If you set out to defend ethically indefensible conduct in print, you better be able to do a better a job of it than this.
Alexandra Robbins, in an op-ed causing quite a bit of controversy in the Washington, D.C. area, attempted to not only justify the despicable conduct of medical professionals deriding and ridiculing their unconscious patients, but to sanctify it, arguing, lamely, that doctors and nurses are mocking the unwitting and vulnerable human beings who have placed their lives in their hands in order to “rejuvenate [the medical personnel] and bond them to their teams, while helping to produce high-quality work. In other words, the benefits to the staff — and to the patients they heal — outweigh occasional wounded feelings.”
Robbins’ protests of virtue amount to a desperate raid on the Ethics Alarms Rationalization List, which, as always, operates as virtual Rotting Ethics Detector, or RED. If you find yourself thinking these corrupting self-delusions, you’re on the verge of unethical conduct; if you find yourself saying them, you’ve applied for membership in the Dark Side, and if you are so rationalization-polluted that you proclaim them in print, like Robbins, you shouldn’t be trusted to mail the water bill, much less to cavort in the operating room.
Rationalizations aren’t the only ethical problem with her loathsome essay. The entire thing is a Jumbo, denying the blatantly undeniable. “Oh, no!” readers are told. “We aren’t being disrespectful to patients when we mock their weight, sex organs, or the maladies that placed them in pain, peril and in our care!” Robbins expects us to believe that insults constitute “non-destructive coping measures” that help nurses and doctors “provide the best possible care, even if those methods might seem unprofessional outside of the health-care setting.”
They seem unprofessional because they are unprofessional. Robbins makes distinctions to bolster her non-argument that exist only in her own, patient-resenting mind. After approvingly citing a California nurse who described her staff’s game called “Interesting Things I Have Found in Obese People’s Rolls of Fat” and chuckling about an unconscious patient’s “tuberculosis of the penis,” the writer asserts, absurdly, that “mocking disabilities and using racial, ethnic or other cruel epithets go too far….Humor has a place in hospitals, even if it’s dark, even if it’s derogatory — as long as it isn’t cruel. ” Obesity isn’t a disability, then? Tell that to the patient who had that TV remote imbedded in his “folds of fat.”
You know whose standards apply when judging what a cruel comment is? The target of the comment, not the unprofessional, arrogant creep issuing it. “’Retard’ is an unacceptable word under any circumstances,” writes Robbins. Why? Her whole argument is that nurses can say awful things about patients as long as the patients don’t hear them…but politically incorrect insults are going too far.
I don’t think I’m comfortable with people who reason this weakly having my life in their hands. You?
That last rationalization is, of course, #10, “The Unethical Tree in the Forest”: “The unethical nature of the act is intrinsic, and exists independently of how many people know about it.”
Robbins’ thesis is based on the Golden Rationalization, Numero Uno, “Everybody Does it.” It also relies heavily on #14, Self-validating Virtue, in which unethical acts are judged by the self-perceived goodness the person doing it, rather than the other way around. Nurses who denigrate their patients “care deeply” about them, says the nurse who denigrates her patients, so it’s OK. Naturally, this dovetails into #13, The Saint’s Excuse. It’s benign to say mean things about patients behind their backs, Robbins maintains, because medical professionals are doing such important work.
That argument isn’t doing well when offered in defense of Ferguson police officers who have made racist comments to colleagues. What’s the difference, Alexandra?
She moves on to 11. (a) “I deserve this!” along with 21. Ethics Accounting (“I’ve earned this”/ “I made up for that”):
“Nursing, while noble and rewarding, can be a physically and emotionally exhausting career. Many nurses are overloaded with more patients than the safe maximum. They’re on their feet constantly, moving heavy equipment or lifting patients — in an eight-hour shift, a nurse lifts an average of 1.8 tons. Nurses routinely observe tragedies and traumas, and perform futile care on critically ill patients. Yet through it all, they must demonstrate mental composure, physical stamina and alert intelligence, even if they are berated by patients and visitors, bullied by doctors or shaken by their cases.”
So the right course is for nurses to take out their frustration, stress and rage on their unconscious and helpless patients, right, Alexandra?
Next up: #2. “They had it coming.” “The patients most likely to be joked about are the ones perceived to have brought on their own medical problems,” writes the caring nurse.
I see! So medical professionals aren’t just caring for us; they’re judging us too! Funny, I can’t find that in the Hippocratic Oath. Then there is this: “Better that patients are mocked and healed than, well, about to take a ‘dirt nap.'” You got me there, Alexandra! Better to be mocked than killed.
That’s #22. The Comparative Virtue Excuse: “There are worse things”…the worst rationalization there is.
One doesn’t even need to tote up all the rationalizations in this disgraceful screed to conclude that this nurse, and apparently too many others, is unfamiliar with the basic concepts underlying professionalism and ethics. Professionalism begins with respect, and her essay is not just a defense of disrespect, but an endorsement of it. As for ethics, someone needs to reacquaint Robbins with The Golden Rule, as well as the pop definition of one’s ethics as what one does when nobody is looking. Interestingly, Robbins quotes an accurate assessment of the conduct she defends, from Johns Hopkins University professor emeritus Ronald Berk:
“Derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves.Those individuals who are the most vulnerable and powerless in the clinical environment … have become the targets of the abuse.”
“I strongly disagree,” writes Robbins.
Of course she does. She disagrees because she’s an unprofessional and unethical nurse.