Four Methods of Ethical Reasoningidentifies four (4) of ethical reasoning: Virtues, Utilitarian, Rights, and Justice.

answer essay questions:

• Analyze whether or not key stakeholder groups (e.g., drug manufacturers) were ethical if you applythe Virtuesmethod of reasoning. Provide examples.
• Analyze whether or not key stakeholder groups (e.g., doctors) were ethical if you apply the Utilitarianmethod of reasoning. Provide examples.
• Analyze whether or not consumers were ethical if you applythe Justicemethod of reasoning. Provide examples.
• Analyze whether or not manufacturers were ethical if you applythe Rightsmethod of reasoning. Provide examples.
• Analyze whether or not Other Actors mentioned in the case were ethical if you applythe Virtuesmethod of reasoning. Provide examples.
• Analyze whether or not Other Actors mentioned in the case were ethical if you applythe Utilitarianmethod of reasoning. Provide examples.
• Analyze whether or not Other Actors mentioned in the case were ethical if you applythe Rightsmethod of reasoning. Provide examples.

Base on the supporting materials listed below and the Profiting from Pain: Business and the U.S. Opioid Epidemic, p. 451-461:

Supporting Articles and Videos:

1. CNN (2023). Court grants Sackler family immunity in exchange for $6 billion opioid, May 30
2. Fox61 (2023). Sacklers, Purdue Pharma to pay $6 billion to settle opioid lawsuit
3. 2022 CNN Walmart agrees to 3 billion opioid settlement
4. Family behind Purdue Pharma engineered opioid crisis, Massachusetts AG says, CBS, Jan 24, 2019
5. BSNewsHour (2020).Conn. attorney general calls Purdue Pharma settlement 'a mirage', Oct. 22

Profiting from Pain: Business and the U.S. Opioid Epidemic, p. 451-461:

In 2017, McKesson Corporation, a leading wholesale drug distributor, agreed to pay $150 million in fines to the U.S. Department of Justice. The charges were that the company had failed to implement effective controls to prevent the diversion of prescription opioids for nonlegitimate uses, in violation of the Controlled Substances Act. For example, McKesson had supplied pharmacies in Mingo County, West Virginiaa poor, rural county with the fourth-highest death rate from opioid overdoses in the nationwith 3.3 million more hydrocodone pills in one year than it had in five consecutive earlier years. At the time, Mingo County had just 25,000 residents. Yet, the company had not flagged these orders to federal drug enforcement officials as out-of-the-ordinary.

McKesson, which at the time was the fifth largest company in the United Stateswith almost $200 billion in annual revenueplayed a largely unnoticed middleman role in the pharmaceutical industry. The firm's main business was shipping legal, government-approved medicines to pharmacies, hospitals, and health systems. McKesson's unmarked trucks rolled out at midnight from its 28 enormous, highly automated distribution centers, on route to their morning deliveries of one-third of all pharmaceuticals sold in North America. Although distributors like McKesson did not either manufacture or dispense opioids, they were responsible for notifying the federal Drug Enforcement Administration (DEA) and corresponding state regulators if orders suggested that controlled substances were being improperly diverted.

McKesson and other drug distributors were not the only businesses implicated in the nation's burgeoning epidemic of addictive opioids. Drug companiessuch as Purdue Pharma, the maker of OxyContinhad developed new prescription opioids and aggressively marketed them to doctors and patients, making vast profits for their owners. Entrepreneurs had opened pain clinics where unscrupulous doctors could write big scripts for the addictive pills, and pharmacies had looked the other way while dispensing drugs to suspicious patients. And illegal businesses, from producers of street drugs like heroin to networks of page 452dealers, had also played their parts. What responsibility did these businesses bear for the tragedy of opioid addiction, disability, and death?

The Opioid Epidemic

At the time of the McKesson's settlement with the Justice Department, the United States was deep in the throes of what the Centers for Disease Control and Prevention (CDC) had called "the worst drug overdose epidemic in [U.S.] history."

Fueling the epidemic was addiction to prescription opioids. Opioids were a class of painkillers derived from the opium poppy. Also referred to as narcotics, opioids included legal prescription medications such as morphine, codeine, hydrocodone, oxycodone, and fentanyl, as well as illegal drugs such as heroin. Opioids worked by dulling the sensation of pain. At high doses, they could also cause feelings of intense euphoria. The journalist John Temple, author of the investigative report American Pain, described the "high" experienced by users of oxycodone, a strong opioid, this way:

To understand oxycodone, imagine everything that makes a man or woman feel good, all the preoccupations and pastimes we are programmed to enjoy. Sex, love, food. Money, power, health. Synthesize all of that pleasure-seeking potency, and multiply by ten. Then cram it all into a pebble-sized blue pill. That's oxycodoneone of the most irresistible opioid narcotics ever cooked up in the six-thousand-year-old history of dope.

Opioids were highly addictive, and as users developed tolerance, they required larger and larger doses to get high or just to feel normal. Withdrawal from opioids, which could occur after even a single dose, could be excruciating. Users in withdrawal often experienced intense cravings, fever, sweats, and painsensations that addicts referred to as "jonesing." Addiction caused physical changes in the brain, weakening a user's impulse control and making it almost impossible to quit without medical assistance.

Opioids were killers. In high doses, these drugs caused breathing to slow and finally stop, bringing death by respiratory arrest. In 2015, 33,091 Americans died from an opioid overdose. This was just slightly less than the number that died that year in car accidents. Between 1999 and 2015, the rate of death from opioid overdose (number of deaths per 100,000 people) quintupled, that is, it was five times higher in 2015 than it was a decade and a half earlier.

Deaths from opioid overdose cut across all geographical regions and demographic groups, but some places and people were harder hit than others. Government data showed that although drug overdose deaths grew for all groups, those in mid-life (aged 45-54) had the highest rates. Rates were higher for non-Hispanic whites than for other ethnic groups. The states with the worst opioid problems were West Virginia, New Hampshire, Kentucky, and Ohio, with Rhode Island, Pennsylvania, Massachusetts, and New Mexico not far behind. Opioid use was higher where the economy was bad; as unemployment rates rose, so did overdose deaths. Some researchers called these drug overdoses a "death of despair," part of a broader pattern of rising mortality among middle-aged whites in the United States. "Ultimately, we see our story as about the collapse of the white, high-school educated working class after its heyday in the early 1970s, and the pathologies that accompany that decline," these researchers wrote.

Many opioid overdoses occurred in private, but a startling number occurred in full view of the community. As Margaret Talbot reported in The New Yorker, "At this stage of the American opioid epidemic, many addicts are collapsing in publicin gas stations, in restaurant bathrooms, in the aisles of big box stores." She related this story about the experience of two small-town paramedics, who responded to an emergency call from a softball field:

It was the first practice of the season for the girls' Little League team, and dusk was descending. [The paramedics] ... stopped near a scrubby set of bleachers, where parents had gathered to watch their daughters bat and field. Two of the parents were lying on the ground, unconscious, several yards apart. As [one of the paramedics] later recalled, the couple's thirteen-year-old daughter was sitting behind a chain-link backstop with her teammates, who were hugging her and comforting her. The couple's younger children, aged ten and seven, were running back and forth between their parents screaming, "Wake up! Wake up!"

The parents survived after the paramedics administered a drug called naloxone, but they were later arrested on charges of child neglect.

The pain inflicted by the opioid epidemic went well beyond overdose deaths. People who were addicted to opioids stole from their neighbors to support their habit, ignored their work and family responsibilities, and strained public welfare and law enforcement systems. Some were incarcerated, filling the jails. They made more visits to hospital emergency rooms and drove up health care costs. Babies born to addicted mothers often suffered from neonatal abstinence syndrome, going through painful withdrawal after birth. Grandparents, other relatives, and foster parents were raising the children of addicted parents.

The costs to local governments were often crushing. Ross County, Ohio, for example, saw its child services budget almost double from $1.3 million to $2.4 million from 2009 to 2016. "This has introduced an entirely different metric, an entirely different unpredictability in budgeting," said the top official of Indiana County, Pennsylvania, which had drawn on contingency funds to cover extra costs associated with the opioid crisis.

Some research showed that opioid abuse had hurt the economy by keeping people out of the workforce. A survey of men between the ages of 25 and 54 who were not working or looking for work found that almost half had taken pain medication the previous day, and two-thirds of these had taken a prescription pain medication. Of course, these men may have been out of the workforce because they were ill or injured, not because they were hooked on opioids. But anecdotal evidence was suggestive. The owner of an auto parts supplier in Michigan, for example, reported that she had great difficulty filling jobs at her factory. Part of the problem: when she sent new hires for a routine drug test, 60 percent failed to show up.

Purdue Pharma and the Rise of OxyContin

Many observers traced the modern opioid epidemic to the introduction, in 1996, of a new prescription medication called OxyContin. The company that developed it was Purdue Pharma, a privately held drug maker based in Connecticut. In 1952, three brothers, Andrew, Raymond, and Mortimer Sacklerall physicianshad purchased Purdue Frederick, a small pharmaceutical firm whose main products at that time were earwax removers and laxatives. The company later introduced MS Contin, an extended-release form of morphine used mainly by cancer patients. As the patent for this drug approached expiration, Purdue turned to development of an extended-release form of another opioid, oxycodone, which had long been available as a generic. The firm spent around $40 million to develop and test its new drug, which it named OxyContin. In late 1995, the Food and Drug Administration (FDA) approved the 80-mg dose of the drug (it later approved other doses).

Purdue's introduction of OxyContin coincided with changing attitudes in the medical community toward pain management. For many years, opioids were generally used only for end-stage cancer patients or those suffering from acute traumatic injuries or short-term post-surgical pain. Because of the risk of addiction, opioids were not considered appropriate for the treatment of chronic pain, and they were often mixed with other medicines like acetaminophen to discourage patients from taking larger amounts. In the 1980s, however, some physicians began to advocate for treating chronic pain more aggressively, saying that many patients with conditions like arthritis, back injuries, migraines, and fibromyalgia were suffering needlessly. Some campaigned to have pain recognized as the "fifth vital sign" (the other four were body temperature, pulse rate, respiration rate, and blood pressure). Because clinicians could not measure pain objectively, some adopted a one-to-ten scale, from "no pain" to "the worst pain" the patient had ever experienced.

Purdue allied itself with this view, cultivating relationships with professional associations, such as the American Pain Society and the American Academy of Pain Medicine, which promoted the idea that pain was undertreated. It sponsored pain-management educational conferences in resort locations for doctors. The company also hired more sales representatives, more than doubling its sales force from 318 to 767 between 1996 and 2000. Purdue sales reps were well compensated, earning an average of $126,500 a year, including bonuses based on sales. In 2001 alone, the company paid $40 million in bonuses. The company's detailers, as its sales representatives were known, used prescriber profiles to target general practitioners and those who were frequent prescribers of opioids. They handed out coupons for a 30-day free supply of OxyContin to doctors, who could pass them along to patients.

Purdue's sales representatives downplayed OxyContin's potential for addiction, claiming the risk was less than 1 percent. This dubious assertion was based on a five-sentence letter to the editor that had appeared in a 1980 issue of the New England Journal of Medicine, based on records of hospitalized patients in controlled settings. Sales representatives also argued that OxyContin's extended-release formula made it less susceptible to abuse; although the pill contained a large dose of oxycodone, users would not get a sudden rush because the drug's effects would be spread out over a 12-hour period, they told doctors.

Despite the company's claims that OxyContin's extended-release mechanism made it hard to abuse, addicts quickly discovered that they could crush one of the pills and then swallow, inhale, or inject it to produce an intense high. As the number of prescriptions for opioid medications rose, so did overdose deaths. Exhibit A shows the quantity of opioids prescribed from 1999 to 2016, alongside the number of deaths from prescription opioid overdose. (The exhibit reports all opioids prescribed, not just OxyContin.)

Exhibit B 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 1994 other substances. 1995 Drug Enforcement Agency Aggregate Production Quotas 1996 for Oxycodone (for Sale) by Year, in Kilograms, 1994- 1997 1998 1999 2000 2001 2002 2003 2004 2005 Sources: Federal Register, 1994-1997; U.S. Department of Justice, Drug Enforcement Agency, Diversion 2006 Control Division, "Controlled Substances: Final Aggregate Production Quotas," 1998-2006, and "Aggregate 2007 Production Quota History for Selected Substances," 2007-2017. This chart includes only oxycodone intended 2017 for sale. The DEA maintains a separate quota for oxycodone intended for other uses, such as manufacturing 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017Exhibit A Overdose Deaths from Prescription Opioids (per 100,000) and Opioid Prescriptions (Morphine Milligram Equivalents per 100), United States, 1999-2016 12 10 - 8 - 6 - 4 - 2 - o 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Deaths from opioid overdose Opioids prescribed Sources: "Prescription Opioid Overdose Death Rate per 100,000 Population," The Henry J. Kaiser Family Foundation, at www.kff. org; Gery P. Guy, Jr. et al., "Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015," Centers for Disease Control and Prevention Weekly, July 7, 2017; Centers for Disease Control and Prevention, "Annual Surveillance Report of Drug-Related Risks and Outcomes, United States, 2017; and personal correspondence with Dr. Guy. Deaths from legal and illegal fentanyl cannot be distinguished, so both are included in the KFF database. Data on prescriptions in MMEs for 2000 to 2005 are unavailable, but data on opioid pain reliever sales in kilograms per 10,000 show a steady rise during this period ("Vital Signs: Overdoses of Prescription Opioid Pain Relievers, United States, 1999-2008," Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, November 4, 2011)