Tag Archives: creativity

Intelligent Disobedience

20180103_131555The (true) story goes, a young nurse, fresh out of nursing school, was assigned to a hospital emergency room.  A cardiac patient was rushed in.  After a quick assessment, the experienced emergency room doctor ordered the new nurse to administer the medication he judged the patient needed.  The nurse was stunned because she had been taught that this particular medication carried grave risks for a cardiac patient.  What would you do if you were this freshly graduated nurse and the doctor was older with years of experience?

Well, the nurse told the doctor that she has been taught that particular medication could be fatal in this patient’s situation.  The doctor was bristled at the questioning of his decision and in a raised voice and stern glare told the nurse “You just do it!”.

What would you do? Seriously?  Imagine yourself as the nurse.  If you administer the medication and the patient dies, how are you going to feel?  How will you face the patient’s family?  How will your future be?  But what if the doctor was right?  What if your refusal to act endangers the life you are trying to save?  How will you live with that?  There is no time to hesitate.  Seriously, what would you do?  Obey or disobey?  If something went wrong, will you say, “I was just following orders”?

The nurse quickly thought of an alternative other than either obey or disobey.  She hooked up the IV bag to the patient, injected the medication the doctor had ordered into the bag, and called the doctor over and told him that the medication is ready.  All that was needed was to open the valve on the IV bag.  The nurse said that she couldn’t do it because it violated her training.  The doctor would need to open the valve himself.  This was enough to get the doctor to rethink the risks and the other options that were available.  The doctor changed his order to administer a different medication.  The nurse promptly did, and the patient recovered fully.

Was the doctor incompetent? Probably not.  He may have been working for long hours, or the emergency room was loaded with patients, or any other reason.  This is not the point here.  The point is that, many times, there is a stance that is neither obeying nor disobeying.  At times, those in authority may not be at their best, yet the responsibilities of their position require them to act.  We must be able to see them as both having legitimate authority and human frailty, and at times be prepared to question them, correct them, or even disobey them.  We can’t say “we were just following orders.”

When weighing the right course of action, we must give our own perceptions, training, and values equal validity to the perspectives of those in authority.  We should not constraint ourselves with the two options of obey or disobey.  There are often other options that can lead to better outcomes.  Just take a deep breath and pause to think, and you may be able to offer creative responses that better meet the need of the situation. Remember, if you obey an order, you are still accountable regardless of who issued the order.

This nurse story and other stories are included in the remarkable book Intelligent Disobedience – Doing Right When What You’re Told to Do Is Wrong, by Ira Chaleff.  The author argues that the danger lies in teaching obedience too well, so the habit of unquestioning obedience is carried into adulthood.  From politics to sports, from financial institutions to religious instructions, from education system to law enforcement, there are stories of individuals and whole departments who went along with programs or orders that came from higher levels that defy common sense or our values as people.

Ira Chaleff summarises Intelligent Disobedience as follows: when you receive an order that does not seem appropriate to the mission, goals, and values, clarify the order and examine it whether it involves any problems with safety, effectiveness, cultural sensitivity, or legality; and make a conscious decision whether to comply with the order or resist it and offer an alternative when there is one.