Ethics question: Would you work on your EX?

[RebelAngel]

My ex was (is) not a very pleasant person, particularly to me and my oldest daughter. We were together over 10 years when I left him early last year. He was controlling and mentally and verbally abusive. He did not support me becoming an EMT and he still feels that EMS takes me away from "his" children and does not approve of me in it at all. He lives in the district we (my boyfriend, oldest daughter who is a new EMT, and I) volunteer for.

I'm not so much concerned with providing quality care or being negligent, because as I see it it's my moral and professional obligation to provide the best care I can no matter what I think of the person. I also know that whether I like him or hate him he's my children's father. My concern is that if something bad did happen, unrelated to the care provided, and he died or became paralyzed or whatnot that the fact that he was a major jerk and I left him could cause issues or bad blood within our families with finger pointing that I could have or should have done something more/different/else or that I did it on purpose.

My daughter takes the stance that as a volunteer EMT in our district she has no obligation to go on the (any) call as long as she is not on schedule or not at the station when a call is dispatched. She has a strong dislike for him and is not as "you do what you've been trained to do" as I am.

 

[Carlos Danger]

My concern is that if something bad did happen, unrelated to the care provided, and he died or became paralyzed or whatnot that the fact that he was a major jerk and I left him could cause issues or bad blood within our families with finger pointing that I could have or should have done something more/different/else or that I did it on purpose.

Of course. In fact I would imagine that it could potentially result in legal accusations.

My daughter takes the stance that as a volunteer EMT in our district she has no obligation to go on the (any) call as long as she is not on schedule or not at the station when a call is dispatched. She has a strong dislike for him and is not as "you do what you've been trained to do" as I am.

I would imagine that could potentially result in legal challenges as well. I don't know. It's something to consider, though.

I would definitely talk to a lawyer about this stuff. Don't count on your volunteer status to automatically insulate you from legal problems.

 

[joshrunkle35]

If it is possible to avoid treating any friend, relative, coworker, etc., then I would let someone else take the call. On the other hand, if you are the first available treatment and they need your help, provide help until someone of equal or greater care can take over. Document, document, document.

Also, remember that opinions that you publicly post on websites like these get brought up in court all the time in these sorts of cases.

 

[RebelAngel]

My daughter's feelings are within our state's duty to act. If you aren't referring to that you will have to clarify.

 

[StCEMT]

Yes. On a personal note? I have no ill will towards her, so it is not like I would try to avoid her even in a moment like that. And if I was one of the only people there, it seems like it'd be the right thing to do. It might be over my head, but I know her health issues better than pretty much anyone else so there is also that.

 

[ERDoc]

Your best bet is to let someone else take care of him if possible (same for the daugter). If you are not on duty and a call goes out at his house, don't respond, pretty simple. If you have no choice but to take care of him, follow your protocols and document everything. As an EMT, there is actually very little you can do to injure someone.

 

[DrParasite]

quite simply: absolutely. my ex, or even worse, my brother, deserves to be helped as best as possible if they were to suffer a medical emergency. I might not like the person, but I will not allow my personal feelings to prevent me from helping them. I might not be nice and cheery about it, but I want to be able to look at myself in the mirror the next day.

I'm not so much concerned with providing quality care or being negligent, because as I see it it's my moral and professional obligation to provide the best care I can no matter what I think of the person. I also know that whether I like him or hate him he's my children's father. My concern is that if something bad did happen, unrelated to the care provided, and he died or became paralyzed or whatnot that the fact that he was a major jerk and I left him could cause issues or bad blood within our families with finger pointing that I could have or should have done something more/different/else or that I did it on purpose.

if your on shift, or on the ambulance, why would you not want to help him? it's your job, as a EMT on the ambulance. further, how do you know he is the person who needs help? maybe it's a guest, his visiting family, etc. maybe a little kid got hit by a car in front of his address....

My daughter takes the stance that as a volunteer EMT in our district she has no obligation to go on the (any) call as long as she is not on schedule or not at the station when a call is dispatched. She has a strong dislike for him and is not as "you do what you've been trained to do" as I am.

She's probably right. if she's not on shift, and not in the station, and as a volunteer, she is under no obligation to answer any request for service. but how do you know if he is the person who needs help?

 

[Ewok Jerky]

I give treatment to peeps I don't like every day.

If your volly and the call is his address, don't go.

If your on shift an the call is his house, ask your partner to tech and you drive.

 

[Underoath87]

Is he a frequent flyer? If not, odds are very slim you'll ever have to worry about it.

 

[RebelAngel]

if your on shift, or on the ambulance, why would you not want to help him? it's your job, as a EMT on the ambulance.

My concerns are in my first post.

further, how do you know he is the person who needs help?

Enough identifying info is usually in dispatch info.

She's probably right. if she's not on shift, and not in the station, and as a volunteer, she is under no obligation to answer any request for service. but how do you know if he is the person who needs help?

I know she's right.

 

[DrParasite]

My concerns are in my first post...
Enough identifying info is usually in dispatch info.

I have a solution... if you are ever on shift, and his address goes out, refuse to go on it. deal with the consequences like an adult,whatever they might be. or if you hear his address, just quit. plain and simple. tell your daughter the same thing. or even easier, to avoid the whole theoretical situation, and hand in your resignation today. This way you don't have to worry about the situation.

Here is the reality: unless he is a frequent flyer, the odds of you running a call where he is the patient is slim. Couple that with the odds of you being on shift when he needs an ambulance are even slimmer. And the odds that he will call 911 for a life threatening situation for himself, when you are on shift, where something you did could actually have a life or death or quality of life impact on him? Without knowing your agency & response area, I can't even fathom the odds, but I would fathom you have a better chance of winning the powerball lottery.

You can what if it all you want, but if this 1 in 100,000 scenario were to actually occur, you are worried that you couldn't have another EMT take over care for you, or have a supervisor respond to the scene to take over, well, then you would just have to be a professional and do the job to the best of your ability. And if you can't do that, well, then I don't know what else to tell you.

 

[RebelAngel]

We don't have shifts or schedules. We run calls as they come. We're losing two EMTs by the end of the year. Your odds are based on ignorance, as you said yourself, because you know nothing about the agency or our area. There is a veryhe needed EMS, particularly after the first of the year, I'd be around to answer it.

I'm not worried about anything regarding my ability to provide care. I was asking to get other's perspectives on the ethics issues with treating an ex that was abusive and I am no longer with. If you would actually really read my first post you would understand that.

 

[Ewok Jerky]

I was asking to get other's perspectives on the ethics issues with treating an ex that was abusive and I am no longer with.

The ethical question is easy. It would be the definition of unethical if you were to withold treatment.

 

[Tigger]

I don't understand the issue. You said you'd have no issue providing care, so do that.

 

[WolfmanHarris]

First we need to differentiate between ethical and problematic. Treating an ex and dealing with the personal stress and drama that may surround that even with the best outcome is problematic at rest and I wouldn't wish anyone to have to face that situation. Ethics, however, has very little to do with that.

A key distinction with ethics over morals is that ethics applies to a group, sometimes informally sometimes in a written code, but the important point is it is a group morality that may run counter to your personal morality. Ethics in medicine revolves around a couple important concepts: autonomy, consent and duty of care are worth considering here.

Autonomy is arguably the guiding principle to medical ethics, certainly it informs many of the decisions we make. Patients must be viewed as independent being capable making their own decisions, for better or worse and must not be deprived of their right to do so. Autonomy informs our ideas of consent and there is often a lot of crossover in discussion of these concepts.

Duty of care is usually discussed in terms of legal obligation, but ethically its best thought of as "first do no harm." It is your obligation within medicine to work for your patient and to provide treatment. Duty of care is fairly straight forward within EMS since we have no control over who our patients are and cannot decline to care for them. Within the greater world of medicine this is where conflicts between a health care providers personal morals and their professional ethics tend to conflict. (See abortion, religion, anti-vaxxers, etc)

You would be in a far more precarious position arriving when called and then refusing, restricting or otherwise altering care due to the patient being your ex. It would not be unethical or unreasonable to ask for a second unit, have your partner take lead and otherwise reduce your direct involvement while still meeting your professional obligations. And of course if your ex does not consent, regardless of whether or not his is in extremis, that is his right as long as he is of sound mind.

Not knowing you're response area perhaps you can switch stations to reduce exposure? A colleague of mine a couple years ago had a family member that she had a restraining order against staying at a local hospital (usually not local). We do a number of IFT's out of the CCU which was on the same floor as he. For the course of his stay we were at our request taken off transfer from that hospital.

In the end, if you feel comfortable setting aside your personal history that's what's important for your well being. Ethically treat like any other patient. Otherwise cross your fingers and hope you're not working if anything happens.

 

[Kyle Vernon]

I fully expect that I may indeed have to one day tx my ex on a PEC. Since the tx would not be considered urgent, I'd likely opt out.
If it were an emergency and she was aware that I was responding, I'd expect she'd want a different unit, and I'd oblige her, pending her condition. If her condition demanded immediate tx, I'd do it, then call my supervisor and lawyer to let them know that they should expect contact from her attorney.

 

[joshrunkle35]

I fully expect that I may indeed have to one day tx my ex on a PEC. Since the tx would not be considered urgent, I'd likely opt out.
If it were an emergency and she was aware that I was responding, I'd expect she'd want a different unit, and I'd oblige her, pending her condition. If her condition demanded immediate tx, I'd do it, then call my supervisor and lawyer to let them know that they should expect contact from her attorney.

I would caution against using the abbreviation "tx", as it can easily mean more than one thing in medicine:

It can mean: transport, transplant, transmission, tumor or therapy.

 

[Kyle Vernon]

Context is key, I use it for transport and transfer a lot. But yes you are right.

 

[RocketMedic]

Certainly. She's a person too and should she ever need my medical services in my area, I would treat her to the utmost of my ability, without judgement or derision, and with respect. Just because I transport/work on/see her doesn't change the past or the present one bit.

 

[johnrsemt]

You have to be able to treat everyone; no matter what the history: I worked for a company that we did prisoner transports for medical care; and I had some co workers that would always ask what the prisoner was in for so they could make the decision of how they would treat them. You can't do that; you either treat everyone or no one
Same as being the 2nd ambulance on a police involved shooting (1st truck usually gets the officer); you need to treat the person who shot the officer even if you know the officer.