Ethics in Emergency Services – WHO CARES?

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

2. Issues • Influences • Investigation • Implementation

3. ISSUES

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

5. Top ethical issues • International survey of 300 companies identified the following ethics issues • Conflicts of Interest 91% • Inappropriate gifts 91 • Sexual harassment 91 • Unauthorised payments 85 • Equity in diversity 84

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

7. Ethics Issues in EMS • 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

8. Fallacies, Myths and Realities • 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

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

10. INFLUENCES

11. Influencing Factors • Problem Definition • Individual Factors • Organisational Factors • External Factors • Ethical Principles

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

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

14. Ethical Principles • UTILITY • HUMAN RIGHTS • JUSTICE • INTEGRATIVE

15. Utilitarianism • 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

16. Utilitarianism and Management • Benefits • considers collective good • collective rather than individual values influence behaviour • Limitations • Non-monetary stakes (health, safety, environment) are hard to measure, collectivist • Problems • changing societal and workforce composition; • changing societal and workforce values.

17. RIGHTS • 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.

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

19. 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

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

22. INVESTIGATION

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

24. Conflict in EMS • Conflict with personal ethical standards • Superiors (65%) • Medical staff (60%) • Conflict with institutional practices • Transparency (60%) • Equal access to promotion or transfer (60%) • Honesty (57%) • Equal access to training (50%) • Discrimination (40%)

25. Organisational Processes • Comparisons of ethical standards over time - Inconclusive • Inappropriate processes • Dishonest dealing with employees (70%) • Lack of information disclosure to employees (66%) • Harassment and bullying (63%) • Eliminating inappropriate processes • Dishonest dealing with employees (65%) • Current roster practices (65%) • Information disclosure (63%)

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

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

28. Future for the Profession • Future • Stay in the profession (65%) • Elsewhere (25%) • Nursing and other (6%) • Retire (4%)

29. IMPLEMENTATION

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

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