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.

As an emergency medical technician (EMT) since 2020, Rachel Whitmoyer '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 physics and philosophy at the University of Rochester who hails from Lebanon, Pennsylvania.

"It's 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," she says. "But even if a patient isn't in need of immediate medical care, they may not have the background necessary to recognize that. They can be scared, confused, and stressed."

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

Ambulances and academia

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

"My 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," Whitmoyer says.

Her research involves synthesizing the results from previous studies and analyzing them from an ethical perspective. "For instance, I've been utilizing studies quantifying unnecessary ambulance use and studies discussing unwanted resuscitation attempts in patients with DNR orders," she says. "Being 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."

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

Pennsylvania is one of 13 states that deem EMS an essential service eligible for state funding. No one can be denied a ride to the hospital in an ambulance-although not everyone needs it, hiccups or otherwise.

"People assume that they will get to the front of the line in the emergency department if they arrive in an ambulance," Whitmoyer says. "That's not true, unless they're in a cardiac or high-acuity situation. Anyone not facing a life-threatening situation usually has to wait."

From EMT to physics and philosophy-by way of the Rochester curriculum

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)

William FitzPatrick, the Gideon Webster Burbank Professor of Intellectual and Moral Philosophy at Rochester and Whitmoyer's thesis adviser, says she's "a particularly impressive and ambitious student" with an exceptional work ethic.

"Combining hard science, philosophy, and medicine is extraordinary, especially with the addition of a senior thesis project," he adds.

FitzPatrick says Whitmoyer's 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.

"Current policy is weighted in favor of deferring to patient demands," he says. "But 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."

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's flexible undergraduate curriculum made it possible to major in two non-related fields. "Going into my first semester and being able to choose classes and explore my interests gave me lots of flexibility," she says. "I took some philosophy courses and just fell in love with it."

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

"That 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," 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's affiliated with two companies back in Pennsylvania-one paid and one volunteer-and 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's 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's emergency department via radio to alert them of their impending arrival and provide a patient care report that details pertinent findings or interventions performed.

"My favorite part is getting to advocate for my patients and help mitigate stress in some of the most emotional moments of their lives," she says. "I 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."

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 US Army's Health Professions Scholarship Program after graduating medical school.

"My grandfather is an Army veteran, and many other family members have served," she says.

Whitmoyer doesn't rule out continuing as an EMT long term, either.

"I'd love to be able to pick up shifts if time allows," she says. "The work is so rewarding."

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