’re trying to park in, but this assertion of moral failing is perhaps an unfair accusation and an oversimplification. There are many reasons why we might find ourselves choosing to leave a cart behind. Some may not return a cart because they left a small child in their car seat. Others might have a disability or avoid returning the cart only when it’s raining or swelteringly hot. Some people might think it’s someone else’s job to turn the carts around.
A number of social science studies have helped us understand complex human choices when presented with similar scenarios that defy the norm.2 In general, when people see that others have already disrupted the norms, they are also less likely to follow the norm. In one study, participants were 3 times more likely to violate a parking lot’s “No Trespassing” sign if they saw that many others had already violated the “No Bike Parking” sign. Other studies with similar results suggest that while there will be outliers who always follow or ignore norms, the majority of us are susceptible to being influenced by the good or bad behavior of others.
Which brings us back to the central importance of standards in life and in medicine. Ethics asks us to think critically about our judgments to determine the right thing to do. When Dr. Martin Luther King, in his 1963 sermon, concluded that to be a good neighbor was to be selfless, he asked us to voluntarily obey unenforceable obligations.3 He reminded us that rules and laws, “binding” obligations that have legal consequences, are not necessarily enough for us to do the right thing. They are often just the floor below which we cannot descend, but they do not necessarily inspire us to do good to those around us.
So what can the solitary shopping cart teach us about our obligations as healthcare professionals? In many cases, the way we decide to take care of our colleagues and our patients will not be dictated by a rule, but rather by a standard. A code of ethics, an oath upon graduation from medical school, or the advice of an ethics committee are all generally advisory, ambitious, and unenforceable. We choose to do the right thing for many reasons: it feels good to help even if it means more work; we were taught this way by a respected mentor or colleague; we think the world will be a little better for it even if we are never known for it; or we remember that we are part of an honorable profession that is built on public trust and embodies a willingness to obey unenforceable obligations.
Whatever the reason, these normative decisions deserve our continued attention. We can all be susceptible to occasional moral failings because we are human. I admit that I don’t always return the basket, but the last time I was in this situation, I felt more obligated to do so because the person next to me was returning their basket. I hope my decision wasn’t just to avoid minor public shaming, but to try to be part of a community of people trying to do their best. We don’t always succeed, but trying is always the right thing to do.
David J. Alfadre MD, MSPH, is a health care ethicist and associate professor in the Department of Population Health at NYU School of Medicine in New York City. The opinions expressed in this article are those of the author and do not necessarily reflect the position or policy of the VA National Center for Ethics in Health Care or the US Department of Veterans Affairs.
- D’Costa K. Why don’t people return their baskets? sci-am. April 26, 2017.
- Keizer K, Lindenberg S, Steg L. The spread of disorder. Science. 2008;322(5908):1681-1685. doi:10.1126/science.1161405
- King ML Jr. On being a good neighbor. Draft Chapter III. Available from the Martin Luther King, Jr. Research and Education Institute, Stanford University.
This article originally appeared on Renal and Urology News