The Age of Moral Ambiguity

When was the last time you held a training session with your supervisors and employees on moral ambiguity?

Ask the average worker in your EMS organization to discuss their approach to moral ambiguity in the workplace specifically in dealing with patients, co-workers and supervisors and you ll probably get a puzzled look. Ask your supervisors about their feelings on the moral ambiguities of their job and how it relates to their approach to managing employees and providing customer service and you ll probably get a blank stare and a shrug of the shoulders.

As the EMS manager, do you have a clear picture of moral ambiguity and how it affects you, your employees and your customers?

In simple terms, morals are usually defined as the difference between good and bad. Ambiguity is the state of having more than one meaning or being open to interpretation. Put those terms together moral ambiguity and you get something that shows conflict between right and wrong.

An example of this concept is if your ambulance service mission was to care for patients but your employees mistreat patients who repeatedly call for minor problems. The mission and purpose of an ambulance responding to a call for help is good, but that good is at the same time bad for those cases when a patient may be mistreated for allegedly abusing the system.

The question for agencies today is to what degree can you be a good representative of EMS delivery against the bad examples? Do all the decisions made by your employees represent the best actions and behaviors of EMS workers in the industry? Do your organizational values demonstrate daily your commitment to doing what is right, and do you and your employee s actions follow those values?

This is not just a question of medical ethics or setting good policies and procedures. Moral ambiguity is different for everyone. In fact, our moral character is determined prior to beginning work in EMS. We became EMTs and paramedics because we wanted to help others. We spent the time to attend classes and clinicals, and our level of commitment was increased by the time we applied for jobs. When we became employees, we were required to follow the established code of conduct of the organization. In most cases, we follow the formal and informal behaviors and actions demonstrated by senior employees and supervisors.

The number of examples of employee and supervisory misconduct in EMS is staggering. Employees who steal from their patients, hit their patients or even sexually assault their patients would probably try to justify their actions by pointing to the overall good they perform by being an EMS provider. Most employees and supervisors would clearly know the difference between good and bad in those cases.

But what about those who are having extramarital affairs, working a side job for cash and not reporting the income on their taxes, or demanding a discount at a restaurant while on duty and in uniform. Are these behaviors overlooked and thus allowed to represent your agency to the public? Obviously not, you re probably shouting in your head (or maybe out loud). But if these activities occur, what actions would you take? You probably don t have a policy against stealing from patients, and I believe you shouldn t have to. So how do you emphasize to your employees and supervisors what s good and what s bad? Isn t everyone supposed to know what s acceptable behavior? Do you have to attempt to cover all the anticipated indiscretions of your employees?

It shouldn t matter if an employee or supervisor doesn t have a policy or procedure to guide their actions or behaviors. They need to know that proper conduct is expected of them both on and off duty. In some cases, organizations mention moral character in either an SOP or a policy and procedure manual. Rarely, if ever, is that term explained, and the meaning is left up to interpretation by the employee and management.

So the key is to not ignore the implications of uncorrected inappropriate behavior and to ensure employees understand the importance of honest and ethical behavior. How you choose to deal with it in your organization could vary a great deal. The first step is bringing this issue to the forefront. Now consider how you would approach the idea of morals in your organization the next time they seem to be declining.