Ethics

Ethics in Advanced Prehospital Care Department of EMS Professions Temple College Topics to Discuss  What are Ethics?  Where do Ethics Come From?  Principles for Resolving Ethical Conflicts  Specific Ethical Issues Facing Paramedics Today Ethics vs. Morals  Ethics  Generally refers to “the rules or standards that govern the conduct of members of a particular group or profession” “generally considered to be social, religious, or personal standards of right and wrong”  Morals  [Bledsoe, Volume 1, p. 141] Morals, Ethics, and Law  Some overlap between ethics and morals often is present  Morals, personal beliefs of right and wrong behavior, often influence our ethics development  Ethics often help shape our legal views  All remain separate issues Principles for Resolving Ethical Conflicts  Key: “What is best for the patient?”    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  Ethical Considerations in Patient Care   Beneficence: the paramedic’s responsibility to “do good” for the patient Nonmaleficence: the paramedic’s responsibility to not harm the patient  Primum non nocere   Autonomy: Patient’s right of self determination Justice: Treat all patients fairly Principles for Resolving Ethical Conflicts  Long Approach     Universal form Implications/Consequences Compare to Relevant Values Accept, Reject, Modify Similar to other problems? Postpone decision? Quick Tests  Quick    Principles for Resolving Ethical Conflicts  Impartiality Test  Universalizability Test Interpersonal Justifiability Test  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  Resuscitation  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  Confidentiality   State Laws Greatest Good Specific Ethical Issues Facing Paramedics Today  Consent   Competent Patient Refusal Patient or Legal Healthcare Decision-Maker Refusal of Specific Therapies Specific Ethical Issues Facing Paramedics Today  Allocation of Resources     True Parity Need Earned Special Specific Ethical Issues Facing Paramedics Today  Provide Obligation to Respond & Care  Inability to pay when seeking emergency services  Known IV drug user suspected of having an AMI requests pain meds for his severe chest pain  Mandates of the Medical Insurance provider  Responding off-duty when not “prepared” or when others are now placed in potential danger Specific Ethical Issues Facing Paramedics Today  Teaching    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  Professional Relationships    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  Research   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  Ethical issues are seldom easy to resolve  Often, there are no easy “right and wrong” decisions  Attempt to foresee issues and discuss possible solutions early