P. Aarne Vesilind's Commentary on "Blowing the Whistle on a Therapeutic Experiment"

Jan's story is sad, but predictable. We all presume a high level of professional conduct on the part of our colleagues, and it takes a while finally to recognize a situation where this standard is not met. We are just not willing to recognize the situation for what it is. We assume there must be something we don't understand about the situation, and we give our colleagues the benefit of the doubt.

With hindsight, Jan should have become aware of the unethical conduct and her own untenable situation immediately and, before she spoke with anyone, gathered irrefutable evidence of wrongdoing. With this evidence in hand, but not necessarily revealed to anyone except her attorney, she should have approached the option of whistleblowing by first discussing the problems with the Director of Nursing (DON) and so on up the ladder to the hospital administration, using as little of her ammunition as needed at every step. It is possible that somewhere up the ladder the situation would have been resolved. If not, Jan should have found herself a good job in nursing or even outside nursing and then quit, blowing the whistle from a position of security and power.

But that's easy to say, of course. As I suggest, few people have such foresight.

Jan's actions in this case are not nearly as interesting as the ethical problems of the Director of Nursing. The DON would certainly be aware of the central issues in the situation (maltreatment of patients), and he/she would be in a situation similar to that of the Morton-Thiokol managers who made the decision to allow Challenger to fly. As engineers (and they were all engineers), they saw the long-range problems to the company if they did not acquiesce to NASA's clear wishes. The DON, both a nurse and a manager, would be in a similar situation. Just as it is more interesting to consider the problems of the Morton-Thiokol managers than the decisions by Roger Boisjoly and his colleagues, so it would be more interesting in this case to evaluate the actions of the DON. What should he/she have done? Does he/she have any responsibility now for what has happened to Jan? Jan clearly did the ethical thing and suffered for it. But we don't know what the DON has done, and what effect these actions have had on his/her career. By focusing on the DON, the case might have been written with less passion and more disinterested journalism.