An Uncertain Future

In your second year of college, you met your current fiancé. You found many interests in common and found little disagreement over the conduct of your daily lives. You cared deeply about this person and looked forward to a life together. After graduating college, you found it difficult to find a great job, so you joined your fiancé in building a small business, which had been started by your fiancé before you met. Your fiancé was much more knowledgeable about the technical side of the business, and throughout your college years, you worked occasionally as an employee and started to learn on the job. After your college graduation, it had grown into a modestly successful construction/design/craftwork business with the potential to make a middle- income for a family. You agreed that getting married about two years after college and starting a family was a great plan that fit your life goals.

As you worked more hours in the business, you learned the business really needed two people (or more) to do all the work necessary to succeed. You found out that your fiancé had a difficult time keeping employees because they were paid "under the table," with no benefits or payroll taxes withheld, and occasionally they had to wait a while after their pay was due because of poor cash flow in the business. Contract work often involved lump sum payments at long time intervals, so pay for employees often came after these lump sum payments were made by clients. In fact, this is how you were paid for your work in the business. You were definitely not an equal partner (and had far less experience), but your fiancé was a patient and easygoing boss and you enjoyed the work. You accepted that, as a spouse, you were probably the only person who would be willing to accept these employment conditions for the long term. Nevertheless, you grew concerned about the legality of being paid "under the table" and noticed that your fiancé frequently violated the most basic accounting practices. You often found invoices and other paperwork stuffed in drawers, seats of vehicles, and other obscure places.

At your urging, your fiancé reluctantly visited an accountant. During the visit, you learned that taxes frequently went unpaid and most records were poorly kept. Ongoing nagging about properly kept records resulted in little action by your fiancé, and you suspected that the business side of the operation would always be unorganized and potentially in legal trouble. Still, your fiancé was more knowledgeable about the business than you. This whole accounting thing could be swept aside by griping about government, taxes, and loss of freedom! You could see that little follow-up would result from your visit to the accountant. You worried about the financial liability if your business was audited by state agencies or the IRS, or if you ever needed the benefits resulting from payroll taxes. You also knew that failing to remit payroll taxes associated with the business would result in an inability for you and your spouse to collect Social Security retirement benefits and Medicare when you retire. Your parents urged you to think carefully before marrying under these work arrangements and warned you against signing on as a legal owner in the business. They also encouraged you to get a job outside the business if you were going to marry this person. They were happy to keep you on their health insurance, but warned you that you would have to get your own health insurance when you turned 26.

About a year and half after your college graduation, just as wedding plans were getting underway, your fiancé came down with a chronic illness, Stage 3 multiple myeloma, which is a type of cancer with effective treatments, but no cure. Your fiancé had no health insurance, which is primarily an employment-based insurance system for young people in the United States. Recall, the business paid no benefits and provided no healthcare insurance. At the time, Obamacare had just been implemented, but it was being implemented in stages. Small businesses, which have the opportunity to obtain government subsidies to make health insurance more affordable for employees, were not yet included in the implementation. Without insurance, it was high unlikely that health care providers would provide the treatments necessary. Without treatment, death within a year was almost certain. Hospitals are only required to provide immediate emergency care, not long-term treatments. Obamacare did require health insurance to be offered to individuals, including those with pre-existing conditions, but such insurance was likely to be extremely expensive if purchased outside government-run websites. Your fiancé had not signed up for health insurance during the Obamacare open enrollment period, so your fiancé was without insurance at the time of discovering this illness. By a stroke of luck, your fiancé remembered that her/his family included 1/16 blood of a Native American tribe that was recently recognized as valid by the U. S. Government. According to tribal laws, this 1/16 portion of progenitor blood allowed full claim on treaties between Native American tribes and the U. S. Government, so your fiancé was able to obtain Obamacare health benefits under agreements for health care with recognized tribes. You yourself had health insurance through your parents because you were under 26 years of age. Tribal law included some uncertainties, and it was unlikely that you or future children could obtain the same insurance as a spouse and offspring.

Once insurance was in place, treatment worth a half million dollars over the course of the next year began. Treatments for the disease caused you to put your wedding plans on hold. You valiantly saw your fiancé through the difficult treatments, hospital stays, and doctor's appointments. Business activity came to a trickle during the treatments, and you obtained several short-term seasonal jobs to help with finances. Your fiancé resented your jobs because of concern that the business needed your time. You did what was possible to keep the business afloat by putting clients on hold or doing the work you were capable of doing, but business was significantly curtailed. You also took on more household duties during the illness. Your fiancé was a difficult patient and made both physical and emotional demands on you. You often felt inadequate to the task and faced frequent criticism from your ailing patient. Many cancer patients go through stages of grief, including anger and resentment. Often these emotions are foisted on the primary caretaker, so what might have once been an easygoing relationship develops into a difficult one. The treatments were very successful, but long-term prospects for the disease were highly uncertain. Usually the cancer comes back within 4 to 10 years, but for some patients, recurrence might be sooner. A few lucky patients make it past 10 years.

You are now at a crossroads. Your fiancé is recovering nicely from a stem-cell transplant (bone marrow transplant in the past). Your fiancé is optimistic and ready to get back to your original plans for marriage, children, a new house, and a small family-run business. You are not so sure about that future for many reasons. What should you do next? That question dogs you nearly every minute of the day now.

Assignment:

Question 1: Determine (the) ethical dilemma(s), competing values, various stakeholders, possible outcomes, and options availablefor this decision.

Question 2: Make a recommendation or decision about what to do. Use at least one ethical viewpoint to help make the decision, being certain to articulate the basis of the ethical viewpoint.