Many of these case studies seem self explanatory and easy to answer, however until we are face to face with such a situation we can never truly say how we will react, or can we.
While adding a case study to this article is a needed formality, I can’t help but say —
This EMS field holds a special place in the hearts and minds of those we serve and those who watch us from the sidelines. We as EMS professionals need to remember that we have to carry the torch of compassion as a light into the darkness of horrors our patients and their families face. We NEED to be the best of the best is ALL avenues of our lives. People trust us with the most precious thing that they have — the lives of those they love dearest.
My fellow brothers and sisters of EMS, please remember that we are the angels these people are calling for in their most horrific of hours. Angles do not cause pain, they do not add to our communities evils such as what some of our fellow EMS workers have done, do they?
Yes I am asking us all to give a lot more, drink one less beer so it isn’t us who kills with a car, keep your speed down, watch our wicked words so we do not destroy the young minds who respect us, use kindness instead of violence, show those who need us that we are here and we are the angels they seek. It doesn’t make us cool, it doesn’t make us tough, and it doesn’t make us respectable. It makes us less then human. Simple isn’t it. Be cognizant of the evils we do cause it DOES matter.
After all how can we be some ones angels in their time of need if we are wickeder at heart then the reaper who calls on our patients?
This is the real case study can you find the answer in you?
With in the medical profession lies a proverbial minefield of ethical dilemmas, situations and positions. We can daily find ourselves tested and tried in a wide variety of ways: money, drugs, members of the opposite sex, information not available to the general public and a whole slew of other things.
Mini Case 1
You and your partner are called to the scene of a possible accidental injury. Upon arrival you size up the scene and determine it safe. You both gather your gear and find the patient lying on a pool of blood, unconscious on the garage floor with no other witnesses around. You quickly determine the patient is pale, his pulse is only felt in the jugular vein which is thready and weak, his respirations are shallow and absent on the left, he has cyanosis in his nail beds and lips, his blood pressure is 88/50 and falling and his skin is cool and clammy. You both begin to provide life-sustaining measures when you begin to realize this was a robbery attempt since your patient has a 4 inch stab wound to his left chest wall. During your examination the patient’s eyes flutter open and he whispers to you both that — “it’s gone they took it all — ” then he passes back out.
Your partner tries the radio but gets no true reception so he heads to the rigs main radio telling you he will bring back any extra equipment you might need plus the cops. You nod at him as you continue your examination. A few short moments later as you are checking him for further injuries you notice a several hundred dollar bills under his right flank — — No one will even know, after all he said it was all gone —
Mini Case 2
Mid summers night nearly 70 degrees at 11 PM. Your crew is called out to the scene of an accidental injury at Hodges Lake, a common hang out for people to swim and camp. Upon arriving on the scene you find a 20 year old female / male in their swim attire. He / she has a deep laceration to the right side from a piece of glass in the sand while playing volleyball. As you approach you can easily tell the patient is fully alert, has a good respiration and good skin color. Once to the patient you get a good breath sound, good pulse at 78 steady and strong, a good Blood Pressure at 122/68, the laceration looks deep and is still oozing blood but it looks venous in nature, he / she has good feeling to all extremities and appears not to be in shock. The patient will need stitches however so you begin to load he / she into the rig. You stay inside with the patient and begin to bandage the laceration as your partner shuts the doors and begins to gather the trash and equipment to return.
Before your partner returns band just as you put the last bit of tape upon the bandage the patient he / she looks at you and casually offers you his or her phone number. The patient has a small wicked grin upon his / her face and is very serious at his / her offer. The patient states she / he thinks you are very cute and is currently in the market for a new relationship. You find the patient very, very attractive — — no one will know — .
Mini Case 3
You have just have finished a long 48 hour shift in which you have had a few very bad calls. Your shift mates ask you to go to the local bar for some liquid relaxer.
You agree and after changing into your civilian clothing head out to the restaurant. Before you know it many hours have passed while your crew and you have had a stupendous time, laughter, stories and lots and lots of drinks. You are soon driving home trying hard to remember just how much fun you actually had and what you had done when you hear a call echo in over your radio and its just block away. You get to the scene to find a car t-boned by another, which you recognize as a fellow co-worker you were just with. Your crewmember waves you past telling you they are fine and to check on the other car. You move towards the car and hear the driver crying about her child. You can see the child seems fine just scared so you move towards the driver side and identify yourself as a trained and licensed EMS worker. As the mother looks to you she tells you in an anxious frightened voice — “Get away from me, I saw you at the restaurant — .” — — — .. was it worth it?
The oldest and enigmatic question / statement is — Can you really teach ethics?
What is ethics by definition?
What does this mean to have ethics?
What does it mean to be ethical?
When one lives by a code of ethics does it make him or her a better person?
Is there some higher state of being one can obtain by being ethical?
Are ethics something you can put on and off much like a coat?
Is being a good person all one needs to be ethical?
What is ethics by definition?
Webster’s definition of ethics still in use from the 1955 is: a system of ethics by which acts are judged within their contexts instead of by categorical principles ‘”called also situational ethics
Also: A set of principles of right conduct.
A theory or a system of moral values:
ethics (used with a sing. verb) The study of the general nature of morals and of the specific moral choices to be made by a person; moral philosophy.
ethics (used with a sing. or pl. verb) The rules or standards governing the conduct of a person or the members of a profession: medical ethics.
— From the Middle English ethik , from Old French ethique (from Late Latin “thica , from Greek “thika , ethics) and from Latin “thic” (from Greek “thik” ), both from Greek “thikos , ethical, from “thos , character; see s(w)e- in Indo-European roots. 1
Ethics is generally a set of rules or standards that govern or control the conduct or behavior of a particular profession or group.
A brief glimpse of Ethics in history.
Ethics or the science of ethics seems to have popped up out of nowhere. Where did this belief system come from?
— To see what is right and not to do it is want of courage. —
Confucius 551 B.C. – 479 B.C., Chinese philosopher, The Analects, Book II, Chapter XXIV
— Not life, but good life, is to be chiefly valued. —
Socrates 469 B.C.-399 B.C., Ancient Greek ethicist-philosopher
— Although gold dust is precious, when it gets in your eyes it obstructs your vision. –
Hsi-Tang Chih Tsang 735 ‘” 814 A.D., renowned Zen master
— The value of life is not in the length of days, but in the use we make of them; a man may live long yet very little. —
Michel de Montaigne 1533-1592, French writer and philosopher
The history of ethics or moral philosophy is often thought of as nothing more then a secondary concept. This seems to make them misconstrued as a separate ideal apart from history itself almost as if they always were. The ideology of ethics seems to be a timeless unchanging nearly supernatural thing that came us from the mists of creation. This seems to be what many of the ancient philosophers have related it to in some of their writings. One thing is definitely clear though many of the historians of ethics and moral practices seem to defer these ideals to a society to society and or person to person based differential when it comes to the good and bad of ethical concepts. If fact it has been documented that moral and ethical behaviors change when social concepts of behavior change. This alteration should not be looked upon as a different thing entirely, such as morality being separate from social life. It should however be viewed as a combination of the two.
In truth ethics in its base form ethics and moral philosophies have been around for thousands of years. We cannot however mistake ethics or the history of ethics to be a methodology of our moral structure. Ethics do not consist of merely a tale of morality based on a chronological view of different cultures or societies. With the historical texts ethics is stated or referred by an assortment of philosophical systems, which over time defer to the moral order. While wise men of antiquity such as Pythagoras (582-500 B.C.), Heraclitus (535-475 B.C.), Confucius (558-479 B.C.) all spoke of moral virtues i.e. ethics they all viewed these moral virtues with eyes focused more like a dogma or didactic frame of mind instead of a philosophical state of being. It was the Greeks who began to develop many of the framework / foundation of ethics as we know it today. This basic framework began to take shape with in the teachings of Socrates.
Socrates (470- 399 B.C.) believed that the ultimate goal of humans is happiness and that virtue is the roadmap to this goal. Since happiness is every person’s goal in life no one is inherently malevolent. Evil with in an individual or a society grows from ignorance. Virtues in general are nothing but so many prudence’s, therefore virtues can be gained through instruction or so he theorized.
Democritus (about 460-370 B.C.) while in Socrates time still had his own version of the ethical evolution. Democritus indicated that a joyous and cheerful disposition is actually the highest goodness a person can get. This seems to make man independent of material things. He also seemed to draw a line between the pleasures that harm and he pleasures that one should seek.
Antisthenes (444-369 B.C.) taught that virtue alone stands for a man’s happiness, which is a direct opposite of Hendoism. He states that pleasure is an evil and if a man is really wise he is above human laws. This teaching eventually crumbled into nothing more then an arrogant contempt for the law itself.
It was Aristotle (384-322 B.C.) who purposed that ethics were actually or should actually be a separate forum or field from theological sciences, after all the methology and the subject matter must match. In the field of ethics (good actions) many generalizations hold sway. Aristotle, Plato and Socrates agreed upon the fact that the virtues of ethics should be central to a well-lived life. Virtues such as temperance, courage, justice, compassion and the like are considered by Aristotle, Plato and Socrates to be complex rational, emotional and social skills. They even agreed in short terms as to how hey fit together as a whole. Aristotle does however disagree with Plato’s ideals that one must seek training in the sciences and the metaphysics as sort of a prerequisite before one can have a full understanding of these ethical virtues in our choices.
Saint Aquinas (1225-1274) blended a minimum of two ethical principles from Aristotle’s ideals and the Christian theology ideals. His studies in moral philosophies brought him to agree with Aristotle’s belief that an act of good or bad contributes to whether or not those acts lead to our proper human happy end. St. Aquinas believed that a person’s eudaimonia or happiness is derived from this ethical state of living. Achieving this one needs a good setting of moral and intellectual qualities that inspire us into seeking this form of personal happiness. However Aquinas believed that we could never full obtain this happiness with in this mortal life, but that’s a theological debate for another time.
What does one need in principle to begin to use ethics in our everyday lives?
Do we need a special title or social rank?
Do we need a certain hormone or gene at birth?
Is there a special class we can take to gain them?
No, it just doesn’t work that way. What we need in order to put these virtues to a practical use is to obtain through proper upbringing, good habits and empathetic and compassionate thoughts towards our fellow man. Only then can we gain the ability to make the ethical choice on each occasion that best stands to be a good reasoning. That being said Aristotle dictated that practical wisdom couldn’t be gained through a learning of the general rules alone but through practice of those emotional and social skills then one can apply ethics in those situational occasions.
Over all ethics in history have changed from Sophists and Socrates ideals, Plato’s and Aristotle’s input, the Christian’s interpretation and alterations into a whole new set of values, followed by the British arguments, the French’s additional arguments, Kants, Hegel and Marx to Kierkegaard and Nietzsche, the Reform and finally modern ethics. A long and valid history for sure but again does this truly give us a view from which to build our own ethical standards?
According to the American Medical Association ethics is used in opinions of the Council on Ethical and Judicial Affairs to refer to matters involving 1: moral principles or practices and 2: matters of social policy involving issues of morality in the practice of medicine. The term “unethical” is used to refer to professional conduct, which fails to conform to these moral standards or policies. 3
When we think of ethics our minds conjure up righteous figures standing tall against a horde of wickedness. We think of good hearted people or moral business practices, but is this really what ethics are?
The study or field of this moral philosophy is basically finding ways to re-enforce good behaviors. Who is responsible for the way in which we think of ethics?
A moral obligation our parents provided us?
A natural instinct with most homo sapiens?
Are these sciences merely social inventions?
Was it a common mans morality or did it come down from aristocrats or religious figures, as a set of rules people should follow?
Are we ourselves the ones who bend ourselves into the ethics mold?
Philosophers, theorists and academics break ethics into three main sections: metaethics, normative ethics and applied ethics.
Metaethics, meta meaning beyond or after, is the studies of answering the questions of ethics in relation to Gods will, universal truths, the role of reason, and general ethical terms not to mention the basic history of its origin. When compared to applied ethics or normative ethics metaethics is much less precise. Metaethics can be further broken down into two more parts, metaphysical issues and psychological issues. Metaphysical ethics deals with whether or not morality exists outside of humanity. Basically it focuses on the study of were ethics within the universe lies, such as the physical component like rocks, trees, water and so on. It also encompasses the non-physical issues like God, spiritualism and thoughts.
Psychological ethics deals with our underlying mental positioning when making a moral judgment. Different philosophers such as the Greek philosopher Plato and the 17th century British philosopher Clark delved into the mathematical and spiritual connection of it all. This is by far not all that lies within this division of ethics.
Normative ethics has the undertaking of finding the moral standards regulating right and wrong conduct by delivering the good habits we need, the values we should follow along with the consequences of our behavior. In a basic overview it is the ideal of tests for proper behavior. The Golden Rule and “do unto other as you have them do unto you” are good examples of normative ethics. This is a fairly good way to help us when we need to make an ethical or moral decision. Normative ethics has three strategic theories with in its base, virtue theories, duty theories and consequentialist theories.
The virtue theory indicates we develop good habits of character instead of following a set of rules and or standards such as do not kill or do not steal, which we must learn in order to better ourselves. Essentially virtue theory emphasizes education in morality since virtuous character traits are learned during our growth and development.
The duty theory bases morality on foundational principles of obligation such as being responsible for our children. Many people believe or “feel” that certain obligations are set with in our subconscious being. The 17th century philosopher Samuel Pufendorf classified several duties under a few headings such as: the duties to God, the duties to ones self, and the duties to others. There are four basic components of the duty theory. Below is a classified list by Samuel.
Duties to God.
a theoretical duty to know the existence and nature of God
a practical duty to both inwardly and outwardly worship God.
Duties to ones self.
duties of the soul, which involves developing one’s skills and talents.
duties of the body, which involves not harming our bodies, as we might through gluttony or drunkenness and not killing ourselves.
Duties towards others.
avoid wronging others
treat people as equals
promote the good of others
These are duties of the FIRST of the central duties.
The SECOND of the central duties is classified by the 17th century British philosopher John Lock. Lock states these duties are a basic approach in rights theory. This theory indicates we have certain innate rights as human beings such as life, liberty and happiness, which is so readily stated with in our own constitution. With in the Duty theory lays four sub-divisions, which can further define this theory. These are: the natural right, which are rights not created by governments or laws of man; the universal rights do not change from country to country or culture to culture; the equal right indicates that all peoples of race, gender or handicap are equal in their rights; the inalienable right states that one can not give up their rights to another.
The THIRD of these central duties based on Kant’s theory states that there is only a single principle of duty known as “categorical imperative”. The biggest difference is that the other main principle known as “hypothetical imperative” deals with a personal desire thereby making an “I want so I must” thought. Kants ideology of the “categorical imperative” indicates that ones personal desires have no bearing on ones action.
The FOURTH principle is the most recent quote-un-quote modern ideology from British philosopher W. D. Ross. This principle focuses on “prima facie”, which he theorized, is based upon the fact that our duties are part of the fundamental nature of the universe. Ross’s list of duties while much shorter seems to be the best gage by which to handle our ethical dilemma:
Fidelity: the duty to keep promises
Reparation: the duty to compensate others when we harm them
Gratitude: the duty to thank those who help us
Justice: the duty to recognize merit
Beneficence: the duty to improve the conditions of others
Self-improvement: the duty to improve our virtue and intelligence
Nonmaleficence: the duty to not injure others 9
Consequentialist normative principles indicate that a person weigh the out comes of both good and bad decisions before making a choice. This is also referred to as teleological theories from the Greek word tele meaning end since the end result determines the moral out come. These theories became popular in the 18th century who were looking for a quick fix to moral actions. The best thing about this theory is that it appeals to public actions and out comes, which fits well into social situations. This theory breaks down further into three sub-divisions as follows:
** Ethical Egoism: an action is morally right if the consequences of that action are more favorable than unfavorable only to the agent performing the action.
** Ethical Altruism: an action is morally right if the consequences of that action are more favorable than unfavorable to everyone except the agent.
** Utilitarianism: an action is morally right if the consequences of that action are more favorable than unfavorable to everyone.
Each of these sub-divisions has greater in depth aspects of them selves but we will not cover them with in this article.
Applied ethics is simply the inspection of controversial issues we face today. 2
All fields of personal and business divisions hold with in it an ethical set of values.
Ethics in general is not a law or set of laws per say they are however a set of standards all professionals must adhere to, so when a professional steps outside the boundaries of these standards a council can fine, suspend or even remove an offender. With in recent years applied ethics has been divided in a few main groups. These being: business ethics, sexual ethics, environmental ethics, social ethics and medical ethics.
Environmental ethics while seemingly self-explanatory does at times overlap with business and medical ethical. This group deals with animal cruelty, pollution situations, endangered species, managing environmental resources issues and much more.
Business ethics division handles things such as drug testing, advertising and marketing issues, insider trading, job discrimination, employee rights, corporate ethics and more.
Sexual ethics deals with issues regarding monogamy versus polygamy, sexual encounters not dealing with love, homosexuality issues, sexual misconduct and comments and more.
Social ethics includes issues such as gun control, capital punishment, nuclear war issues, drug control, racism, welfare issues and much more.
Medical ethics is the division in which we are most interested. This sub-division encompasses issues in and out of a clinical setting such as: criteria for life and death decision making, frozen embryo situations, dealing with communicable disease, abortion, cloning issues, organ harvesting and replacement, artificial limbs and so many more issues and circumstances. We in the field deal with a slight variant form of this ethics with items such as: patient confidentiality, patient dignity, scene integrity, actions that others view, how we handle ourselves at a scene, how the public sees us act off duty, patient treatments that are need but seem harsh and many more.
Many people seem to think that laws are formed from ethics and or vice versa. This is not actually the case. In many cases a law may contradict an ethical behavior.
So what differentiates a law from an ethic? Interesting question. Well typically a law is set in motion to aid, protect or guide us with in our society so society can be a better place for all to function. An ethical code is set in place to aid, guide and improve a persons well being for the benefit of ones self. Or in the medical field another individual to which we assist. The consequence of breaking a law ranges from fines to imprisonment. The consequence of breaking and ethical code ranges from fines to loss of ones profession.
Ethics and morals also seem to have a similar direction but also have different foci. Morals tend to focus on religious, social or personal standards of what’s right and wrong. Ethics are rules that govern the conducts of professionals or groups of individuals.
If ethics overall is a difficult subject to teach, understand or even grasp perhaps its best to see what ethics is not.
Ethics are not personal feelings.
Ethics are not laws.
Ethics are not religion.
Ethics is not science.
Ethics are not cultural standards. 5
With in this framework we get a clear view of what is not an ethic. Does this help?
Well we know that while many laws have some ethical standards with in them many laws actually stray from these some ethical standards. Actually some laws can grow to be ethically corrupt. Laws can be nothing more then a power set in place to guard a narrow set of views.
As above ethics are not feelings per say, feelings do play into the aspect of the ethical decisions we make. Some people actually have a much more elite / advanced base of feelings and feel bad when they do something wrong. Others have a subdued / weaker set of feelings and still feel good when doing something bad. Where does this come from? Is this upbringing, environmental behavior learning, personal choice or actual book learning.
Religion typically holds many moral and ethical values high religion does not give advice on all the situations we will face. Religion may only focus on the values, which best fit the churches needs.
Does science even come into play when dealing with ethics? Science may be able to give us some data or reasoning as to why we make certain choices but said sciences cannot inform us on what to do. Many people rely very heavily on the science of science. This is very informative but dose nothing to actually defend or counter an ethical issues decision.
While some cultures try to live by ethical values many actually find reasons to justify why it’s all right to live immorally. This goes back to the way lawmakers set their standards for the laws they make. So is it safe to say that cultural norms are tied to laws? Whether this is true or not many cultural ethics change based on what the people find acceptable and what this culture finds acceptable is steadily sliding downwards.
Some learned institutions say there are five sources of ethical standards.
The utilitarian approach indicates that ethical choices need to determine how to do the least harm based on the choices made.
The right approach is another one of these standards that simply states an ethical action is one that protects the moral rights of those affected.
The fairness or justice approach indicates that based on Aristotle and other Greek philosophers ideals that all humans basically should be treated equally.
The common good approach suggests that society itself holds the basis for ethical behavior.
The virtue approach indicates that we with in a society hold true to a certain set of virtues or values we were taught during our development as we grew.
Of course separately these five sources may only be philosophical theories on how to define or more accurately determine an ethical standard. The largest problem we face within these five sources is that we need to agree or find a common understanding of the content. After all we all may not agree on the same set of what is good and what is harmful. Of course any of these sources may not even be able to help us identify what an ethic even is, problem two.
There seems to be a deeper problem with ethics however. If this could be considered a real issue but it there are dozens of different ethic types such as:
Ethics in Business
Ethics in Education
Ethics in Nursing
Ethics in Medical Practice
Ethics in America
Ethics in Accounting
Ethics in the Workplace
Ethics in Research
Ethics in Advertising
Ethics in Marketing
Ethics in Journalism
Ethics in Parenting
This is just a few of the different types of ethical divisions. Is this really necessary? Shouldn’t we simple have a moral / ethical standard that everyone follows? How hard would this be? Should we begin to screen each candidate before allowing him or her to become a paramedic?
Above we examined a brief history of ethics and where they came from along with a slight breakdown of the term itself now let us get down to what they mean to us in the EMS field.
What ethics means to the EMS personal.
Believe it or not in earlier years ethics in the medical field wasn’t even really considered by philosophers to be a valid system where ethics should be applied. It wasn’t until the 1960 that a value system began to be put in place. It took a slew of lawyers, medical professionals, a range of learning center committees and philosophers to help create an entire series of journals and manuals on this subject.
Even with in our medical field our ethical standards are subdivided into medical ethics, which governs physicians, health care ethics, which governs nurses and other health care professionals, clinical ethics, which governs hospital and institutional decisions, and bioethics, which governs birth control, donation of organ distribution and other medical issues.
Issues such as: do not resuscitate orders or wishes of patients and or their guardians, patient confidentiality, help in passing, drug experimentation on children, patients with dementias, dying persons, doctor deceptions practices, incompetent patients, uninsured or poor patients, non-prejudice health care, patients with diseases, death, harvesting viable organs from donors, abortion, fetus testing, genetic selection, forced hospitalizations, mentally ill and many more topics all fall under this medical ethical study or practice.
With all this in mind we should focus on EMS in general and what ethics mean to us.
While it still holds true that the doctor has the last say in any medical issue and he or she holds a great responsibility when dealing with the lives and well being of others. We also need to realize that we as first responders to hundreds of emergencies monthly or even yearly bear witness to a plethora of moral and horrific scenes. So it is we the EMS providers that are put under a heavy ethical burden long before the physician even sees the patient.
How will we act?
What will or legacies have been to the people that we aid?
And if we make the wrong ethical choice who will pay the price?
It is a statistical fact that at least 15% (that’s 15 out of every one hundred calls) of all urban advanced life support calls have an ethical dilemma attached to them with patient destination, advanced directive orders, consent, patient confidentiality and patient refusals nearing the top of the list. This means that any EMS worker that’s been in the field at least a month has had an ethical issue to deal with.
Ethics can be a complicated issue to understand let alone teach. The applied or relative use of ethics advises that each person must decide for them-selves how they should react to various situations. This makes sense in practical notion but it doesn’t hold totally true for certain professions. Working in specific fields that deal directly with people in their worst of times we as professionals should adhere to a much more strict code of ethics.
There are always consequences to every action. The deontology technique indicates that people should simply just follow their duties. There is no question that EMS workers will perform their said and needed duties with out hesitation the real question still remains that which ethical side of the fence will they take. Consequentialism indicates that actions can truly only be judged once the consequences are known. This sounds like a cop out to some degree. It seems to indicate that if we know what the penalty or cost of our actions will be we will do the right thing. Nay, nay this makes no sense. The right thing should be something that each individual feels inside or knows to be correct.
I think that many of us EMS providers as well as other medical professionals need to consider when faced with an ethical situation is simply what is best for the patient, 4 end of story. We should never, never worry about what is best for us when an ethical dilemma presents it self. We should however remember that our safety is critical for others well being. As we are taught with in the confines of our medic classrooms if the scene places us in extreme danger we should wait for scene safety. After all if we go down that only complicates matters.
— Ok be truthful, do we really follow that rule or is it more of a situational guideline? —
Codes of conduct
Well this is a tricky subject to be sure. It seems that each and every medical situation has its own special conduct list to adhere to. There are codes of conduct for private practices, treating children, treating older adults, marriage and guidance counseling, EMS services and nearly 60 + other situations. That’s a lot.
— “Awareness of the ethics codes is crucial to competence in the area of ethics, but the formal standards are not a substitute for an active, deliberative, and creative approach to fulfilling our ethical responsibilities. They prompt, guide, and inform our ethical consideration; they do not preclude or serve as a substitute for it. There is no way that the codes and principles can be effectively followed or applied in a rote, thoughtless manner. Each new client, whatever his or her similarities to previous clients, is a unique individual. Each situation also is unique and is likely to change significantly over time. The explicit codes and principles may designate many possible approaches as clearly unethical. They may identify with greater or lesser degrees of clarity the types of ethical concerns that are likely to be especially significant, but they cannot tell us how these concerns will manifest themselves in a particular clinical situation. They may set forth essential tasks that we must fulfill, but they cannot tell us how we can accomplish these tasks with a unique client facing unique problems. . . . There is no legitimate way to avoid these struggles.” – –Ethics in Psychotherapy & Counseling, 3rd Edition —
With this in mind is it really a feasible thought to even begin to mention we learn each and every situational list of conducts? I think not. So then what is the answer?
Here are a few of the conduct codes from 1949. These are a doctors general conducts:
A doctor must always maintain the highest standards of professional conduct.
A doctor must practice his profession uninfluenced by motives of profit.
The following practices are deemed unethical:
– Any self advertisement except such as is expressly authorized by the national code of medical ethics;
– Collaborate in any form of medical service in which the doctor does not have professional independence;
– Receiving any money in connection with services rendered to a patient other than a proper professional fee, even with the knowledge of the patient.
– Any act, or advice, which could weaken physical or mental resistance of a human being may be used only in his interest.
A doctor is advised to use great caution in divulging discoveries or new techniques of treatment.
A doctor should certify or testify only to that which he has personally verified.
Here are a few of a doctor’s duties to the sick:
A doctor must always bear in mind the obligation of preserving human life from conception. Therapeutic abortion may only be performed if the conscience of the doctors and the national laws permit.
A doctor owes to his patient complete loyalty and all the resources of his science.Whenever an examination or treatment is beyond his capacity he should summon another doctor who has the necessary ability.
A doctor shall preserve absolute secrecy on all he knows about his patient because of the confidence entrusted in him.
A doctor must give emergency care as a humanitarian duty unless he is assured that others are willing and able to give such care. 8
These are but a few of the duties from the Third General Assembly of the World Medical Association.
What we hear in medical schools on the subject.
The above codes are simply scratching the surface of a now whole range of directives set in place to make a more professional and dedicated medical person be it doctor, nurse or EMS worker.
Very few institutions actually instruct the subject of ethics in a valuable or direct manor. While the battle of teachable ethics rages on the subject in general still seems to be an area where an instructor can merely highlight or enhance what an individual already has an understanding of.
** To gain and maintain the respect of their colleagues and their patients, it is vital that individual paramedics exemplify the principles and values of their profession. **
1985 saw a sudden change in the standards taught by every medical institution across the United States this change was implemented by the Liaison Committee on Medical Education (LCME) sponsored by the American Association of Medical Colleges (AAMC) and the American Medical Association (AMA). With this change ethics and ethical behavior began to be imparted to students on a curriculum basis. For instance in during that year 84% of responding schools taught some sort of ethical and human values course during the first few semesters and 34% taught those courses in the last few semesters of their programs. 6
In 2000 a group of researchers began to put together an actual ethical curriculum. They began this by exploring the strengths and weaknesses in which each institution teaches. Once a unified curriculum is compiled we can focus more on a true understanding of a core values structure and begin to spread these standards to the whole of medical community. Okay with the said structure in place what is the best way to expose medical students and or professionals to these values. Well one way is described in the Standards for Accreditation of Medical Education Programs Leading to the M.D. Degree Section ED-23 states:
— A medical school must teach medical ethics and human values, and require its students to exhibit scrupulous ethical principles in caring for patients, and in relating to patients’ families and to others involved in patient care. Each school should assure that students receive instruction in appropriate medical ethics, human values, and communication skills before engaging in patient care activities. As students take on increasingly more active roles in patient care during their progression through the curriculum, adherence to ethical principles should be observed and evaluated, and reinforced through formal instructional efforts. In student-patient interactions there should be a means for identifying possible breaches of ethics in patient care, either through faculty/resident observation of the encounter, patient reporting, or some other appropriate method. ‘Scrupulous ethical principles’ imply characteristics like honesty, integrity, maintenance of confidentiality, and respect for patients, patients’ families, other students, and other health professionals. The school’s educational objectives may identify additional dimensions of ethical behavior to be exhibited in patient care settings. — 7
Here are a few suggested guides questions / statements you can use to help when an ethical issue arises.
– Beneficence is the principle of doing good for the patient. ‘”
– Non-malfeasance is the obligation not to harm patients. ‘”
– Autonomy is a competent adult patient’s right to determine what happens to his or her own body. ‘”
– Justice refers to the obligation to treat all patients fairly. – 4
Some persons think that there may be a way to help persons make better ethical decisions. I’m not sure that’s a reliable way, however whatever helps cant hurt right?
The courses taught by the instructors, while valid, truthful and appropriate still do not fulfill all the requirements we need in the field. So again what is the answer?
Ethics in use.
So after all we have seen, read and figured we still do not have a definite understanding of what ethics truly means. One could even make the argument that the ethical items we covered can fit into business, personal as well as medical life styles. Sure we have a view point from historical figures, we have a slight look at some codes used by the medical field, we have scientific theories of what people can do to make ethical choices but that doesn’t make us ethical. So what does?
We know that ethics in general are not our actual feelings because some peoples feelings may actually prevent them from doing the right / ethical thing in some situations. With this in mind is it a fact then that ethics are based on our feelings or are they a separate set of standards or virtues. This brings up another set of items, virtues.
We as EMS providers have an oath to serve. We are truly never off duty. We are set by obligation to put our lives in danger for others even with out a pay check
What are virtues? There seems to be a list of common virtues or standards many people believe and agree upon. A few of these are: honesty, compassion, loyalty, courtesy, fairness, kindness, cheerfulness est. These virtues more then likely were derived from the long practiced standards of chivalry. Several of these virtues wee actually with in the code a squire took during his ceremony to become a full-fledged knight. This code of conduct incorporated things like bravery, courtesy, honor and gallantry towards women.
Here are the vows of knighthood.
To fear God and maintain His Church
To serve the liege lord in valor and faith
To protect the weak and defenseless
To give succor to widows and orphans
To refrain from the wanton giving of offence
To live by honor and for glory
To despise pecuniary reward
To fight for the welfare of all
To obey those placed in authority
To guard the honor of fellow knights
To eschew unfairness, meanness and deceit
To keep faith
At all times to speak the truth
To persevere to the end in any enterprise begun
To respect the honor of women
Never to refuse a challenge from an equal
Never to turn the back upon a foe
Would it be better as a society, a person or a profession if we followed these conducts perhaps adapted to today or maybe not. The two conducts at the end seem to be a bit extreme for a modern world however the remaining seem worthy of a good ethical process.
Putting a good set of virtues into play with in our daily lives is nothing more then being a decent person right? Then why is it so hard for people to do that even people in the EMS profession?
In Decatur County In. a paramedic was jailed for stealing morphine.
In Troy township Ohio the wife of an assistant chief was arrested for stealing morphine, atropine and valium.
In Hamilton Massachusetts a paramedic was arrested for working as a medic under falsified documents.
Squad members at a Roanoke County VA service were charged with burglary of patient’s apartment
In Blanco County Texas a director was stealing painkillers from the ambulance stock.
A Wake County N.C. paramedic was arrested for stealing drugs.
In Fairmount WV. a paramedic was arrested fro exposing himself to a woman in an alleyway.
In Cleveland a paramedic was arrested for fondling two patients in an ambulance.
In Crawford County GA two EMS workers were charged with racketeering in the form of stealing donated money to their service.
A Lincoln County North Carolina paramedic accused of stealing from his co-worker’s cars
Baton Rouge New Orleans police arrested a paramedic Thursday for allegedly stealing drugs from a patient he treated on the job.
A Gonzales Texas EMS worker was arrested for child porn ring.
A Bedford County paramedic who’s been charged with more than 200 sex crimes accepted a negotiated sentence.
A paramedic was sentenced Friday in Clark County Superior Court to 14 years in prison for five sex-related crimes
In New York two paramedics on break watched as a pregnant Brooklyn woman died from a fatal seizure. They ordered their breakfast told the staff to call 911 and left.
Come on, no wonder people have are leeriness when it comes to trusting EMS workers. The above items are since 2007 and are not even 1% of the full indictments. Is it that we EMS personal just see or deal with to much and have a hard time dealing with it or has the standards for becoming an EMS worker been lowered that far? There was a time when becoming a community professional had some serious requirements.
Putting ethics to use is by far an easy thing to do or accomplish. The very nature of ethics makes it difficult because of the varying situations one can be put into, not to mention the multiple levels of the ethical position in question. There may be a few minor questions you can ask yourself but will they actually help and are they actually even relevant to ethical issues?
Either way these questions are:
To ask your self during an EMS situation would you allow your self or a loved one to undergo the same type of procedure that the patient is about to have?
To ask your self if you would want this procedure preformed under the same situation.
To ask your self if you can justify or defend your actions in this situation.
Educators call the first question to this ethical challenge test The Impartiality Test, the second question is called The Universalizability Test and the last question is called The Interpersonal Justifiability Test.
Again does these set of questions really fit and do they really challenge our ethical decision making capabilities? Perhaps we should set a few questions of our own in place of those about so we may better serve not only ourselves but also our patients. Not to undermine our valiant educators but shouldn’t we, those out in the streets who face these dilemmas daily, have a more relative series of questions we can draw from. Perhaps even with a better and more empathetic understanding of not only ethics in general but the sheer terror of what our patients face will make us more ethical in our decisions and our lives.
Let us look at these questions instead.
How terrified would I be in this situation?
What would I need to see in a stranger so that I may trust him or her?
Is what I am saying or asking going to cause any type of uneasiness to my patient?
Is my patient’s comfort or feelings really worth my attempt at looking cool?
If I were in that much pain how would I react to a strangers questions?
If this is the last thing my patient sees, hears or feels will my actions be worthy?
How would an outsider, court of law or some one we care about judge my actions and words?
Would I let just any stranger take care of my loved ones?
Here is a question we need to ask ourselves and find a SERIOUS answer.
Why did I really take this job?
Once I compromise my own self how far along this path will I fall?
Remember people can tell, no they can feel if your compassion is real or not. No matter how slick you think you are.
An EMS provider can fall into any number of ethical dilemmas. These situations can range from resuscitation, patient confidentiality, patient consent and so many other areas of the job they cannot be listed here for lack of room. In any case or situation always, always do what is best for the patient such as resuscitation. Learn your local and state Do Not Resuscitate laws and statures and if there is ever any doubt — resuscitate. Turn in any suspected child or elderly abuse information but always maintain a tight grip on patient information obtained while on the scene. Being able to distinguish when a patients consent is actually their own or not.
There is another situation an EMS provider can get into and is just as serious as those above are resources and triaging a scene. The biggest decision one of us faces is using our resources on every patient evenly. Yes this includes criminals, enemies and the like. Providing care to those in need is the most basic fundamental piece of what paramedic is. Using your life stabilizing skills while off duty is actually a necessity not a choice and when one chooses not to get involved because they are “not on the clock” so to speak is a travesty.
Even though ethics have been around for thousands of years, well at least the concept of ethics, people are still trying to refine its ideals and use. While every situation demands a different approach to its moral solution we still try desperately to plug what little ethics we have learned into every hole we encounter.
In our modern world and our so-called civilized communities it sure looks like our ethics and morals have taken a nosedive. As you can see from the above incidents we are not
We as a profession should be an elite group. We need to hold ourselves not above people but be a role model for society. See our oath, as lifesaver and comfort bringer SHOULD not only be in an emergency but as an example in our every day lives. This oath whether metaphorically or literally should not be taken lightly.
In answering the long debated question can ethics be taught? Well in my opinion the only thing that can be taught is a basic foundation of what ethics is but not how to be ethical. One can maybe be taught a better awareness of how to make an ethical decision.
Above all of what we have learned this set of ideals seems to be the best we can use to aid us on our quest for ethical behavior.
Fidelity: the duty to keep promises
Reparation: the duty to compensate others when we harm them
Gratitude: the duty to thank those who help us
Justice: the duty to recognize merit
Beneficence: the duty to improve the conditions of others
Self-improvement: the duty to improve our virtue and intelligence
Nonmaleficence: the duty to not injure others 9
While the above article speaks a lot about ethics do not forget that ethics is a complex and highly detailed issue to discuss. So while we have dissected it fairly well please feel free to research the complete details of ethics, you may find it very interesting.
P.S. although we do not wish to sound aloof or preachy we in the EMS do need to be cognizant of our actions. After all people do look to us to be at our best when everything else is at its worst.