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Ethics in Emergency
Services – WHO CARES?
Dr. Erica French 29th September 2007
Issues
 Influences
 Investigation
 Implementation
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ISSUES
Ethics - Defined
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Concerns the moral philosophy, values and
norms of behaviour that guide activities
within society
Top ethical issues
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International survey of 300 companies
identified the following ethics issues
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Conflicts of Interest
Inappropriate gifts
Sexual harassment
Unauthorised payments
Equity in diversity
91%
91
91
85
84
Ethical Issues cont
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Women (n=1400) identified the following
as occurring frequently in business
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Managers lying to employees
Expense account abuses at high levels
Office nepotism and favouritism
Taking credit of another’s work
Ethics Issues in EMS
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Decline in ethics standards due to poor
resourcing of EMS
Generational change
Standards higher today
Passion for service in decline
Lack of honesty by management
Fallacies, Myths and Realities
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Ethics – private not public affair
Business and ethics don’t mix
Ethics can be managed
Rules and laws may be insufficient to
guide morally complex decisions
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Dilbert page 65
Source: The Dilbert Principle, Scott Adams, HarperBusiness, 1996
INFLUENCES
Influencing Factors
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Problem Definition
Individual Factors
Organisational Factors
External Factors
Ethical Principles
Problem Definition
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Problem Definition and
Identification
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Different levels and perspective
How would you define the problem if
you stood on the other side of the
fence?
Individual and Organisational
Factors
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Individual Factors
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Organisational Culture
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Moral Responsibility
Stages of Development
Values, beliefs, goals, norms
Social Responsibility
External Factors
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National values
Competition
History
Ethical Principles
 UTILITY
 HUMAN
RIGHTS
 JUSTICE
 INTEGRATIVE
Utilitarianism
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Greatest good for the greatest number of
people affected by it.
Actions judged as right, good, or wrong
depending on consequences.
Ends justifies the means
Benefits should outweigh costs of other
alternatives
Utilitarianism and Management
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Benefits
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Limitations
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considers collective good
collective rather than individual values
influence behaviour
Non-monetary stakes (health, safety,
environment) are hard to measure, collectivist
Problems
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changing societal and workforce composition;
changing societal and workforce values.
RIGHTS
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Protects individual freedom, dignity and
choice
Driven by individual entitlement
Based on legal rights and principle of duty
Viewed from individual perspective rather
than societal or group view.
Rights and Management
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Benefits
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Limitations
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supports basic entitlements; eg anti discrimination legislation overcomes
utilitarianism
can be used by some groups to own
advantage
Problems
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determining rights and duties;
addressing cultural differences.
Justice
All persons should be treated fairly
 Based on principles of fairness and
equality
 All persons should have equal
opportunity to share in society’s
benefits and burdens
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Justice and Management
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Benefits
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Limitations
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addresses unfair distribution of access to
service
rules and processes determining justice may
not be transparent or fair.
Problems
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determining who is right and who is wrong;
power, cultural norms.
Principle
Value
Outcome
Utility
Greatest good
for greatest
number
All patients be
transported
Human Rights Individual
entitlement
Patients’ rights
and paramedic
duties
Justice
Group decision
Community
fairness
INVESTIGATION
Research
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Survey - 59 ACAP Members
Interviews – 6
70.00%
60.00%
50.00%
40.00%
Individual
dignity
Cost Benefit ratios
Utility
Rights
Justice
30.00%
20.00%
10.00%
0.00%
Individual
Org
Conflict in EMS
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Conflict with personal ethical standards
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Superiors (65%)
Medical staff (60%)
Conflict with institutional practices
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Transparency (60%)
Equal access to promotion or transfer (60%)
Honesty (57%)
Equal access to training (50%)
Discrimination (40%)
Organisational Processes
Comparisons of ethical standards over
time - Inconclusive
 Inappropriate processes
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Dishonest dealing with employees (70%)
Lack of information disclosure to employees
(66%)
Harassment and bullying (63%)
Eliminating inappropriate processes
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Dishonest dealing with employees (65%)
Current roster practices (65%)
Information disclosure (63%)
Consultation
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Consultation with others on ethics conflict
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Colleagues (60%)
Supervisors (51%)
Friends (36%)
Only 7% approached ethics committee
Only 2% approached LAC
Most helpful in consultation process
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Colleagues (48%)
Friends (29%)
Ethics in EMS
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Factors of higher ethical standards
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Increase in higher education
Code of conduct
Increased professionalism
Ethics training
Increase in public awareness
Factors of lower ethical standards
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Poor rewards for Ambulance professionals
Poor resource allocation for EMS
Poor work life balance
Future for the Profession
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Future
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Stay in the profession (65%)
Elsewhere (25%)
Nursing and other (6%)
Retire (4%)
IMPLEMENTATION
Ethics management challenges to
meet the emergency medical
service requirement
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1. Recognition of competing interests in ethical
dilemmas
2. Finding a balance
3. Building a culture of trust
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Acknowledgment of conflict
Recognition of competence and accomplishment
Ethics codes and training
Support for employee decision-making
Audit of organisational practices
Improved communication processes
Ethics in Emergency
Services – WHO CARES?
Dr. Erica French 29th September 2007