Ethics in Emergency Services – WHO CARES? Ethics in Emergency Services – WHO CARES? Dr. Erica French 29 th September 2007

Issues Issues Influences Influences Investigation Investigation Implementation Implementation

ISSUES

Ethics - Defined Concerns the moral philosophy, values and norms of behaviour that guide activities within society Concerns the moral philosophy, values and norms of behaviour that guide activities within society

Top ethical issues International survey of 300 companies identified the following ethics issues International survey of 300 companies identified the following ethics issues Conflicts of Interest 91% Conflicts of Interest 91% Inappropriate gifts 91 Inappropriate gifts 91 Sexual harassment91 Sexual harassment91 Unauthorised payments85 Unauthorised payments85 Equity in diversity84 Equity in diversity84

Ethical Issues cont Women (n=1400) identified the following as occurring frequently in business Women (n=1400) identified the following as occurring frequently in business Managers lying to employees Managers lying to employees Expense account abuses at high levels Expense account abuses at high levels Office nepotism and favouritism Office nepotism and favouritism Taking credit of another’s work Taking credit of another’s work

Ethics Issues in EMS Decline in ethics standards due to poor resourcing of EMS Decline in ethics standards due to poor resourcing of EMS Generational change Generational change Standards higher today Standards higher today Passion for service in decline Passion for service in decline Lack of honesty by management Lack of honesty by management

Fallacies, Myths and Realities Ethics – private not public affair Ethics – private not public affair Business and ethics don’t mix Business and ethics don’t mix Ethics can be managed Ethics can be managed Rules and laws may be insufficient to guide morally complex decisions Rules and laws may be insufficient to guide morally complex decisions

Dilbert page 65 Dilbert page 65 Source: The Dilbert Principle, Scott Adams, HarperBusiness, 1996

INFLUENCES

Influencing Factors Problem Definition Problem Definition Individual Factors Individual Factors Organisational Factors Organisational Factors External Factors External Factors Ethical Principles Ethical Principles

Problem Definition Problem Definition and Identification Problem Definition and Identification Different levels and perspective Different levels and perspective How would you define the problem if you stood on the other side of the fence? How would you define the problem if you stood on the other side of the fence?

Individual and Organisational Factors Individual Factors Individual Factors Moral Responsibility Moral Responsibility Stages of Development Stages of Development Organisational Culture Organisational Culture Values, beliefs, goals, norms Values, beliefs, goals, norms Social Responsibility Social Responsibility External Factors External Factors National values National values Competition Competition History History

Ethical Principles UTILITY UTILITY HUMAN RIGHTS HUMAN RIGHTS JUSTICE JUSTICE INTEGRATIVE INTEGRATIVE

UtilitarianismUtilitarianism Greatest good for the greatest number of people affected by it. Greatest good for the greatest number of people affected by it. Actions judged as right, good, or wrong depending on consequences. Actions judged as right, good, or wrong depending on consequences. Ends justifies the means Ends justifies the means Benefits should outweigh costs of other alternatives Benefits should outweigh costs of other alternatives

Utilitarianism and Management Benefits Benefits considers collective good considers collective good collective rather than individual values influence behaviour collective rather than individual values influence behaviour Limitations Limitations Non-monetary stakes (health, safety, environment) are hard to measure, collectivist Non-monetary stakes (health, safety, environment) 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.

RIGHTSRIGHTS Protects individual freedom, dignity and choice Protects individual freedom, dignity and choice Driven by individual entitlement Driven by individual entitlement Based on legal rights and principle of duty Based on legal rights and principle of duty Viewed from individual perspective rather than societal or group view. Viewed from individual perspective rather than societal or group view.

Rights and Management Benefits Benefits supports basic entitlements; eg anti - discrimination legislation overcomes utilitarianism supports basic entitlements; eg anti - discrimination legislation overcomes utilitarianism Limitations Limitations can be used by some groups to own advantage can be used by some groups to own advantage Problems Problems determining rights and duties; determining rights and duties; addressing cultural differences. addressing cultural differences.

JusticeJustice All persons should be treated fairly All persons should be treated fairly Based on principles of fairness and equality Based on principles of fairness and equality All persons should have equal opportunity to share in society’s benefits and burdens All persons should have equal opportunity to share in society’s benefits and burdens

Justice and Management Benefits Benefits addresses unfair distribution of access to service addresses unfair distribution of access to service Limitations Limitations rules and processes determining justice may not be transparent or fair. rules and processes determining justice may not be transparent or fair. Problems Problems determining who is right and who is wrong; power, cultural norms. determining who is right and who is wrong; power, cultural norms.

PrincipleValueOutcome Utility Greatest good for greatest number All patients be transported Human Rights Individual entitlement Patients’ rights and paramedic duties Justice Community fairness Group decision

INVESTIGATION

Research Survey - 59 ACAP Members Survey - 59 ACAP Members Interviews – 6 Interviews – 6 Cost Benefit ratios Individual dignity

Conflict in EMS Conflict with personal ethical standards Conflict with personal ethical standards Superiors (65%) Superiors (65%) Medical staff (60%) Medical staff (60%) Conflict with institutional practices Conflict 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 Processes Comparisons of ethical standards over time - Inconclusive Comparisons of ethical standards over time - Inconclusive Inappropriate processes Inappropriate processes Dishonest dealing with employees (70%) Dishonest dealing with employees (70%) Lack of information disclosure to employees (66%) Lack of information disclosure to employees (66%) Harassment and bullying (63%) Harassment and bullying (63%) Eliminating inappropriate processes Eliminating 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%)

Consultation Consultation with others on ethics conflict Consultation with others on ethics conflict Colleagues (60%) Colleagues (60%) Supervisors (51%) Supervisors (51%) Friends (36%) Friends (36%) Only 7% approached ethics committee Only 7% approached ethics committee Only 2% approached LAC Only 2% approached LAC Most helpful in consultation process Most helpful in consultation process Colleagues (48%) Colleagues (48%) Friends (29%) Friends (29%)

Ethics in EMS Factors of higher ethical standards Factors of higher ethical standards Increase in higher education Increase in higher education Code of conduct Code of conduct Increased professionalism Increased professionalism Ethics training Ethics training Increase in public awareness Increase in public awareness Factors of lower ethical standards Factors of lower ethical standards Poor rewards for Ambulance professionals Poor rewards for Ambulance professionals Poor resource allocation for EMS Poor resource allocation for EMS Poor work life balance Poor work life balance

Future for the Profession Future Future 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%)

IMPLEMENTATION

Ethics management challenges to meet the emergency medical service requirement 1. Recognition of competing interests in ethical dilemmas 1. Recognition of competing interests in ethical dilemmas 2. Finding a balance 2. Finding a balance 3. Building a culture of trust 3. Building a culture of trust Acknowledgment of conflict Acknowledgment of conflict Recognition of competence and accomplishment Recognition of competence and accomplishment Ethics codes and training Ethics codes and training Support for employee decision-making Support for employee decision-making Audit of organisational practices Audit of organisational practices Improved communication processes Improved communication processes

Ethics in Emergency Services – WHO CARES? Ethics in Emergency Services – WHO CARES? Dr. Erica French 29 th September 2007