What happens when we find ourselves in moral distress on a frequent basis? At the 2013 Veterinary Social Work Summit, Sonnya Dennis, DVM, DABVP, presented a session on “Ethics Exhaustion.” She defined “ethics” in this regard as a code of moral conduct or rules, following duty and not convenience, and doing the thing that “I should do.”
The problem is, there is not universal acceptance of what is “wrong” and “right”; ethics is clearly a personal concept and will vary from person to person. Yet if we accept a position in a practice that provides a service we personally feel is immoral or unethical, we are allowing our ethics to be compromised. Dr. Dennis explains that ethics exhaustion is fatigue, emotional distress and lack of will to continue to act in a way that is consistent with what you believe is the ethical thing to do. It is having failed to square behavior with belief so often that you no longer care to try. At times, ethics exhaustion can be having trouble defining what that right thing is, or can be a mismatch between your ethical belief and your actual behavior. “Ethics exhaustion is not a loss of compassion, but being prevented from acting on what you believe is the compassionate, caring thing to do,” Dr. Dennis explained.
In order to explore your personal ethics versus the practice’s ethics, consider the range of possibilities when a client decides upon euthanasia. How do you feel — and what does your practice do — about the 17-year-old poodle with end-stage heart failure whose family is choosing euthanasia? Compare that to an otherwise healthy animal whose family cannot financially bear the burden of the surgery to fix a broken leg and are also considering euthanasia? What about the client who can’t be “bothered” to give insulin to a newly diagnosed diabetic pet, as compared to the family that is moving and can’t take the pet with them? What you would like to do, and what you are asked to do by the practice owner, can be two very different things.
These are circumstances that can test our ethics, but there are many other “smaller” challenges we may face: syringes and needles being reused, and IV line being moved from one patient to another, “sterile” surgery packs that are used for 3 successive surgeries on 3 different patients, sick pets kept overnight in a hospital with no overnight staff, and more. How much are we asked to compromise our ethics, and at what point do we decide “enough is enough?”
In the moment, we’ve learned to cope with this paradox by justifying our actions to ourselves. Reasons we tell ourselves its OK might include being too exhausted to fight for what we believe, or believing that no one else cares so why should we, or we might as well do the task because someone will. Likely the most common feeling is that it is not our fault, and we had no choice. Perhaps we even feel that we will suffer repercussions if we say no, by losing our job, losing our friendships, or losing face in front of our teammates.
Prevention is the key to minimizing moral distress, which can lead to ethics exhaustion. So how do we prevent ourselves from being put in this position? We more closely analyze any new position we consider accepting. When interviewing for a job, for example, the values of the organization and the values of the candidate should be expressed and discussed to see if it is a good fit of ethics.
In order to stand up for what you believe is the right thing to do, you must possess a certain amount of assertiveness. This is not always an easy thing to learn, or to use.
Our series will conclude next time when we explore assertiveness, and tips for how to increase yours to have your voice heard.