Personal Risk versus Personal Success: Should I Approve Pam?
June 2005
To my knowledge, Pam and Apex, Inc., the home
healthcare agency through which Pam works as an aide, do not actually exist.
They are composites of the many aides and the several agencies with which I
have worked over the years in meeting my own personal care needs arising from
the cerebral palsy which "confines" me to a wheelchair.1 While Pam and Apex are fictitious, the ethical issue they raise for us here—whether
an employer should allow individual employees to intentionally expose themselves
to extra job hazards for the employer's, the employee's, and/or others' apparent
benefit—is a very real concern for risk management professionals who seek to
do what is right.
by George
L. Head, Ph.D.
American Institute
for CPCU
Living alone, I need an aide every morning and evening to get dressed, undressed,
and for other personal care—what the healthcare industry politely calls "activities
of daily living," or ADL—a total of about 4 hours daily. My aides, 4 or 5 of
them each filling several of the 14 "slots" in a continuing morning/evening
weekly care cycle, drive to and from my suburban apartment from their homes
or from other Apex clients, usually 10 to 15 miles each trip.
I rely on Apex to recruit potential aides and to handle payroll, employee
benefits, training, disciplinary, and other administrative matters related to
the aides who work with me. Recruiting is a difficult task for Apex and similar
agencies because, nationally and in nearly every locality, there are more disabled
people entitled under federal and state law to more hours of in-home care than
there are aides willing and qualified to provide such care.
Each aide usually works with several clients during a typical week. Decisions
to appoint or dismiss an aide to or from a client's case are made jointly by
Apex and the client, hopefully with the aide's consent. As a practical matter,
good care requires that Apex, the client, and the aide all agree on an aide's
assignment to a particular client's case. A client needing a new aide asks Apex
to find one, Apex recommends a given aide, and the client and the aide must
both approve the recommendation before the new aide's appointment to that client
becomes effective. For several legal and tax reasons, every Apex client is his
or her aide's employer during the specific hours that aide is with that client,
whether in that client's home or running errands with or for that client.
Under the business model Apex follows, Apex is never the employer; for my
care through Apex, I am. The aides Apex recommends and I approve are my employees
for as long as they, Apex, and I want them to stay in my employ.
Meet Pam
This brings us to Pam, whom Apex recently recruited and who has done well
with each of her first two clients, both of whom live in the same small town
as Pam and her two children, ages 3 and 12, for whom she is the single parent.
Apex wants me to work with Pam because that will fulfill its contract to meet
my ADL needs. Pam definitely wants to work with me to earn the income her household
needs. Furthermore, as a new aide with Apex, Pam also wants to prove that she
can care for me well so that Apex will assign her to even more challenging,
better-paying, cases.
After interviewing Pam at my apartment, I have good reasons to believe that
Pam's skills, intelligence, strength, and attitude are at least as good as those
any other aide Apex has found for me in the last 3 years. All Pam appears to
lack is reliable access to a car and to babysitting for her 3-year-old during
the evening hours she would work for me. (Reliable transportation and childcare
are not challenges for any of my current aides, but several of my past aides
over the years have resigned because they could not cope with at least one of
these problems.)
The Dilemma
Pam wants to overcome these problems by bringing her younger child with her
and using the metropolitan area bus system to reach me. She brings her child
with her on the bus to her two other daytime clients, who both live much closer
to her home than I do. Every time she works with me, she knows she will have
to walk across a four-lane highway twice, most often in the dark, with her child
either in her arms or in a stroller. The intersection at the most direct crossing
has no traffic signal: getting to an intersection that does have a stoplight
will require Pam and her child, twice a night, to walk an extra half mile along
the edge of a busy highway with no sidewalks.
Given this situation, should I approve Pam as my aide, making her my employee
(and her child, who probably is legally my guest), at least while they are with
me and possibly (given the concept of an aide being "on the clock" while running
errands for the client's benefit) making them my employee and guest from the
time they get off the bus until the time they are back on it?
The all-business risk management professional in me shouts, "NO! You cannot
allow Pam to endanger herself and her child this way; moreover, look at your
own liability exposures while they are with you! Much as you may need help,
George, be a risk manager first. Regardless of the legalities of exactly when
Pam and her daughter become your employee and guest, you would be morally responsible
for their safety as soon as they got off the bus until the got back on it. You
may need help, George, but you need to manage risk first. NO, do not accept
Pam!
But the more humanitarian person in me, also the one who cannot stand up
(much like Pam cannot buy a car right now), whispers, "Now, George, wait a minute.
Pam deserves at least an opportunity with you; you need the care, and Apex wants
you to approve Pam. She may well be the best Apex can offer you right now. For
everyone's sake, you have to find a way to say YES."
The Key Ethical Issue
Still, trying to blame Apex for my dilemma misses the key, essentially universal,
ethical issue that Pam poses for me. It is an issue that, in other settings,
many other employers unknowingly face. For me, the core issue is this: Does an employee have the right to knowingly
take significant personal risks on the job in order to perhaps achieve significant
job or personal success? In our case here, Pam wants to risk her and
her child's safety in order to earn money she needs and to show Apex that she
can handle more challenging assignments than she has had so far. Is she ethically
entitled to do this? To make more money now and to potentially advance her career,
does Pam have the right to significantly endanger her own life to fulfill her
wish to make money by working for me? What about endangering the life of her
child?
Like many questions in business (and, thus, in the ethics of managing risk),
these are not questions of right versus wrong, but rather of right versus right.
Things are not all black or white, not all good or evil. In Pam's case, there
are potential benefits on both sides for everyone. My approving Pam would give
her economic opportunity, get me daily ADL help, and let Apex fulfill its contract
for my care. In contrast, my rejecting Pam as an aide would shield her from
a significant danger, relieve me of great moral guilt and possibly legal liability
if she or her daughter were injured or killed while traveling to or from my
apartment, and put pressure on Apex to find a more appropriate aide for me and
a more suitable client for Pam.
My Decision
My decision whether to approve or reject Pam as my aide would have been much
easier if some third, safer, option had been available—perhaps hiring a babysitter
or paying for cab rides for her. But the rules under which Apex operates do
not allow anything of monetary value (except paychecks, which Apex issues) to
pass between aides and clients, which is probably a wise rule. So, again like
many decisions in business ethics and risk management ethics, the decisions
have to be "Yes/No"; there are no easy, "Both…And" options.
As I wrestled with both "Yes" and "No" in just Pam's situation, I thought
about her daughter. I realized that the daughter would have no real choice or
voice here, although her life was clearly at stake on each journey to or from
the bus stop. She was at her mother's mercy. That was the key to my answer to
this dilemma. In good conscience, I could not put Pam in a position where Pam
felt she had no choice but to endanger her daughter. Pam had no right to endanger
her helpless daughter. I had no such right either. Under these circumstances; I had to reject Pam.
The More General Case
Is Pam's a special case, complicated by the unusual circumstance that her
daughter must be with her? In more typical situations, should employees have
the ethical right to intentionally expose themselves to significant on-the-job
dangers in order to benefit themselves, their employers, or others? In thinking
more about Pam's situation, I realized that her and her daughter's case was
not at not at all unusual just because Pam's decision to endanger herself also
threatens her daughter. In fact, given the congested and interdependent industrial,
commercial, and urban settings in which most Americans are employed, it would
be unusual that an employee's conscious decision to take extra risks on the
job would not expose more people (fellow
employees and others) to added dangers.
The disruptions in an organization's operations that are likely to result
from an individual employee's choice to take special risks also may harm those
who invest in the organization or rely on its output. More often than not, one
person's choice to undergo danger significantly threatens others.
Perhaps, just perhaps, an employee is ethically entitled to take special
personal risks if this can be done without exposing others to real harm. But
that rarely happens. In the reality of the workplace and, therefore, in making
ethics-charged decisions about workplace safety, few of us are privileged to
stand so alone. In dealing with daily dangers, especially in deciding to tempt
fate as Pam and Apex might have been so eager to do, we are all members of a
very large family. Within good families, we should all look out for one another.
1I purposely have put "confines" in the quotation
marks above just to follow the common idiom about wheelchairs. For me, my wheelchair
liberates rather than confines, perhaps because I've never walked. But that's
another matter for another place and time. Our issue here concerns Pam, Apex,
and me.
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