The instructor began the class with a question, “Let’s say you just got done with a long shift as an EMT. You’re tired so you stop at a Dunkin Doughnuts for a coffee and a muffin. A women sitting in a corner eats her munchkins too quickly and starts to choke. People look to you because you are wearing your EMT uniform. Do you have a duty to act?” The conversation that insured was the most fascinating conversation on ethics that this philosophy major has witnessed.
During the debate I kept my mouth shut, at first out of that certain arrogance that comes along with knowing names like Kant, Hume, and Leibniz, but then out of fear. I was quite hesitant to utter a sentence as I was not sure there was an original thought on the matter in my head. Sure I could have said, “this dead white guy would say blah and this other dead white guy would respond with blah” but such utterances seemed out of place in this context. The distinction between morals, values, virtues, ends, and means all became meaningless in this discussion because all that was left was action. “Do you have a duty to act?”
A second scenario further muddied the water, “You enter a home an old women is lying on the floor gasping for air. Before she passes out she yells out to you, ‘Save Me’. After she passes out you notice a bracelet on his wrist with the letters D.N.R. The old women at some point signed a legal document asking not to be resuscitated should she lose consciousness. Her husband sits on the sofa screaming for you to help her. Do you have a duty to act?” Life and law are placed into direct conflict here. One’s sense of duty is compromised by legality. The force behind this conflict is basic self-preservation. To resuscitate someone who has made it know that they do not wish it is punishable by fines, potential jail time, loss of job and certification. Yet, despite all that is at risk watching the women die is simply counter to the nature of your existence both as an EMT but also as a human being. “Do you have a duty to act?”
The hierarchy of safety is taught as safety of self, safety of partner, safety of patient. Such logic is similar to the airplane emergency instruction to put your face mask on before you assist others. I always thought that it was beautiful that such an announcement had to be made. The force of pronouncement is necessary to counter the innate, though sometimes ill-informed, compulsion to help our fellows. The Duty to Act flows from the self in both cases and to the self in both cases.
The answer the instructor provided for the first case was a simple and resolute no. His answer was met with much aggression in the room, once again our basic compulsion got the best of us. He explained that it the women who has choking had a DNR or if she was injured during the rescue attempt the person the off-duty EMT could be held personally liable. Such a precaution was also applied to the situation where someone asked an on or off-duty EMT for medical advice.
Ultimately the instructor told us that the easiest way to avoid the issues that might arise when it comes to duty is threefold 1) Stay within our Scope of Practice 2) Adhere to the Standard of Care expected within the scope’s context and 3) Do not where a uniform when off duty. It may be implied from this that the question of duty necessarily arises from the self. “Do you have a duty to act?” It seems to depend on who, where, and when you are. Of course there is nothing particularly profound or new here except my very real contemplation of its implications as it relates to the mundane medical duty to save lives.