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    The Heinz Dilemma Revisited
    By Laura Hult | August 10th 2009 04:12 PM | 13 comments | Print | E-mail | Track Comments
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    As a paramedic working for many years in the Chicago metropolitan area, I witnessed firsthand the devastating and lasting effects of trauma not only...

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    What would you do in this situation?

    In Europe, a woman was near death from a special kind of cancer. There was one drug that the doctors thought might save her. It was a form of radium that a druggist in the same town had recently discovered. The drug was expensive to make, but the druggist was charging ten times what the drug cost him to make. He paid $200 for the radium and charged $2,000 for a small dose of the drug.

    The sick woman's husband, Heinz, went to everyone he knew to borrow the money, but he could only get together about $1,000 which is half of what it cost. He told the druggist that his wife was dying and asked him to sell it cheaper or let him pay later. But the druggist said: "No, I discovered the drug and I'm going to make money from it."

    Heinz got desperate and broke into the man's store to steal the drug-for his wife.

    Should the husband have done that?

    W.C. Crain. (1985). Theories of Development.  Prentice-Hall. pp. 118-136

    Comments

    Gerhard Adam

    Yes.  In the same way that the druggist had a right to place himself outside any moral or altruistic situation by simply declaring that the drug was a commodity he could sell.  The husband also had a right to sidestep the moral issue of stealing by doing what was necessary to look out for his own interests.

    It is pointless to discuss right or wrong in such a situation unless one is prepared to establish an objective moral standard.  The law does not fulfill that role.  There are many things which may be legal but not moral, just as there may be moral positions that are not legal.

    In the end, you do what you must.

    Gerhard Adam | 08/10/09 | 16:21 PM
    LauraHult
    Yes.  In the same way that the druggist had a right to place himself
    outside any moral or altruistic situation by simply declaring that the
    drug was a commodity he could sell.  The husband also had a right to
    sidestep the moral issue of stealing by doing what was necessary to
    look out for his own interests.
    A very interesting take on this, Gerhard, and not one that I had previously considered.
    In the end, you do what you must.
    I agree, and this is the balm that covers guilt for things we have done in the past to survive. 
    • Did you do the best you could at the time with the tools you had at your disposal? 
    • Had you thought of and tried other options? 
    • Did you have any other recourse?
    If my clients are a representative sample, then lots of people have trouble with guilt just for seeing to their own self-interest.  And individuals with PTSD seem to carry an overwhelming amount of this guilt:
    • "I should have seen it coming."
    • "I kick myself for not seeing it sooner."
    • "Why did I do this?" - this is a biggie, because the question can't be taken at face value.  There is a lot of self-loathing attached.
    • "I just wasn't good enough/smart enough/fast enough to stop it." - more self-loathing
    Questions like the Heinz Dilemma can help us predict what we might do and why, and how we got to this place to begin with.  The exercise is not just a simple moral development assessment tool.  It's off-label uses are also quite powerful.  Once a client can look at his/her circumstances somewhat more objectively, say from Mr. Heinz's point of view, they can perhaps begin to relax and quit blaming themselves.
    Laura Hult | 08/11/09 | 01:01 AM
    Gerhard Adam
    Laura, actually my approach is almost taken directly from game theory (Iterated Prisoner's Dilemma) and the "Tit for Tat" strategy.  In that case a player approaches the game to cooperate however if the opponent betrays (behaves selfishly), then the next round the opponent is punished by being betrayed.  Ultimately this will give rise to a cooperative environment, but it offers retaliation for having betrayed an implicit trust which is a necessity within a cooperative society.
    Gerhard Adam | 08/11/09 | 00:52 AM
    LauraHult
    Sorry Gerhard, I edited my reply after you initially read it.
    Ultimately this will give rise to a cooperative environment, but it
    offers retaliation for having betrayed an implicit trust which is a
    necessity within a cooperative society.
    Ah, but we do this already do we not?  Within our penal system the emphasis is not on rehab, but retribution.  Yes, there are some who are never going to be able to reintegrate into society, but some will.

    For instance, the young man who was incarcerated for dealing drugs but now wants to go straight and have a nice family.  His desires are simple, but he got into trouble for engaging in an illegal activity.  However, the young man originally began dealing drugs because he could not find a job and was slowly starving to death.

    His guilt over the situation is terrible, and he still cannot find a decent job.  Using the Heinz Dilemma as an example mitigates some of the frustration and self-hatred.  It still does not get him a job, but perhaps it gives him the will to stay clean for another day - and that one day may mean the difference between re-offending or finding a job.
    Laura Hult | 08/11/09 | 01:13 AM
    Gerhard Adam
    This is an argument I've often gotten into with people over the purpose of the law, because it is my contention that the only purpose of the law is to define the state's right for retribution.  It does nothing to offer protection (as is often alleged) nor does it satisfy the victims (since it is retribution by proxy).

    Overall I'm neither dazzled with the legal system or the penal system.   
    Gerhard Adam | 08/11/09 | 01:25 AM
    LauraHult
    Overall I'm neither dazzled with the legal system or the penal system.
    An understatement, my friend.  :)
    Laura Hult | 08/11/09 | 01:30 AM
    Gerhard Adam
    Ah, but we do this already do we not? 
    More to your point, I don't believe we do.  This type of reaction must occur between individuals and not a non-specific entity like "society" or "the law".  The problem with the scenario you've described is that "society" has no vested interest in cooperating, so it tends to leave people outside the system to fend for themselves.

    The example of the Heinz Dilemma is between individuals and lends itself quite well to the idea of game theory since each responds "in kind" without escalation and each has a vested interest in the outcome. 

    A key element of game theory strategies is that the most workable always has a provision for "forgiveness" so that the game doesn't degenerate into an endless round of retributions.  Unfortunately "society" hasn't discovered that part yet.
    Gerhard Adam | 08/11/09 | 02:03 AM
    LauraHult
    The problem with the scenario you've described is that "society" has no
    vested interest in cooperating, so it tends to leave people outside the
    system to fend for themselves.
    Society does have a vested interest - but the collective "we" hasn't figured out that maximizing the potentials of it's individual members is advantageous.  Sad to say, some of my colleagues don't even recognize the value of rehabilitation and have instead become functionaries and administrators of programs that are only marginally successful.

    The purpose of this exercise was to inspire thought, and perhaps encourage other therapists to think a bit outside the box.  An instrument such as the Heinz Dilemma can be useful not in diagnostic terms, but to reduce the burden of guilt that trauma survivors experience.  Alleviating symptoms goes a long way in maximizing potential...one person at a time.
    Laura Hult | 08/11/09 | 02:52 AM
    Steve Davis
    the druggist had a right to place himself outside any moral or altruistic situation
    And I think that at this point Gerhard, he placed himself outside the protections that society offers. He separated personal interests from society's interests.
    Steve Davis | 08/11/09 | 03:04 AM
    Gerhard Adam

    Yes, in a sense he elected to act outside the "trust" that constitutes a cooperative group.  Some people may argue that this is placing an altruistic requirement on the druggist, but it doesn't.  There is no compulsion for him to act in any particular way, but similarly there is no protection afforded to his choices either. 

    In particular, it is important to note that there is nothing required of the druggist that would be construed as "altruistic" because there is ultimately no sacrifice implied by the husband's request. 

    Gerhard Adam | 08/11/09 | 04:13 AM
    Warren Davies
    And I think that at this point Gerhard, he placed himself outside the protections that society offers. He separated personal interests from society's interests.


    Yes exactly.  The husband did everything in his power to raise the cash, his wife is dying, and the druggist is still making 5x profit.  The way I see it, what's immoral here is for the druggist to turn the husband down.  In other words; the druggist is an asshole who takes his Ayn Rand novels too seriously!  
    Warren Davies | 08/14/09 | 18:21 PM
    LauraHult
     The way I see it, what's immoral here is for the druggist to turn the husband down.
    Exactly my thought, Warren.  The husband would have gotten the druggist the money, just not all at once.  Faced with his wife dying or committing a crime, Heinz chose the lesser of two evils and stole the drug.

    Just as I would have.
    Laura Hult | 08/15/09 | 00:43 AM
    I found the reference to Ayn Rand very apropos. I always felt that what she missed in pushing the "virtue of selfishness" is that by treating any altruistic behavior on an individual's part as if it was a disease, she was denying the possibility that the altruism itself may have been in the person's self-interest. A mother who drowns trying to keep her child from drowning, might have preferred that result to one where she did not take a risk and had to face a lifetime of guilt.

    In the case of the druggist, if he had been only slightly less rigid--not to mention greedy, he could presumably have avoided damages to his shop, higher insurance premiums, and the loss of the drug. It would have been in his self-interest to accede to the husband's request.

    The AIG million-dollar-bonus guys never figured this out. What if hundreds of people who were wiped out by their financial chicanery had stormed AIG, attacked the workers and burned the building down? Would they still think those bonuses were in their self-interest?

    Rob Breyer (not verified) | 09/07/09 | 04:53 AM