Paramedic Care: Principles & Practice Volume 1 Introduction to Advanced Prehospital Care

Chapter 7 Ethics in Advanced Prehospital Care

Topics Overview of Ethics Ethical Issues in Contemporary Paramedic Practice

Introduction In one survey, almost 15% of ALS calls in an urban system generated ethical conflict. In another survey, EMS providers reported frequent ethical problems related to patient refusals, hospital destinations, and advance directives.

Overview of Ethics

Overview of Ethics Ethics and morals are closely related concepts but distinctly separate. Morals The social, religious, or personal standards of right and wrong Ethics The rules or standards that govern the conduct of members of a particular group or profession

Relationship of Ethics to Law and Religion Ethics are not the same as law. Laws have a much narrower focus than ethics. Frequently describe what is wrong in the eyes of society Ethics look at what is right, or good, behavior.

Relationship of Ethics to Law and Religion Ethics must be understood by and applied to people who hold a broad range of religious beliefs. Or no religious beliefs at all

Making Ethical Decisions Ethical relativism Each person must decide how to behave and whatever decision that person makes is okay. “Just do what is right” The Golden Rule

Making Ethical Decisions The Deontological Method Suggests that people should simply follow their duties Consequentialism Actions can only be judged after we know the consequences. The purpose of an action should be to bring the greatest happiness to the greatest number of people.

Code of Ethics Organizations have drafted codes of ethics for the members of their organizations Codes address broad humanitarian concerns and professional etiquette. Few provide solid guidance on the kind of ethical problems commonly faced by practitioners.

Impact of Ethics on Individual Practice Consistently displaying ethical behavior will gain the respect of colleagues and patients. Paramedics must understand and agree to abide by the responsibilities.

The Fundamental Question What is in the patient’s best interest? Answer is typically obvious Resuscitation issues A paramedic must be very cautious in accepting a family’s description of what a patient desires. Take into consideration the state and local laws regarding patient resuscitation desires.

Fundamental Principles Beneficence Principle of doing good for the patient Nonmaleficence The obligation not to harm the patient Autonomy Patients right to determine what happens to his or her own body Justice The obligation to treat all patients fairly

Resolving Ethical Conflicts The paramedic needs to have a system for resolving ethical conflicts. Must be able to be applied quickly

Resolving Ethical Conflicts Impartiality test Would you be willing to undergo this procedure or action? Helps to reduce the possibility of bias Universalizability Would you want this action performed in all relevantly similar circumstances?

Resolving Ethical Conflicts Interpersonal justifiability Can you defend or justify your actions to others? The paramedic should consider whether other people would think the action reasonable.

Ethical Issues in Contemporary Paramedic Practice

Ethical Issues in Contemporary Paramedic Practice Resuscitation attempts Confidentiality Consent Allocation of resources Obligation to provide care Teaching Professional relations Research

Resuscitation Attempts Learn the local laws regarding Do Not Resuscitate (DNR) orders The patient is still entitled to reasonable measures intended to make her more comfortable. Respect the patient’s wishes when a competent patient has clearly communicated. When in doubt, resuscitate.

Confidentiality Your obligation to every patient is to maintain as confidential the information you obtained as a result of your participation in the medical situation. Reporting certain information such as child neglect or elder abuse are exceptions.

Consent Patients of legal age have the right to decide what healthcare they will receive. Core of patient autonomy Implied consent may apply

Consent In order for a patient to provide consent, the patient must have: The information necessary to make an informed decision The mental faculties to weigh the risks and benefits of various treatment options Freedom from restraints that might hamper his ability to exercise his options

Allocation of Resources Approaches to consider: All patients could receive the same amount of attention. Patients could receive resources based on need. Patients could receive what someone has determined they’ve earned. Triage is a common field activity that demonstrates one method of allocating scarce resources.

Obligation to Provide Care The paramedic: Has a responsibility to help others Is obligated to provide care without regard to the ability to pay or other criteria Has a strong ethical obligation to help others even while off-duty

Teaching Student caring for patients: Should patients be informed that a student is working on them? System runs the risk of being accused of concealing important information from patients How many attempts should a student be allowed to have in performing an intervention?

Professional Relations A paramedic answers to the patient, the physician medical director, and to his employer. Sometimes conflict arises out of such relationships.

Professional Relations Physician conflicts Physician orders something the paramedic believes is contraindicated The paramedic believes an order is medically acceptable but not in the patient’s best interests The physician orders something the paramedic believes is medically acceptable, but morally wrong

Professional Relations Resolving physician conflict issues Confirm the order and ask the physician to repeat it. Ask the physician for an explanation. The paramedic must determine for himself how the patient’s interests are best served.

Research The goal of research is to help future patients by gaining knowledge about a specific intervention. It is important to gain informed consent. The patient who is unable to consent Federal government has strict rules about community notification before the study begins.

Summary Overview of Ethics Ethical Issues in Contemporary Paramedic Practice