BY TORI CUTHBERTSON
This story is meant to bring awareness and a shift in thinking towards individuals with chronic illness/disabilities encountered by persons working within a paramedic service, not to shame, assign blame, or disrespect anyone. I do not assert that all paramedics have the bias or devaluing belief.
Service Dogs (SD) are increasingly recognized as an effective tool for managing many chronic conditions including mobility, diabetes, seizure alert, autism and more. The most common associated image of working dogs are Guide Dogs or PTSD service dogs for military veterans. However, there are many different types of SD-Handler teams that are used for a variety of different disabilities and situations. I use the words ‘disabled’ and ‘disability’ for several reasons. First, I meet the legal Supreme Court of Canada and Ontario Human Rights Code (OHRC) definitions for medical and physical impairment (1-2). The OHRC states the need for a SD for mobility assistance meets the legal definition of disability, so by that criteria alone I can adopt that label. The second reason I use ‘disability’ is the level of stigma associated with the word; it feels abrupt, and people are taken aback when they hear it is used to describe someone who does not “obviously” (or visibly) have a disability. My SD, Watson, and I have been a team outside of the typical image for 2.5 years. Before Watson, my medical conditions could remain invisible, essentially allowing me to appear ‘fine’ from others’ perspectives. Now, every interaction I have with the paramedic community and the world has drastically changed.
In an ableist profession, the idea of having a disabled individual with the job title of ‘paramedic’ challenges the status quo. Perhaps the newness of this integration into the paramedic field creates uncertainty due to lack of established guidelines of how to proceed. To help bring some confidence and normality to the situation as the profession learns how to discuss these topics, one might consider critical disability theory (CDT). CDT speaks to the devaluing of individuals with disabilities while also placing emphasis on the intersectional analysis categories, including gender (3). There is a focus on activism and participation through sharing of lived experiences directly from the voices of individuals with disabilities (3). CDT aims to confront the negative assumptions and views held by mainstream society. These views inevitably affect the paramedic assumptions and beliefs regarding disability (4). Paramedics have a social culture of telling stories about calls therefore taking advantage of this could be a powerful tool to evoke emotion (5). Writing narratives with such emotion forms connection with the reader, creating a metaphorical participatory space to enact change (5). In society, more attention is given to male voices. This is also true in paramedicine, where gender parity has not yet been reached in all services. This makes remembering intersectionality of otherness crucial to ensuring all voices are heard and represented (6). The above pathways have roots in well-developed qualitative research methodology, meaning the roadmaps already exist to promote inclusion and added value (3,4,7).
One of the more difficult issues to address is the social culture, attitudes, and beliefs surrounding the perception of a medic with a service dog now that an otherwise invisible illness/disability are made visible. It is near impossible to miss an adorable Golden Retriever. Most handlers have a service dog for PTSD, have retired from various positions, and will not be returning. Therefore, the relevance of such a SD-Handler team in a paramedic service would not be considered. This translates powerfully into the incorrect perception that SD teams have little value, little to contribute, and begs the question of, “should you even be at work?”. Comments such as ‘well if he makes you feel better’ or ‘whatever gets you through the day’ also echo this perception. These are called “attitudinal barriers” (7) which are defined by the World Health Organization (WHO) as the discrimination, prejudice, and stigma directed towards persons with disabilities (WHO, 2016). Attitudinal barriers are also negative assumptions some members of societies have about disabled individuals and disability in general. These attitudes and biases seep into paramedic social culture, especially if the prevailing collective opinion assumes said persons are “noncontributing … parties to the social contract” (4).
A personal account of such dismissal and discrimination was after the second seizure I had ever had in my life, years before COVID-19. Paramedics were called as I had no diagnosis or neurologist appointment, and I was post-ictal at the time of the 911 call. The paramedic refused to allow my service dog or my husband in the ambulance with me. The paramedic informed myself and my husband that no family members were ever allowed in their ambulance. Upon arrival at the hospital this paramedic loudly mocked my attempt to say goodbye to my service dog. We were the middle of the triage area with other patients & paramedics. The medic encouraged the triage nurses to make fun of me as well, because this medic believed that a second seizure was no reason to call an ambulance, despite the obvious presence of a seizure disorder. This was gut wrenching and unexpected. Further, both my husband I previously worked for this paramedic service. This paramedic set the tone for the rest of my hospital visit. If these attitudes exist within a patient-yet-peer interaction, logic follows that such attitudes exist within the profession as a whole. While this was not an isolated incident, not every interaction has been negative. I have had some exception crews help me along the way and I am incredibly grateful for their help.
Returning to the workplace environment, I felt completely supported and respected in terms of needs and space to work with my dog. Management had done the absolute best they could to accommodate myself & Watson; the supervisors had put much time and effort into preparing for my return. They even added a picture of Watson on the staff wall! While filled with gratitude, I felt socially alone and isolated, disconnected from the sense of family I once had with my peers. I did not expect to feel a greater sense of otherness at work than I feel outside of work. Likely, it was because no one knows what to do with me. I feel the elephant in the room is a career pathway; what would the future of a paramedic with a SD look like within a paramedic service? Re-classification to another position does not remove the challenges of including SD teams in the workplace. The lack of policy & procedure, social resources, and removal attitudinal barriers could make for easier transition for future SD teams. Other factors to be addressed are the politics involved with organizational change (8). CDT addresses this very real concern and claim:
disability is not fundamentally a question of medicine or health, nor is it just an issue of sensitivity and compassion; rather, it is a question of politics and power(lessness), power over, and power to. (as quoted in Gillies 2014)
As suggested above, disability inclusion is not solely a problem for the individuals, in this case a SD team. Direct advocacy, both personal and political, is a key part of critical disability theory activism for policy and community change (4). Management must see the potential value of critical disability activism and use forward thinking to plan for employees who develop disabilities, while acknowledging the political aspects of power imbalance. Utilizing the available experience, skills, and unique lens of this ableist world could remove the devaluing of disabled paramedics. Ableism culture permeates paramedic social society in both paramedic community and within clinical practice. My own SD removes the invisibility cloak of my disabled status, just like we must lift the shroud of lies, misconceptions, stigma, and prejudice woven into the fabric of paramedic culture that is so interconnected that such attitudes might as well be the cloth of our uniforms.
Stronger together is not just asking female identified paramedics to get together and solve the world’s problems. Feminist philosophy argues that, like disabled people, women have been devalued, dismissed, and displaced (3). Arguably, similar strategies of analysis and discourse may be helpful as, “a beacon to guide disability theory” (4) to overcome various barriers. Feminists striving for equality may recognize the disparity and wish to join in advocacy action. To the many members that have found themselves in a sexist or misogynistic situation at some point in their paramedic career, perhaps that feeling can help understand why this is so important to discuss. The phrase ‘throwing like a girl’ demonstrates the confounding belief that women are physically inferior to men and stigmatizes a woman’s physicality, may be familiar to many (3). Equipment, such as stretchers and stairchairs, are not built for women’s bodies; the handles are too large or set too far apart to be comfortable. The burden of compensating is placed on the woman, not the tool. Physical devaluing and emotional devaluing or dismissal of women’s concerns over belief of hysterics is still very real today (3). Finding ways to avoid social exclusion and preventing a loss of identity and purpose should be considered. Similarly, career pathways for differently-abled persons should not be ‘dead ends.’ Disabled individuals often, “will develop cognitive approaches and abilities that differ from most other people’s,” (3) providing value in unexpected ways. Critical disability theory addresses the assumptions held by mainstream society and by paramedic culture and can be used to help guide the discussion of disability in paramedicine. The goal of telling my story is to evoke emotion and connection to start discourse and change around disabled individuals within our professional community. My hope is to set the stage for future conversations and solutions.
- Gov’t. (2018). Federal Disability Reference Guide. Government of Canada: Human Resources & Accessibility resource centre. From: https://www.canada.ca/en/employment-social-development/programs/disability/arc/reference-guide.html#h2.3-h3.1
- (n.d.) Policy on ableism and discrimination based on disability. Ontario Human Rights Commission. From: http://www.ohrc.on.ca/en/policy-ableism-and-discrimination-based-disability/2-what-disability#_edn19
- Hall, M. (2019). Hall, Melinda C., “Critical Disability Theory”, The Stanford Encyclopedia of Philosophy (Winter 2019 Edition), Edward N. Zalta (ed.), URL = <https://plato.stanford.edu/archives/win2019/entries/disability-critical/>.
- Silvers, A. (2021). Silvers, Anita, “Feminist Perspectives on Disability”, The Stanford Encyclopedia of Philosophy(Spring 2021 Edition), Edward N. Zalta (ed.), forthcoming URL = <https://plato.stanford.edu/archives/spr2021/entries/feminism-disability/>.
- Bochner, A., & Ellis, C. (2016). Evocative autoethnography: Writing lives and telling stories(2nd ed.). Routledge.
- Schmeichel, M. (2015). Skirting around critical feminist rationales for teaching women in social studies. Theory & Research in Social Education, 43(1), 1-27.
- Sillaby, B. (2016). Governing Dogs: An Autoethnographic Tale of Redefining ‘Service Dog’ in Canada. McMaster University, Dept. of Health & Aging. From: http://hdl.handle.net/11375/20578
- Gillies, J. (2014). Critical Disability Theory. Encyclopedia of Quality of Life and Well-Being Research. Alex C. Michalos (ed.), Dordrecht: Springer Netherlands, 1348–1350. doi:10.1007/978-94-007-0753-5_619
- World Health Organization [WHO]. (2016a). International Classification of Functioning, Disability and Health. Retrieved from http://www.who.int/classifications/icf/icf_more/en/