[Originally posted to my personal blog, reposted here with edits.]
Introduction
You could call it heroic responsibility, maybe,” Harry Potter said. “Not like the usual sort. It means that whatever happens, no matter what, it’s always your fault. Even if you tell Professor McGonagall, she’s not responsible for what happens, you are. Following the school rules isn’t an excuse, someone else being in charge isn’t an excuse, even trying your best isn’t an excuse. There just aren’t any excuses, you’ve got to get the job done no matter what.” Harry’s face tightened. “That’s why I say you’re not thinking responsibly, Hermione. Thinking that your job is done when you tell Professor McGonagall—that isn’t heroine thinking. Like Hannah being beat up is okay then, because it isn’t your fault anymore. Being a heroine means your job isn’t finished until you’ve done whatever it takes to protect the other girls, permanently.” In Harry’s voice was a touch of the steel he had acquired since the day Fawkes had been on his shoulder. “You can’t think as if just following the rules means you’ve done your duty. –HPMOR, chapter 75.
Something Impossible
Bold attempts aren't enough, roads can't be paved with intentions...You probably don’t even got what it takes,But you better try anyway, for everyone's sakeAnd you won’t find the answer until you escape from theLabyrinth of your conventions.Its time to just shut up, and do the impossible.Can’t walk away...Gotta break off those shackles, and shake off those chainsGotta make something impossible happen today...
The Well-Functioning Gear
I feel like maybe the hospital is an emergent system that has the property of patient-healing, but I’d be surprised if any one part of it does.Suppose I see an unusual result on my patient. I don’t know what it means, so I mention it to a specialist. The specialist, who doesn’t know anything about the patient beyond what I’ve told him, says to order a technetium scan. He has no idea what a technetium scan is or how it is performed, except that it’s the proper thing to do in this situation. A nurse is called to bring the patient to the scanner, but has no idea why. The scanning technician, who has only a vague idea why the scan is being done, does the scan and spits out a number, which ends up with me. I bring it to the specialist, who gives me a diagnosis and tells me to ask another specialist what the right medicine for that is. I ask the other specialist – who has only the sketchiest idea of the events leading up to the diagnosis – about the correct medicine, and she gives me a name and tells me to ask the pharmacist how to dose it. The pharmacist – who has only the vague outline of an idea who the patient is, what test he got, or what the diagnosis is – doses the medication. Then a nurse, who has no idea about any of this, gives the medication to the patient. Somehow, the system works and the patient improves.Part of being an intern is adjusting to all of this, losing some of your delusions of heroism, getting used to the fact that you’re not going to be Dr. House, that you are at best going to be a very well-functioning gear in a vast machine that does often tedious but always valuable work. –Scott Alexander
Recursive Heroic Responsibility
Heroic responsibility for average humans under average conditions
I can predict at least one thing that people will say in the comments, because I've heard it hundreds of times–that Swimmer963 is a clear example of someone who should leave nursing, take the meta-level responsibility, and do something higher impact for the usual. Because she's smart. Because she's rational. Whatever.
Fine. This post isn't about me. Whether I like it or not, the concept of heroic responsibility is now a part of my value system, and I probably am going to leave nursing.
But what about the other nurses on my unit, the ones who are competent and motivated and curious and really care? Would familiarity with the concept of heroic responsibility help or hinder them in their work? Honestly, I predict that they would feel alienated, that they would assume I held a low opinion of them (which I don't, and I really don't want them to think that I do), and that they would flinch away and go back to the things that they were doing anyway, the role where they were comfortable–or that, if they did accept it, it would cause them to burn out. So as a consequentialist, I'm not going to tell them.
And yeah, that bothers me. Because I'm not a special snowflake. Because I want to live in a world where rationality helps everyone. Because I feel like the reason they would react that was isn't because of anything about them as people, or because heroic responsibility is a bad thing, but because I'm not able to communicate to them what I mean. Maybe stupid reasons. Still bothers me.
My $0.02: it matters whether I trust the system as a whole (for example, the hospital) to be doing good.
If I do, then if I'm going to be "heroically" responsible I'm obligated to take that into account and make sure my actions promote the functioning of the system as a whole, or at least don't impede it. Of course, that's a lot more difficult than just focusing on a particular bit of the environment that I can improve through my actions. But, well, the whole premise underlying "heroic" responsibility is that difficulty doesn't matter, we just do the "impossible" because hey, it needs doing.
If I don't, then I can basically ignore the system and go forth and "heroically" do good on my own.
So, yeah, maybe being a "heroically" responsible nurse (as opposed to a "heroically" responsible person, who as you suggest might find it necessary to stop being a nurse and instead take over the medical profession and run it properly) would involve coordinating with the other nurses on your unit, and not just going off on your own to do what you can do with your own two hands.
Which, I understand, is a very different model of "heroic" responsibility than what's presented in the Sequences (and HPMOR), which is much more about individual achievements against a backdrop of a system that's at best useless and more often harmful.
Another $0.02: this whole notion of "heroic" responsibility seems incompatible with counting the cost. If achieving whatever-it-is requires working 24-hour shifts, according to this model, then by gum you work 24-hour shifts!
So, yes, burnout is inevitable if whatever-it-is is the sort of thing, like sick patients, that is being presented in a steady stream.
There's a big difference between a goal like "invent a technology that optimizes the world for human value," which only needs to be done once, and a goal like "care for my patient" which has to be done over, and over, and over. I'm not sure it's possible for humans to be "heroic" about the latter without generalizing to the root causes and giving up being a nurse.