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Exploring the ethical dilemmas of emergency care on the front lines

Rachel Whitmoyer brings her work as an emergency medical technician to bear on her philosophy studies at Rochester.

Rachel Witmoyer in an EMT uniform sitting on the back of an ambulance and peering over her shoulder into the vehicle.
MINDFUL MEDIC: As an EMT, Rachel Whitmoyer has helped countless patients facing dire situations. Those experiences prompted her senior thesis topic: an exploration of the biomedical ethical issues faced by EMTs. (Photo provided)

As an emergency medical technician (EMT) since 2020, Rachel Whitmoyer 糖心传媒�24 has helped countless patients facing dire situations. But she also has dealt with less-extreme scenarios, including one man who demanded transport to the hospital via ambulance because of . . . hiccups.

That incident proved annoying and enlightening for Whitmoyer, a double major in and at the 糖心传媒 who hails from Lebanon, Pennsylvania.

糖心传媒淚t糖心传媒檚 easy to become frustrated when the area you service is short on first responders and policy requires you to transport non-emergent patients to the hospital,糖心传媒� she says. 糖心传媒淏ut even if a patient isn糖心传媒檛 in need of immediate medical care, they may not have the background necessary to recognize that. They can be scared, confused, and stressed.糖心传媒�

Situations like this prompted Whitmoyer to dedicate her senior thesis to exploring the biomedical ethical issues faced by EMTs. 糖心传媒淪o much of health care emphasizes curing patients as a solitary goal,糖心传媒� she says. 糖心传媒淏ut high-quality patient care cannot exist without realizing that a patient is a person, and not a problem to be solved.糖心传媒�

Ambulances and academia

Whitmoyer糖心传媒檚 thesis focuses on a few points: justice considerations in triage and resource allocation in prehospital and hospital settings, the benefits that Emergency Medical Services糖心传媒搃nitiated refusal of transport protocols have on individuals and communities, and why Do Not Resuscitate (DNR) orders outside of hospitals often don糖心传媒檛 honor patients糖心传媒� autonomy in end-of-life health care decisions.

糖心传媒淢y goal is to address how unyielding legal requirements have taken precedence over patient-specific care over the past few decades, and the potential solutions that would allow providers to maintain a balance of both,糖心传媒� Whitmoyer says.

Her research involves synthesizing the results from previous studies and analyzing them from an ethical perspective. 糖心传媒淔or instance, I糖心传媒檝e been utilizing studies quantifying unnecessary ambulance use and studies discussing unwanted resuscitation attempts in patients with DNR orders,糖心传媒� she says. 糖心传媒淏eing able to connect with subject-specific University librarians was extremely helpful in beginning the research process, as well as what I learned in my introductory writing and philosophy courses.糖心传媒�

Cases lacking genuine medical need can stretch limited resources and compromise the ability of EMTs to attend to genuine emergencies.

Pennsylvania is eligible for state funding. No one can be denied a ride to the hospital in an ambulance糖心传媒攁lthough not everyone needs it, hiccups or otherwise.

糖心传媒淧eople assume that they will get to the front of the line in the emergency department if they arrive in an ambulance,糖心传媒� Whitmoyer says. 糖心传媒淭hat糖心传媒檚 not true, unless they糖心传媒檙e in a cardiac or high-acuity situation. Anyone not facing a life-threatening situation usually has to wait.糖心传媒�

From EMT to physics and philosophy糖心传媒攂y way of the Rochester curriculum

, the Gideon Webster Burbank聽Professor of Intellectual and Moral聽Philosophy at Rochester and Whitmoyer糖心传媒檚 thesis adviser, says she糖心传媒檚 糖心传媒渁 particularly impressive and ambitious student糖心传媒� with an exceptional work ethic.

糖心传媒淐ombining hard science, philosophy, and medicine is extraordinary, especially with the addition of a senior thesis project,糖心传媒� he adds.

FitzPatrick says Whitmoyer糖心传媒檚 thesis explores interesting and timely questions about how to balance deference to patient demands for emergency hospital transportation with professional judgment concerning genuine medical need.

糖心传媒淐urrent policy is weighted in favor of deferring to patient demands,糖心传媒� he says. 糖心传媒淏ut in cases lacking genuine medical need this can stretch resources and compromise the ability of EMTs to attend to genuine emergencies; on the other hand, refusal of transport in such cases raises its own problems unless the underlying social challenges and vulnerabilities are also addressed.糖心传媒�

Whitmoyer took classes with FitzPatrick in her sophomore and junior years and wrote a paper about the limitations of obtaining informed consent in medical emergencies. She so enjoyed doing the research and connecting it to her experiences as an EMT that she decided to take on an additional project this year to explore more of the ethical issues in pre-hospital emergency medicine.

Whitmoyer entered the University as a physics major in 2020 but added philosophy as a second major her sophomore year. She says Rochester糖心传媒檚 flexible undergraduate curriculum made it possible to major in two non-related fields. 糖心传媒淕oing into my first semester and being able to choose classes and explore my interests gave me lots of flexibility,糖心传媒� she says. 糖心传媒淚 took some philosophy courses and just fell in love with it.糖心传媒�

One of the early impactful classes was Philosophy 105: Reason and Argument, with associate professor Zeynep Soysal.

糖心传媒淭hat class taught me that learning how to construct a good argument makes it much easier not only to effectively communicate your ideas but also to analyze information coming from other sources,糖心传媒� Whitmoyer says.

Answering the call

Whitmoyer took an EMT class in high school and became certified in June 2020, when the COVID-19 pandemic was surging. She糖心传媒檚 affiliated with two companies back in Pennsylvania糖心传媒攐ne paid and one volunteer糖心传媒攁nd during summers she can work up to 60 hours per week. She usually works 12-hour shifts and always has at least one partner.

The first step when responding to a call is determining the patient糖心传媒檚 level of consciousness and the reason EMTs were summoned. Whitmoyer may have to administer oxygen or medication or perform life-saving interventions to control high-acuity issues relating to airway, breathing, or circulation. The EMTs contact the hospital糖心传媒檚 emergency department via radio to alert them of their impending arrival and provide a patient care report that details pertinent findings or interventions performed.

糖心传媒淢y favorite part is getting to advocate for my patients and help mitigate stress in some of the most emotional moments of their lives,糖心传媒� she says. 糖心传媒淚 am often a stranger to many of the people I meet on scene and view it as an immense honor and privilege to be given their trust. Driving with lights and sirens on is pretty cool, too.糖心传媒�

Whitmoyer plans to pursue a career as an emergency medicine physician, which she will train for as she completes a military medical residency under the after graduating medical school.

糖心传媒淢y grandfather is an Army veteran, and many other family members have served,糖心传媒� she says.

Whitmoyer doesn糖心传媒檛 rule out continuing as an EMT long term, either.

糖心传媒淚糖心传媒檇 love to be able to pick up shifts if time allows,糖心传媒� she says. 糖心传媒淭he work is so rewarding.糖心传媒�