EMS Ethics by LisaB1982

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									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”
 Morals
       “generally considered to be social, religious, or
        personal standards of right and wrong”
[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
 Quick
     Similar to other problems?
     Postpone decision?
     Quick Tests
Principles for Resolving Ethical
            Conflicts
                    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 “clot-
      busting” 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
is
      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

								
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