I think he raises a good point that while its ideal to be ethical its not always possible due to other constraints/priorities. Being ruthless can probably save your skin in some cases.However, I have been thinking about the personal side of ethics; how its an individual thing. I would probably work for a fast food chain if need be because I feel there is enough information out there about how unhealthy this food is, for people to make an informed decision about whether and how often you should go there. On the other hand this video mentions the five year old girl on a diet. I personally think that self esteem is not a decision it is an influenced feeling, it is not something you can have in moderation. I would like to think that my work encouraged this amongst children particularly.
I agree with what he says about being a struggling designer. You may not be able to turn down a job that you deem goes against ethics and responsibility if you are not in work and need to pay the bills. Obviously if if it was something extreme you may decide against. It's easy for established designers and studios to pass up work.