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

2. Chapter 7 Ethics in Advanced Prehospital Care

3. Topics Overview of Ethics
Ethical Issues in Contemporary Paramedic Practice

4. 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.

5. Overview of Ethics

6. 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

7. 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.

8. 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

9. 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

10. 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.

11. 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.

12. 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.

13. 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.

14. 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

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

16. 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?

17. 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.

18. Ethical Issues in Contemporary Paramedic Practice

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

20. 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.

21. 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.

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

23. 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

24. 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.

25. 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

26. 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?

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

28. 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

29. 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.

30. 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.

31. Summary Overview of Ethics
Ethical Issues in Contemporary Paramedic Practice