Ethics in Advanced Prehospital Care

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Ethics in Advanced Prehospital Care

• Department of EMS Professions
• Temple College

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Topics to Discuss

• What are Ethics?
• Where do Ethics Come From?
• Principles for Resolving Ethical Conflicts
• Specific Ethical Issues Facing Paramedics Today

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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

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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

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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?

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Principles for Resolving Ethical Conflicts

• Ethical Considerations in Patient Care
• Beneficence the paramedics responsibility to
  do good for the patient
• Nonmaleficence the paramedics responsibility to
  not harm the patient
• Primum non nocere
• Autonomy Patients right of self determination
• Justice Treat all patients fairly

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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

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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?

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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

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Specific Ethical Issues Facing Paramedics Today

• Confidentiality
• State Laws
• Greatest Good

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Specific Ethical Issues Facing Paramedics Today

• Consent
• Competent Patient Refusal
• Patient or Legal Healthcare Decision-Maker
  Refusal of Specific Therapies

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Specific Ethical Issues Facing Paramedics Today

• Allocation of Resources
• True Parity
• Need
• Earned
• Special

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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

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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?

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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

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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

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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