Ethics in Advanced Prehospital Care Topics to Discuss

Ethics in Advanced Prehospital Care

Topics to Discuss w What are Ethics? w Where do Ethics Come From? w Principles for Resolving Ethical Conflicts w Specific Ethical Issues Facing Paramedics Today

Ethics vs. Morals w Ethics n Generally refers to “the rules or standards that govern the conduct of members of a particular group or profession” w Morals n “generally considered to be social, religious, or personal standards of right and wrong” [Bledsoe, Volume 1, p. 141]

Morals, Ethics, and Law w Some overlap between ethics and morals often is present n Morals, personal beliefs of right and wrong behavior, often influence our ethics development w Ethics often help shape our legal views w All remain separate issues

Principles for Resolving Ethical Conflicts w Key: “What is best for the patient? ” n n n Based upon what/whose standards? Who is the ideal person to determine what is best? What other persons or groups may play a role in the decision-making process?

Principles for Resolving Ethical Conflicts w Ethical Considerations in Patient Care n n Beneficence: the paramedic’s responsibility to “do good” for the patient Nonmaleficence: the paramedic’s responsibility to not harm the patient l n n Primum non nocere Autonomy: Patient’s right of self determination Justice: Treat all patients fairly

Principles for Resolving Ethical Conflicts w Long Approach n n Universal form Implications/Consequences Compare to Relevant Values Accept, Reject, Modify w Quick n n n Similar to other problems? Postpone decision? Quick Tests

Principles for Resolving Ethical Conflicts n n n Would you agree to the same thing if you were the patient? Would you want this performed in all similar & future circumstances? Can you defend or justify your actions to others?

Specific Ethical Issues Facing Paramedics Today w Resuscitation n Valid DNR is present but patient is breathing and has a pulse Family Conflicts in the presence of a DNR Terminating resuscitation when efforts appear futile or valid DNR now presented

Specific Ethical Issues Facing Paramedics Today w Confidentiality n n State Laws Greatest Good

Specific Ethical Issues Facing Paramedics Today w Consent n n Competent Patient Refusal Patient or Legal Healthcare Decision-Maker Refusal of Specific Therapies

Specific Ethical Issues Facing Paramedics Today w Allocation of Resources n n True Parity Need Earned Special

Specific Ethical Issues Facing Paramedics Today w Provide Obligation to Respond & Care n Inability to pay when seeking emergency services n Known IV drug user suspected of having an AMI requests pain meds for his severe chest pain n Mandates of the Medical Insurance provider n Responding off-duty when not “prepared” or when others are now placed in potential danger

Specific Ethical Issues Facing Paramedics Today w Teaching n n n Should students be identified as such to patients? How far does the teacher allow the student to “practice” unsuccessfully without intervening? Is a “student” always a student?

Specific Ethical Issues Facing Paramedics Today w Professional Relationships n n n Your EMS Director has asked that you try to obtain refusals on those persons who clearly can not pay. Your Medical Control asks you to administer a harmful dose of a medication Your Partner suggests administering a higher dose of morphine to a terminal patient in order to “end it”

Specific Ethical Issues Facing Paramedics Today w Research n n Your EMS agency wants to deliver a “clotbusting” drug as part of a research trial but the patient does not have to provide consent. Your medical director asks you not to include the adverse outcome of a study participant since this may cause the IRB or DSMB to prematurely end the research trial

Summary w Ethical issues are seldom easy to resolve w Often, there are no easy “right and wrong” decisions w Attempt to foresee issues and discuss possible solutions early