The Ethicist
By KWAME ANTHONY APPIAH

I was walking home from dinner with a friend one evening down a quiet residential street. Two boys, ages somewhere between 8 and 10, were biking down the road accompanied by a middle-aged woman. I assumed she was their mother. The front wheel of the second boy’s bike took a glancing blow from the curb and sent its rider straight onto the sidewalk. The boy, nursing what looked like a bruised knee and ego, held back tears.

I stopped, expecting his mother to help him back up. Instead, I saw her slow down (but not stop cycling) and yell: “Watch where you’re going, you idiot! Now get up! What do you expect me to do, run over and make sure you’re O.K.? Come on.” At that point, the boy began to cry. I was so taken aback that I came very close to answering her rhetorical question myself. I held my tongue, however, because I noticed that another pedestrian ahead of me — who also slowed when the boy fell — put in her earphones and walked away quickly. Would I have been justified in intervening, or was it more appropriate for me to permit her to parent as she desired — even if it was obviously hurtful to the child and offensive to popular sensibilities? Sebastian Marotta, Toronto

I’m glad you mentioned the other pedestrian, because — speaking psychologically for a moment — you’re surely right to think that she played a role in your response. There’s a great deal of social science that shows that an individual is more likely to do nothing when there are others around who do nothing. In fact, the phenomenon has a name: the bystander effect.

As I’ve said before, we’ve gone too far in the direction of treating adults other than parents as barred from intervening when they see children in distress. A child who has been thrown to the sidewalk may well have suffered an injury that needs attention. You say that it looked as if he had a bruised knee and a bruised ego. But someone should have checked. That was the mother’s job, and yet it still needed to be done when she failed in her duty. You should at least have asked the child if he was O.K. In a situation where two people had already failed, your own nonintervention was psychologically understandable, but it wasn’t ethically permissible. Had you or the other pedestrian stopped, the mother might have been embarrassed (or annoyed) enough to turn back and make the necessary inspection.

Your response may have been motivated by concern for the child’s psychological welfare. You don’t want to heedlessly undermine a mother’s authority, and most parents would rightly insist that you can’t tell much from a single incident. But the little evidence you have suggests that the boy is stuck with a mother who took parenting tips from “The Great Santini.” A single intervention wouldn’t save him from that. And you clearly didn’t have sufficient grounds to report what happened to the child-welfare authorities. Still, a kind word would have let him know that there were people in the world more solicitous than his mother. The world is made better by such acts of kindness. (Though I suppose it’s possible that a child trained to our modern mores might have been disturbed by the attention of even a kindly stranger.) If this was a typical episode in the child’s life, your intervention wouldn’t have made up for his mother’s general callousness. If it wasn’t, there’s not much long-term harm done. So, either way, the world probably wasn’t made much worse by your abstention.

Four years ago I was raped by a friend who attended my high school. At the time, my rapist was dating someone who attended a different local high school. He furiously denied the rape, characterizing it instead as consensual sex. I had lied, he said, to conceal the fact that we had each been unfaithful to our significant others. His girlfriend, my boyfriend at the time and many of our mutual friends sided with him and either harassed me or cut off contact entirely. This fallout, combined with the trauma of the assault, threw me into a period of intense psychological and emotional distress. Over the past four years, I’ve struggled with anxiety and depression, post-traumatic stress disorder and substance abuse. It has taken time, but I am in a much healthier place now.

Another friend, who also went to my high school, knows all of this, and she has been fully supportive of me and has never doubted my account of the rape. In December, we were at a bar together when we ran into the woman who was dating my rapist when he committed the assault. This woman confronted me, and during this confrontation she clearly and repeatedly indicated that she still believed I had lied to cover up my infidelity. It immediately brought back the intense feelings of despair that I had worked so long to quell in the intervening years. My friend witnessed this encounter, and she saw how it affected me. At the time, she even broke up the conversation and spent the rest of the night comforting me while I sobbed.

Now, through an acquaintance, she has begun to form a friendship with this woman. I have expressed to her that this makes me uncomfortable, and she has apologized. But she continues to spend time with her. Although she never asks that I spend time with this woman, nor that I befriend her myself, I feel deeply uncomfortable with their developing friendship. To me, this friendship is a betrayal. I feel that my friend is effectively jettisoning our eight-year friendship for this woman whom she barely knows but whom she saw be so openly hostile to me. Is it selfish to be hurt by this? Do I have a right to ask her not to continue the friendship? If not, how do I respond to this friendship appropriately? I am at a complete loss on how to proceed, but I worry that this will harm this friendship that I value so much if I leave it unaddressed. Name Withheld

Since your friend knows about your situation, and knows how you feel about the woman who called you a liar, she has a conflict of loyalties. You should make it plain that you regard this new friendship as a betrayal. And then be prepared to drop her if she won’t stand by you. Friendship without loyalty is a lake without water.

I am a primary-care physician and have a patient who has a number of chronic orthopedic concerns that limit his ability to work in construction, his usual occupation. He is also addicted to methamphetamines and has zero interest in substance-abuse treatment. (He receives Social Security disability payments for an injury he suffered long ago in the service, and he is using this money to support his drug habit.) He also owes child support to his ex-wife. He asked me to write him a letter stating that he is disabled because of the orthopedic issues so that he won’t have to pay child support. I legitimately believe the patient cannot do construction work because of his joint problems. However, I don’t feel comfortable excusing him from his child-support responsibilities so that he can spend his pension money on drugs — especially when he declines to avail himself of substance-abuse treatment. I am torn about whether to write a letter on his behalf, knowing that his request stems from a desire to evade his financial obligations to his children (not to mention spending government dollars on illegal drugs). What are my ethical responsibilities to this patient? Name Withheld

The responsibilities in a case like this are rightly distributed among many parties. While his medical-privacy rights mean that you can’t write a letter without his consent, your job, as his doctor, is to report the facts of his medical condition accurately. The relevant authorities then have to decide whether, in the light of those facts, they will excuse him from paying child support. So whatever you write, you won’t be the one who relieved him of these responsibilities.

You don’t have to agree with every use that’s made of medical information you provide; there are decisions here that may lie outside your professional competence. And letters from doctors who are thinking about the outcome of the proceedings, not about the medical facts, are less useful to the authorities in question. If the system were hugely unjust or corrupt, you might have reason to refuse to comply with it. But you’re not justified in doing so simply because you disagree about the possible outcome in one case.