Ethics Dunce: Alexandra Robbins, The Mocking Nurse


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?

Oh, nice.

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.

12 thoughts on “Ethics Dunce: Alexandra Robbins, The Mocking Nurse

  1. When my wife and I were discussing whether or not her sister, an R.N., would ever engage in this activity (she wouldn’t, by the way, IMHO, she is WAY to caring and professional), my wife perfectly defined my stance on this for me. “Any medical person should be free to engage in this activity” she asserted, “as long as the family is present and are free to slap the medico’s around for it”. Every so often, my wife demonstrates that she actually does have a sense of humor, despite her protestations to the contrary.

  2. When my beloved 14 year old Jack Russell, Dickens, Rugby’s predecessor, was dying of a lung disease, I took him to a specialist. He had been on a diet and exercise regimen to lose weight, but when he had trouble breathing the vet told us to let him eat what he wanted, Bbviously he could exercise, and he had been a very active dog. When he was being examined, I overheard the vets and assistants joking about Dickens excessive weight, in the examination room, laughing and mocking the dog, whom I had brought there to try to save his life.

    We had to put him to sleep the next day. I am still angry about that incident; I would never go back to that clinic, and I’m mad at myself that I didn’t walk through the doors and tell those “professionals making fun of my suffering dog that they were utter, UNprofessional assholes.

    Does this experience color myview of the Post op-ed? Damn right it does.

    • That’s awful, Jack, unforgivable. I’m so sorry that happened to you. It’s hard enough to lose a pet without something like that happening.

  3. Maybe the slow down will come if more patients and their family members bring to the full attention of others on the floor in front of other patients, family members of other patients, other staffing immediately, demand that the CEO of the hospital is called no matter day or night and press charges/sue the hospital for mental cruelty to someone in distress , then maybe the hospitals and clinics will start demanding professionalism at all cost.
    Because you have a degree of any type ,does not make a professional. Ms. Robinson demonstrates this well and it reflects the hospital/clinic/physicians she works for of their low standards and total lack of respect for any one, anything and yes even themselves.
    Whenever an individual has to derive enjoyment at someone else pain, then they show inept intelligence within themselves, total lack of professionalism, total lack of compassion of themselves.
    People like this has no business of being allowed in the medical field.

  4. There are competing issues; the need to be professional, and the limits of the human psyche. With the shortages of doctors and nurses in many parts of the country, there is going to be ethical conflict here.

    It is impossible to justify such “gallows” humor; that is likely where the op-ed author makes the mistake, saying this is “OK”. Still, when conflict exists, actors need to consider the most ethical path, even if the “most ethical” is not itself fully ethical. If doctors and nurses, to ward off crippling depression and anxiety, need to make crude jokes about unfortunate situations, then the best they can do is make said comments way out of earshot, in break rooms/locker rooms, etc.

    Doctors and nurses are often put into impossible situations. Private comments to blow off steam need not be publicly revealed; strict liability exists should said comments become public anyways.

  5. Seems as if nurse Robbins is so “professional,” she has exempted herself and fellow “professionals” from the Golden Rule. What kind of human doormat would say, “It’s OK with me, if, for fun, the health care providers who are responsible for my well-being made crude and insulting remarks about my body, my condition, or my case, as long as I am unconscious”? Let us see Robbins say she trusts implicitly any health care team that “builds itself” by doing such cruelty, when she is the patient.

  6. I have to wonder nurse/author Robbins is operating on the “no publicity is bad publicity” theory and will sell 100,000 copies of her latest book due to this controversy.

  7. I have noticed the strong trend of medical professionals who perceive of themselves as a better class of humans than the rest of us. The rest of humanity is just a mildly mentally retarded version of the medical profession, to be cared for like an annoying stray animal. I believe this attitude is what they use to justify treating patients like this, it is the same attitude that makes them believe that 4-5 hours of their time should be billed as equal to an entire working year of a ‘normal’ person. It is also what sprung to mind immediately in the aftermath of the Aurora, Colorado shooting. Pre-meds often wrap their entire self-worth into being a physician, being better than everyone else. They look down on their non-premed classmates and even their professors as being something less than they are or will become. Imagine what happens to such a person when that future of being the uberbeing called physician is yanked away from them.

    I think the most outrageous example of this was a group of premed students who were discussing the case of a local physician. The DA was charging him with manslaughter after he used an unapproved technique with an unapproved drug to treat a nonfatal condition which directly resulted in the patient’s death. The DA brought the charges because the medical board refused to do anything about it. The students were outraged that the DA would charge the physician. “Who does he think he is to charge a doctor with a crime?” they asked. When a faculty member stated that the physician had violated the law (by using an unapproved drug), violated medical ethics, and had directly caused the death of the patient, they were unmoved. “She should just feel lucky that a physician was willing to try to help her at all” one of the students stated (of the dead patient). There you have it, we should all just feel lucky that some medical professional took enough pity on us to actually help us, the poor, miserable, beings that we are. The insults and mocking need to be ignored because they are so warranted by our pathetic, non-medical-professional existence.

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