1. Paramedic Care: Principles & Practice Volume 1: Introduction to Paramedicine CHAPTER Fourth Edition ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethics in Paramedicine 8

2. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Standard Preparatory (Medical/Legal and Ethics)

3. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Competency Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical/legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.

4. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Introduction Although ethical problems often have legal aspect, most are solved in field and not in a courtroom. Ethical issues often begin with specific circumstances; lead to broad general rules or principles for behavior.

5. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Morals: social, religious, or personal standards of right and wrong. Ethics (moral philosophy): branch of philosophy; addresses questions about morality. –Rules or standards that govern conduct of members of particular group or profession; how institutions should function

6. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Relationship of Ethics to Law and Religion –Ethics not the same as law. –Laws much narrower focus than ethics. –Law frequently has little or nothing to say about ethical problems.

7. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Relationship of Ethics to Law and Religion –Law: impartiality, consistent procedures, methods to identify and balance conflicting interests. –Ethics cannot derive from single religion. –Religion can enhance and enrich one's ethical principles and values.

8. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. The relationship of ethical and legal issues and medicine.

9. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Making Ethical Decisions –Ethical relativism: each person must decide how to behave; whatever decision that person makes is okay. –Ethics and morality overlap; professional ethics go beyond what one individual thinks is right or wrong.

10. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Making Ethical Decisions –Reason and logic used; emotion excluded as much as possible from decision-making process –Deontological method: people should just fulfill their duties.

11. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Making Ethical Decisions –Consequentialism: actions can be judged as good or bad only after we know consequences of those actions.

12. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Codes of Ethics –Honesty –Objectivity –Integrity –Carefulness –Openness –Legality –Confidentiality –Responsible publication

13. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Codes of Ethics –Responsible mentoring –Respect for colleagues –Social responsibility –Nondiscrimination –Competence –Respect for intellectual property –Human subjects protection

14. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Impact of Ethics on Individual Practice –Paramedics exemplify principles and values of profession. –Understand and agree to abide by responsibilities (implicit and explicit) of profession. –Common sense helps in resolving conflicts.

15. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics The Fundamental Questions –What is in patient's best interest?  Reassurance, relief from pain, prompt and safe transport  Written statement of patient's desires  Paramedic obligated to respect patient's desires

16. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics The Fundamental Questions –Be cautious in accepting family's description of what patient desires. –State and local laws

17. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Fundamental Principles –Beneficence: doing good.  Paramedic's obligation to patient –Nonmaleficence: not doing harm.  Paramedic obligated to minimize risk as much as possible.

18. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Fundamental Principles –Autonomy: competent adult patient's right to determine what happens to his own body.  Treatment for medical illnesses and injuries –Justice: paramedic's obligation to treat all patients fairly.

19. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Resolving Ethical Conflicts –Institutional review boards (IRBs): protect rights of subjects in research projects. –To reason out ethical problem:  State action in universal form.  List implications or consequences of action.  Compare them to relevant values.

20. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Resolving Ethical Conflicts –Is current problem similar to other problems for which you have already formulated rule? –If yes, follow rule. –If no, determine if you can buy time.

21. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Overview of Ethics Resolving Ethical Conflicts –Impartiality test: would you be willing to undergo procedure or action if in patient's place? –Universalizability test: would you want action performed in all similar circumstances? –Interpersonal justifiability test: can you defend or justify your actions to others?

22. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. A quick approach to new ethical problems. (Based on Iserson, K.V., et al. Ethics in Emergency Medicine. 2nd ed. Tucson, AZ: Galen Press, 1995)

23. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Resuscitation Attempts –Every state that has laws or rules regarding Do Not Resuscitate (DNR) orders requires you to see order and verify legitimacy. –If patient alive, valid DNR order would not prevent you from assessing patient and administering basic care.

24. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Resuscitation Attempts –Nonmaleficence says do no harm. –Beneficence and nonmaleficence urge you to help patient. –DNR order must meet state and local requirements regarding wording and witnesses.

25. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Resuscitation Attempts –Description of which interventions to be withheld, under which circumstances –Every patient entitled to reasonable measures intended to make patient more comfortable (comfort care). –Family and loved ones entitled to emotional support from EMS providers.

26. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Resuscitation Attempts –When in doubt, resuscitate. –Once you have verified validity of order and identity of patient, you are obligated ethically (perhaps legally) to cease resuscitation efforts. –Follow your local protocols.

27. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Confidentiality –Obligation to patient to maintain confidential information –Every state has laws requiring reporting of certain health facts.  Births, deaths, particular infectious diseases, child neglect and abuse, elder neglect and abuse

28. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Confidentiality –Valid court order justification for breaching confidentiality –Clear threat by patient to specific person –Probability of harm, magnitude of expected harm, alternative methods of avoiding harm

29. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Consent –Competent patient of legal age has fundamental right to decide what health care he will receive and will not receive. –Doctrine of implied consent: patient unable to give consent.

30. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Allocation of Resources –Civilian triage: most seriously injured receive most care based on need. –Military triage: help least seriously injured; produces greatest number of soldiers who can return to duty. –Resolving issue of allocation of scarce resources: examine competing theories in light of circumstances at hand.

31. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Obligation to Provide Care –Those who provide emergency care have special obligation to help all those in need without regard to ability to pay. –Act in patient's best interest, even when against HMO's economic interests. –Good Samaritan statutes in every state in U.S.

32. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Teaching –Many paramedics act as preceptors or mentors in EMS systems. –Inform patients of presence of student. –Request patient's consent before student performs procedure. –Student's skill level; difficulty of procedure; importance of procedure

33. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Professional Relations –As health care professional, paramedic answers to patient. –As physician extender, paramedic answers to physician medical director. –As employee (or volunteer), paramedic answers to EMS system.

34. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Professional Relations –Physician orders something paramedic believes contraindicated –Physician orders something paramedic believes medically acceptable but not in patient's best interests. –Physician orders something paramedic believes medically acceptable, but morally wrong

35. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Professional Relations –Ultimately, paramedic must determine how patient's interests best served. –Important for paramedic to understand that no matter what decision he makes, he will have to defend it. –Disagreements with physician orders happen rarely.

36. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Ethical Issues in Contemporary Paramedic Practice Research –Paramedics implement research protocols and gather data. –Goal of research: to help future patients by gaining knowledge about specific intervention. –Gain patient's expressed consent

37. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary As paramedic, you must learn to make ethical decisions that will have an effect on you, your patient, or others. Decision-making process should always be based on patient's best interest. Patient's best interest includes more than lifesaving procedures. Cultural sensitivity included

38. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary Patient has autonomy; right to determine what happens to his own body, and can legally dictate that. Clear distinction between ethics, religion, law even though common ground between them.

39. ©2013 Pearson Education, Inc. Paramedic Care: Principles & Practice, 4 th Ed. Summary Your actions should be: –Legal and within your scope of practice (justice) –Helpful (beneficence) –Not harmful (nonmaleficence) –Direct wishes of patient (autonomy)