Ethics Are Everything

The scenario started out simple enough: You and your partner were dispatched to an "unknown medical" that turned out to be an older man who had clearly been dead for several hours. After confirming asystole and a no-resuscitation order from base, you begin to pack up your gear when you notice your partner pick up a roll of money sitting on the man's dresser and slip it into his uniform pants.

Having painted this picture, one member of the selection committee looks at the paramedic applicant and asks, "What are you going to do?" The young man sitting across the table thinks for a moment and answers, "I'd tell him to put it back." The committee member then says, "OK, he puts the money back. Now what?"

Again there is a brief pause, and the candidate answers, "We'll finish cleaning up and get the rig back in service, and I'll just keep an eye on him for the next few calls."

That wraps up the interview, so we thank the candidate, and he leaves the room. Then we fill out our evaluations. The candidate has failed one of the two ethics questions and is immediately disqualified from admission to the program.

As with any candidate who applies to the program and is not admitted, the young man got a letter inviting him to set up a meeting to review his performance, and he did. When he found out that he actually had enough points for admission but was eliminated because of the ethics question, he appeared stymied. "But I told him to put the money back, and he did," he protested. "And I said I'd keep an eye on him."

Clearly, this young man just didn't get it. I looked at him and said, "Consider this: A guy robs the local bank, and as he's leaving, a police officer puts a gun in his face and tells him he's under arrest. So the bank robber says to the officer, 'How about if I just put the money back, and you and I go on about our business?' "

"That's ridiculous," the young man told me. "This is nothing like that."

"No," I said, "that's where you're wrong. It's exactly like that. In both cases, we're talking about thieves. Putting the money back does nothing to change that."

Abusing the Vulnerable

Out there in EMS Land, we see patients at some of the most vulnerable points in their lives. Frequently, we care for patients who are under the influence of alcohol or drugs, in shock or suffering the effects of a serious head injury-any or all of which could leave them mentally vulnerable. At those moments of extreme vulnerability, how easy would it be to slip a ring off a finger, take a charge card out of a wallet while you check for ID or take a roll of money off a dresser? Too easy...unless you're an ethical provider. If you're an ethical provider, each of those possibilities becomes an impossibility, since ethical providers don't steal from their patients.

Unlike many other aspects of life, ethics don't come in shades of grey. It's kind of like being "a little bit pregnant." Pregnancy doesn't come in that flavor-you're either pregnant or you're not. The same is true of ethics in your medical practice: You're either an ethical provider or you're not.

The people we serve, who invite us into their homes, their bedrooms and the most intimate parts of their lives, believe we're honest and trustworthy. If they didn't, we wouldn't be in their homes, bedrooms and lives.

Several years ago, as the grasp of Alzheimer's and dementia was squeezing the life out of my mother, she finally got so ill that she had to be put in an extended-care facility. She'd been there less than two weeks when I noticed her wedding ring was missing. I immediately went to the administrator, and at first he tried to dance around the subject, asking how he could even be sure she'd ever had a wedding ring on. Suppressing my anger, I handed him my copy of her personal-belongings sheet, which showed that she had indeed come with her wedding ring. No longer able to dance, he said they would replace the ring. I told him I didn't want the ring replaced, I wanted the ring she'd worn for 52 years back, and I wanted the person who took it identified and fired. It took a couple of weeks, but they finally found the guy who'd taken her ring-but not before he'd pawned it. By that time it was gone forever, and four months later my mom died and was buried with that replacement ring on her finger.

Though officials at the facility suspected the employee had been stealing from other patients in the Alzheimer's/dementia wing (arguably some of the most vulnerable of all patients), they couldn't prove anything, so all they could do was fire him.

In regard to the opening scenario, one of the other questions that played into our decision was this: After witnessing the theft of the money and its return to the dresser, would the applicant have reported the issue to his supervisor? When we asked him this, there was once again a pause before he answered, "I don't know. After all, he is my partner."

Indeed he is. But if you see an unethical act such as theft and don't report it, are you really any better than the person committing it? In the legal world, the term used to describe you would be accessory-and that's just a stone's throw away from thief. It is essential that we take a hard line on ethical issues in our profession, because as I see it, in medicine, ethics are everything.

Until next month...