Last month, I wrote about recent instances of racism, the Black Lives Matter movement, and my own connection to it all, which is deeply personal to me. I have also written previously about my experience of paramedic care provided to my mother at the end of her life. From a traditional perspective, this personal approach could be seen as unprofessional; but from a contemporary perspective, we are required to bring our authentic selves to our roles in order to connect with one another in a genuine way—and nowhere is this truer than in the provision of patient healthcare.
Being authentic in healthcare is essential in bringing the ‘human touch’ to the patient experience, which is integral to a compassionate, patient-centred care approach. However, with authenticity comes the potential for ethical dilemmas, not only concerning appropriate professional boundaries for example, but also where paramedics' values and beliefs may differ from those of the patient. What happens when it is deemed that a patient requires a blood transfusion for a bleeding ulcer, but refuses any blood products—even if the consequence is her death—because she is a Jehovah's witness and the transfusion would conflict with her religious beliefs? In this month's issue (p. 304), Emma Moore delves into a case study about patient autonomy and what happens when it conflicts with a paramedic's professional autonomy to make critical decisions in an emergency and provide life-saving care.
This is a complex and difficult situation, but ultimately, adults who have decision-making capacity have the right to make informed and uncoerced decisions regarding their care. Genuinely accepting a patient's decision, even when it conflicts with a paramedic's personal beliefs or even duty of care, is essential in order for the patient to be treated equitably. Otherwise, a paramedic's behaviour may subconsciously reflect their conflicting belief, having a negative impact on care or making the patient feel judged for their decision. Accepting a patient's decision, particularly when it could result in their death, may cause a paramedic to feel that their duty of care has been breached and/or that their values have been compromised as a result of not taking what he or she feels is the right course of action. This is likely to result in ethical or moral distress for the paramedic, which must not be left unresolved, as it will negatively impact the paramedic's mental health, and could lead to longer-term burnout and a lack of compassionate care.
A paramedic's labour after all is underpinned by an emotional one. On p. 319, Hayes et al discuss a paramedic's emotional labour, and the irrevocable impact of COVID–19. They highlight that while, conventionally, there has been a clear sense of separation between emotions felt on a personal level and those shown on a professional level, in 21st century healthcare, acting outwardly in a way that is not aligned with who you are, ‘implies a sense of disingenuity, where authenticity is a keystone, central to the foundation and building of genuine compassionate care’.
Nonetheless, a health professional is required to behave professionally and lawfully; but rather than masking true feelings to achieve this (which patients will often feel), work can be done to resolve inner conflicts, and genuinely accept a patient's autonomy, and their right to make the ultimate decision about their care.