Ethics in Emergency Ethics in Emergency Services – WHO CARES?Services – WHO CARES?

Ethics in Emergency Ethics in Emergency Services – WHO CARES?Services – WHO CARES?

Dr. Erica French 29th September 2007

Issues Issues Influences Influences

Investigation Investigation ImplementationImplementation

ISSUESISSUES

Ethics - DefinedEthics - DefinedEthics - DefinedEthics - Defined

Concerns the moral philosophy, Concerns the moral philosophy, values and norms of behaviour that values and norms of behaviour that guide activities within societyguide activities within society

Top ethical issues Top ethical issues

International survey of 300 International survey of 300 companies identified the following companies identified the following ethics issues ethics issues Conflicts of Interest Conflicts of Interest 91%91% Inappropriate gifts Inappropriate gifts 9191 Sexual harassmentSexual harassment 9191 Unauthorised paymentsUnauthorised payments 8585 Equity in diversityEquity in diversity 8484

Ethical Issues contEthical Issues cont

Women (n=1400) identified the Women (n=1400) identified the following as occurring frequently in following as occurring frequently in businessbusiness Managers lying to employeesManagers lying to employees Expense account abuses at high levelsExpense account abuses at high levels Office nepotism and favouritismOffice nepotism and favouritism Taking credit of another’s workTaking credit of another’s work

Ethics Issues in EMSEthics Issues in EMS

Decline in ethics standards due to Decline in ethics standards due to poor resourcing of EMSpoor resourcing of EMS

Generational changeGenerational change Standards higher todayStandards higher today Passion for service in declinePassion for service in decline Lack of honesty by management Lack of honesty by management

Fallacies, Myths and RealitiesFallacies, Myths and Realities

Ethics – private not public affairEthics – private not public affair Business and ethics don’t mixBusiness and ethics don’t mix Ethics can be managedEthics can be managed Rules and laws may be insufficient to Rules and laws may be insufficient to

guide morally complex decisionsguide morally complex decisions

Dilbert page 65Dilbert page 65

Source: The Dilbert Principle, Scott Adams, HarperBusiness, 1996

INFLUENCESINFLUENCES

Influencing FactorsInfluencing FactorsInfluencing FactorsInfluencing Factors

Problem DefinitionProblem Definition Individual Factors Individual Factors Organisational FactorsOrganisational Factors External FactorsExternal Factors Ethical PrinciplesEthical Principles

Problem DefinitionProblem DefinitionProblem DefinitionProblem Definition

Problem Definition and Problem Definition and IdentificationIdentification Different levels and perspectiveDifferent levels and perspective How would you define the How would you define the

problem if you stood on the other problem if you stood on the other side of the fence?side of the fence?

Individual and Organisational Individual and Organisational FactorsFactors

Individual and Organisational Individual and Organisational FactorsFactors

Individual Factors Individual Factors Moral ResponsibilityMoral Responsibility Stages of DevelopmentStages of Development

Organisational Culture Organisational Culture Values, beliefs, goals, normsValues, beliefs, goals, norms Social ResponsibilitySocial Responsibility

External FactorsExternal Factors National valuesNational values CompetitionCompetition HistoryHistory

Ethical PrinciplesEthical PrinciplesEthical PrinciplesEthical Principles

UTILITY UTILITY HUMAN RIGHTSHUMAN RIGHTS JUSTICEJUSTICE INTEGRATIVEINTEGRATIVE

UtilitarianismUtilitarianismUtilitarianismUtilitarianism

Greatest good for the greatest Greatest good for the greatest number of people affected by it.number of people affected by it.

Actions judged as right, good, or Actions judged as right, good, or wrong depending on consequences.wrong depending on consequences.

Ends justifies the meansEnds justifies the means Benefits should outweigh costs of Benefits should outweigh costs of

other alternativesother alternatives

Utilitarianism and ManagementUtilitarianism and ManagementUtilitarianism and ManagementUtilitarianism and Management Benefits Benefits

considers collective good considers collective good collective rather than individual values collective rather than individual values

influence behaviourinfluence behaviour Limitations Limitations

Non-monetary stakes (health, safety, Non-monetary stakes (health, safety, environment) are hard to measure, collectivistenvironment) are hard to measure, collectivist

Problems Problems changing societal and workforce composition; changing societal and workforce composition; changing societal and workforce values.changing societal and workforce values.

RIGHTSRIGHTSRIGHTSRIGHTS

Protects individual freedom, dignity Protects individual freedom, dignity and choiceand choice

Driven by individual entitlementDriven by individual entitlement Based on legal rights and principle of Based on legal rights and principle of

dutyduty Viewed from individual perspective Viewed from individual perspective

rather than societal or group view.rather than societal or group view.

Rights and ManagementRights and ManagementRights and ManagementRights and Management Benefits Benefits

supports basic entitlements; eg anti -supports basic entitlements; eg anti -discrimination legislation overcomes discrimination legislation overcomes utilitarianismutilitarianism

Limitations Limitations can be used by some groups to own can be used by some groups to own

advantageadvantage Problems Problems

determining rights and duties; determining rights and duties; addressing cultural differences.addressing cultural differences.

JusticeJusticeJusticeJustice

All persons should be treated All persons should be treated fairlyfairly

Based on principles of fairness Based on principles of fairness and equalityand equality

All persons should have equal All persons should have equal opportunity to share in opportunity to share in society’s benefits and burdens society’s benefits and burdens

Justice and ManagementJustice and ManagementJustice and ManagementJustice and Management

BenefitsBenefits addresses unfair distribution of access addresses unfair distribution of access

to serviceto service Limitations Limitations

rules and processes determining justice rules and processes determining justice may not be transparent or fair.may not be transparent or fair.

Problems Problems determining who is right and who is determining who is right and who is

wrong; power, cultural norms. wrong; power, cultural norms.

Principle Principle ValueValue OutcomeOutcome

UtilityUtility Greatest good Greatest good for greatest for greatest numbernumber

All patients be All patients be transportedtransported

Human Human RightsRights

Individual Individual entitlemententitlement

Patients’ Patients’ rights and rights and paramedic paramedic dutiesduties

JusticeJustice Community Community fairnessfairness

Group Group decisiondecision

INVESTIGATIONINVESTIGATION

ResearchResearch

Survey - 59 ACAP MembersSurvey - 59 ACAP Members Interviews – 6Interviews – 6

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Individual Org

Utility

Rights

Justice

Cost Benefit ratiosIndividual dignity

Conflict in EMSConflict in EMS

Conflict with personal ethical standardsConflict with personal ethical standards Superiors (65%)Superiors (65%) Medical staff (60%)Medical staff (60%)

Conflict with institutional practicesConflict with institutional practices Transparency (60%)Transparency (60%) Equal access to promotion or transfer (60%)Equal access to promotion or transfer (60%) Honesty (57%)Honesty (57%) Equal access to training (50%)Equal access to training (50%) Discrimination (40%)Discrimination (40%)

Organisational ProcessesOrganisational Processes Comparisons of ethical standards Comparisons of ethical standards

over timeover time - Inconclusive - Inconclusive Inappropriate processesInappropriate processes

Dishonest dealing with employees (70%)Dishonest dealing with employees (70%) Lack of information disclosure to Lack of information disclosure to

employees (66%)employees (66%) Harassment and bullying (63%)Harassment and bullying (63%)

Eliminating inappropriate processesEliminating inappropriate processes Dishonest dealing with employees (65%)Dishonest dealing with employees (65%) Current roster practices (65%)Current roster practices (65%) Information disclosure (63%)Information disclosure (63%)

ConsultationConsultation

Consultation with others on ethics Consultation with others on ethics conflictconflict Colleagues (60%)Colleagues (60%) Supervisors (51%)Supervisors (51%) Friends (36%)Friends (36%) Only 7% approached ethics committeeOnly 7% approached ethics committee Only 2% approached LACOnly 2% approached LAC

Most helpful in consultation processMost helpful in consultation process Colleagues (48%)Colleagues (48%) Friends (29%)Friends (29%)

Ethics in EMSEthics in EMS

Factors of higher ethical standardsFactors of higher ethical standards Increase in higher educationIncrease in higher education Code of conductCode of conduct Increased professionalismIncreased professionalism Ethics trainingEthics training Increase in public awarenessIncrease in public awareness

Factors of lower ethical standardsFactors of lower ethical standards Poor rewards for Ambulance professionalsPoor rewards for Ambulance professionals Poor resource allocation for EMSPoor resource allocation for EMS Poor work life balance Poor work life balance

Future for the ProfessionFuture for the Profession

FutureFuture Stay in the profession (65%)Stay in the profession (65%) Elsewhere (25%)Elsewhere (25%) Nursing and other (6%)Nursing and other (6%) Retire (4%)Retire (4%)

IMPLEMENTATIONIMPLEMENTATION

Ethics management challenges to Ethics management challenges to meet the emergency medical meet the emergency medical

service requirementservice requirement 11. . Recognition of competing interests in Recognition of competing interests in

ethical dilemmas ethical dilemmas 2. Finding a balance2. Finding a balance 3. Building a culture of trust 3. Building a culture of trust

Acknowledgment of conflictAcknowledgment of conflict Recognition of competence and accomplishmentRecognition of competence and accomplishment Ethics codes and trainingEthics codes and training Support for employee decision-makingSupport for employee decision-making Audit of organisational practices Audit of organisational practices Improved communication processesImproved communication processes

Ethics in Emergency Ethics in Emergency Services – WHO CARES?Services – WHO CARES?

Ethics in Emergency Ethics in Emergency Services – WHO CARES?Services – WHO CARES?

Dr. Erica French 29th September 2007