Everyday EMS Ethics? Where do I get my authority to talk about anything ethical? Iím definitely not a perfect person. Iíve made some decisions that Iím not proud of in this life, Iím human, and Iím certainly not immune to the mud that life can sling on a person. How then can I talk about ethics with a straight face, knowing that Iíve made some of the very mistakes that I seem to be condemning?
Itís because that just like everyone else, I have the ability to feel good or bad about anything that happens to me and anyone else, I have the ability to introspect and wonder why my gut feels the way it does about something, I also have the ability to want to be a better, more ethical person. As silly as it seems in this world sometimes, striving to be a better person on this journey we call life is what we all must do as we edge closer to ďPoint BĒ in our path.
The omnipresent ďtheyĒ have always told me that ďBeing a good person means doing the right thing even when nobodyís lookingĒ and I like that phrase. If a lot more people took that view, I think that the world could improve overnight. Imagine if everyone did the ďrightĒ thing all the time? Weíd have no crime, no ďhalf-assedĒ jobs, and everyone would get along, right?
Well no, probably not. Of course things would improve and crime would cut down, but since two perfectly ethical people can have logical disagreements on the same issue, weíd still have discord and differences of opinion. Weíre all still human and human beings have different thoughts, feelings, emotions, and standards of right and wrong. Therefore, when one throws out the term ďEthicsĒ it seems to draw a lot of shrugs from people who arenít looking for the conflict it can generate, or who simply arenít looking to put forth the effort to debate their positions effectively.
Grey areas abound in any discussion involving ethics, but I think that it can be simplified. Even in an area where lives are literally on the line such as in EMS or other healthcare disciplines, the realm of ethics can be summed up in the above phrase about doing the right thing when nobodyís looking and with the application of the Golden Rule, the one about doing unto others as you would have others do unto you.
Of course, thatís not always easy as it sounds, is it? People are motivated by different things and behaving ethically in one situation may justify behavior that may be considered unethical in another. For example, take the case where a familyís breadwinner has to make more income to feed his/her family at home and that need justifies taking more overtime at work than would normally be considered his/her ďshareĒ of the OT and the extra income that it brings. The breadwinnerís coworkers may consider the person to be an ďovertime hogĒ and may think that he/she is behaving unethically whereas the breadwinner may feel that the need to feed his family with the extra OT income justifies his taking more OT than is his/her share. Who would be ďrightĒ here? If everyone had a family at home that they were supporting with the extra income from the OT, it wouldnít be ethical for that one person to take more than their proper percentage of the OTÖ but would it be right if everyone else was a single person with no families to support? Who would decide that?
We have to be unafraid to discuss the grey areas and tailor solutions to fit the unique situations we face. Discussion among rational adults can help guide the actions of the group towards a more ethical and equitable organization, which makes everyone happier in the end. Some organizations discourage this, and instead make overarching rules that discourage the rational adults within those organizations from free thought that would benefit the overall operations, and some are too lax and instead encourage unethical behavior by never sanctioning those who engage in it.
On political topics, Iíve always liked the words of a country song that state ďYouíve got to stand for something or youíll fall for anythingĒ meaning that a person has got to have a set of values and beliefs based upon their own moral compass and introspection in order to guide their decision making when faced with an overwhelming amount of information. †And weíre all overwhelmed. I firmly believe that human beings can only process so much information and that there is no possible way for any human being to be well-enough informed on every issue to form a truly solid and rational opinion. Therefore, when we hear something, if we judge it based upon our foundation of core beliefs, we have a way to gauge how we feel about it. For example, Iíll bet that if any, only a small percentage of the people who read this post have ever studied the effects of globalization on the food supply in Micronesia. Sure, we could research the issue, but our core beliefs most probably would tell us that anything that decreases affordable food for the majority of the population is bad. My guess is that this opinion on the issue is perfectly fine and I donít have the time to put in the requisite study to find out otherwise. This can be applied to EMS almost daily. I believe that a thorough assessment and judicious application of treatment modalities benefits the highest number of patients. I believe that any amount of study time that I put in learning about pathophysiology enables me to better assess my patients and judiciously apply treatment to them. Therefore, I can ethically and logically assume that putting in one hour of study time per day on pathophysiology is a good thing.
Of course, if there were to be a study that came out unequivocally showing that 45 minutes per day is the optimal number and that one hour actually causes degradation in knowledge through um, brain fatigue or something, then my opinion would be wrongÖ but nobody has studied this topic with enough depth to be sure of that.
Hereís what it comes down to for little ole imperfect me: ďShower GuiltĒ. I usually say that when I make decisions itís because I have to look myself in the mirror and shave every morning but thatís honestly not where it gets me. My conscience rears its head during my morning shower. If Iíve done something that I donít feel deep-down is ethical, my ďShower GuiltĒ kicks in and I beat myself up for it. I usually can tell how Iím doing by how rough my showers are. Itís been that way for years for me and Iím thankful for it. The introspective time has made me a better, more rounded person.
I guess what Iím saying with this post, and with my whole Everyday EMS Ethics series is that ethical issues must be discussed in a positive, adult manner for progress to be made. When people look at problems or violations in ethical standards in a rational and objective manner, solutions come out that go beyond heavy-handed rule spewing and approach the realm of positive resolution and healthy growth. By maintaining an open dialogue, others participating and observing the dialogue can glean lessons that will allow them to make more ethical decisions in their own lives and professional situations. Ethical behavior encourages others to behave ethically. Discussing the ethical standards of a group in a positive and uplifting manner makes people within the group feel good about doing the ďrightĒ thing.
Paramedics and EMTs face heavy ethical questions in our day to day work. Itís in our job description.
What does your organization do to encourage ethical behavior?