Dr. Jillian Horton is an internist and writer in Winnipeg. Her forthcoming memoir, We Are All Perfectly Fine, will be published in February.
Here’s a question for my fellow health care workers: If you were at the back of a long virtual line for the COVID-19 vaccine, and you could secretly jump the queue, would you?
To be clear, I received my first shot in mid-January, with my birthdate and place of work meaning that I qualified unequivocally. But while many of us thought we knew the answer to how we’d handle this ethical question about queue jumping – for ourselves, our friends, our colleagues – changing the scenario might prompt some people to tell you in confidence that the answer is a bit murky. What if other people are jumping the queue, making your wait even longer? What if you have a serious underlying condition? Those same people may argue that it isn’t realistic to expect health care workers, who have contracted COVID-19 at rates that are significantly higher than the general population, to avoid what amount to survival behaviours.
When these incidents on the part of health care providers come to light, Canadians have been quick to judge them. Two physicians recently incurred fines for allegedly failing to disclose that they had hosted a visitor from Britain – and were ultimately found to harbour the highly infectious B.1.1.7 coronavirus variant. A hospital chief executive felt entitled to take a tropical vacation, despite the strong advisory against non-essential travel. All of these individuals must have at least some track record of working for the common good, but they also acted in a way that was personally beneficial while ignoring the negative consequences for other groups as a result.
We’ve asked our health care workers to do some very jarring, almost undoable things these past few months. There’s a literary quality to the surreal experience of driving to the hospital for a day of pandemic-related work and passing a 100-person-long lineup at Ikea. Dissonance like that has the capacity to breed futility and resentment. I’ve heard more than one health care worker express grief and frustration at a minority of the population’s anti-social actions, which are having an outsized impact on our nation’s health. Another sentiment I’ve heard from more than one colleague: I don’t want to die for this job.
Of course, no one wants to die working, whatever that work may be. But in some fields, extreme potential risk are generally visible upfront. A feeling that’s grown prevalent among some health care workers is that they’ve been handed much more than they signed up for. Of course, there are members of many other professions in that boat, and I’m one of tens of thousands of health care workers who is grateful just to have a stable job while so many of my fellow Canadians face indescribable financial hardship. But it is perfectly normal for health care workers to find themselves regretting their choice of profession right now, during these abnormal circumstances. That sentiment is being articulated by us all in some way, from teachers and stay-at-home parents to desk workers and small-business owners. To err, of course, is human – and ultimately, that’s what we all are.
So perhaps before we hastily condemn those actions, we can examine what fuels the impulse to do things we wouldn’t normally do, and understand it as one of a variety of normal responses to the stress and trauma of the times. The pandemic has been a nightmare for most citizens, but it has had some unique personal and professional effects on health care providers. The default response to this has been for society to anoint them as “heroes,” but perhaps when we refer relentlessly to people in these terms, rather than addressing what they actually need, we don’t just set up unrealistic expectations – we also introduce the idea that they might be more deserving of advantages, perks and exceptions to rules.
But this is the bottom line: If you want to work in health care, you have to live up to a higher standard.
We’ve been vested with power and authority on the grounds that we know how to use it wisely. Having moral authority at this moment in time requires that we ourselves act morally, and behavioural drift is often the beginning of permanent changes in our moral and ethical codes. We know that when we start to justify small deviations from not only safe practices but also from what we know is right, we are led further and further away from the standard of care. When we begin to surrender our standards – the bar of excellence we demand as professionals and as a society – we can lose sight not just of what we’re doing, but who we really are.
Is this a fair ask, after everything we’ve borne in health care in the last year? Some will say it isn’t, but I don’t see another path. It’s true that we are only human. Perhaps that means we expect ourselves to be flawed. But it can also mean something a little more hopeful: that we won’t allow ourselves to be anything less.
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