I know that some people may not see any ethical conflict in physician-reporters like CNN's Sanjay Gupta, CBS' Jennifer Ashton and ABC's Richard Besser reporting on their own delivery of health care in Haiti.

But people who think a lot about these issues DO have concerns.

Media ethics guru Bob Steele of the Poynter Institute and DePauw University told the Los Angeles Times: "It clouds the lens in terms of the independent observation and reporting." Given that Gupta's story involved a child who — in the end had a cut but no head injury — Steele said, "Frankly, it isn't much of a story. You can't help but look at this and worry there is a marketing element in it." Los Angeles Times media columnist James Rainey referred to it as "self-promotion." That's from a journalism ethics perspective.

Physician-ethicist Steve Miles, MD, of the University of Minnesota Center for Bioethics wrote to me:

"The reporters who have been practicing well-televised drive-by medical care in Haiti are demonstrating an appalling abuse of medical and journalistic ethics." He feels the decisions on what to broadcast are based on what presents itself as a "telegenic case."

Miles served as medical director for the American Refugee Committee for 25 years, including service as chief medical officer for 45,000 refugees on the Thai Cambodian border and projects in Sudan, Croatia, Bosnia-Herzogovina, Indonesia, and the Thai-Burmese border. He is on the board of the Center for Victims of Torture. He wrote:

"They justify this form of self-aggrandizement by its effect in mobilizing response for the larger disaster. The added value of their self promotion largely goes unchallenged."
 
Dr. Carl Elliott, also on the faculty of the UMN Center for Bioethics, wrote to me:

"It's worse than self-promotion. It's exploiting the suffering of Haitians for the PR goals of their employers. They should not be reporting on their own work. That's a classic PR tactic: using humanitarian aid as a public relations device, in order to drive up ratings for their network."

Allow me to drop back and apply an ethics tool to the situation. For years I've trained undergraduate journalism students in the use of the Potter Box, named after Ralph Potter, an emeritus professor of social ethics at Harvard Divinity School.

The box has four quadrants, labeled Facts, Loyalties, Values and Principles.

The facts of the situation are that these MD-reporters are in Haiti, where there are overwhelming health-care needs.

What are the different values at play? Clearly, the moral value of helping a person in need is a dominant value.

What ethical principles may apply to the situation? Again, the "persons as ends" or "do unto others" principle could dominate the decision-making. But Aristotle's or Confucius' golden mean might call for a middle grounds of practical wisdom — an appropriate decision between two extremes. So, rather than doing nothing to help, or — at the other extreme — rather than reporting on one's own involvement in helping, a middle ground might be to help, but with the cameras off. In his media ethics workshops, Bob Steele always asks journalists to think about alternative pathways for telling a story — alternatives that might eliminate or minimize ethical conflicts.

To whom does the journalist have loyalties? This is probably the most essential quadrant of the Potter Box in this situation. Is this a journalist with loyalties to journalism principles? Or this is a physician with loyalties to his/her medical professional oath? It is difficult to be both. Time-honored journalism principles would dictate that a journalist should not be part of the story, that the "lens of independent observation and reporting" might be clouded if the reporter becomes part of the story. If an MD-reporter is guided by his/her sense of physician responsibility to care, look at how one citizen observer commented on the LA Times blog:

"With people dying around him every minute he should not waste a single minute serving as a reporter. He's a doctor and it seems unethical to me that he is not spending every waking moment of his time providing medical care to the thousands that desperately need it. Can't CNN find any other reporters and spare him for a few weeks so he can save some lives? I appreciate the fact that he helped that baby, but he could help SO many more if he would just put down his microphone."

Applying the values, loyalties questions to newsworthiness
One could apply both the "values" and the "loyalties" questions to the news value of the stories. Why, exactly, were these episodes that Gupta, Ashton and Besser featured in, deemed to be newsworthy? Because they were outstanding news stories? Or because it was a way to feature a CNN, CBS, or ABC employee in an active, care-giving role?

The code of ethics of the Radio-Television News Directors Association states: "Resist any self-interest or peer pressure that might erode journalistic duty and service to the public."

The Potter Box demonstrates the complexity of the ethical decision-making involved. The first two quadrants might seem like a slam-dunk in favor of the MD-reporters doing whatever they could to lend a hand of help. But the last two quadrants raise considerable complexities.

So the comments that media ethicist Bob Steele and media columnist James Rainey made were not just trivial comments made by people in the Ivory Tower or sitting on the sidelines of journalism — as I've seen some online comments charge. They raise legitimate journalism ethics concerns which are worthy of greater thought and consideration.

Before getting on a plane to Haiti, each of these MD-reporters and their news organizations knew what they were getting into. Such journalism ethics discussions need to take place in newsrooms before events take place, not during or after. What discussions took place? Or was it a matter of: "Go down there. Jump into action as soon as you can and we'll put it on the air?"

Ivan Oransky, a journalist who earned his MD, responded to my request for a reaction:

"When you're the only specialist — or even doctor — around for miles, treating victims of wars and natural disasters you come across is the natural human inclination. I actually think it's both understandable and justifiable, and probably even commendable.

"But where these episodes start to worry me is when networks start making their doctors' heroics into the story, and then pound viewers with clips repeatedly. That's what all the networks are doing now. What I'm not in favor of is the reporter becoming the story, and the episode turning into marketing. It smacks of all kinds of exploitation, and it throws independence and skepticism into serious question. There are already enough forces eroding those principles."

Gary Schwitzer is an associate professor in the University of Minnesota School of Journalism & mass Communication. This article is reprinted from his HealthNewsReview Blog.