Ethics in Advanced Prehospital Care. Topics to Discuss What are Ethics? Where do Ethics Come From?...

Ethics in Advanced Prehospital Care

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?


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 patientPrimum 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


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?


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


Confidentiality State Laws Greatest Good


Consent Competent Patient Refusal Patient or Legal Healthcare Decision-Maker

Refusal of Specific Therapies


Allocation of Resources True Parity Need Earned Special


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


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?


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”


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

Ethics in Advanced Prehospital Care. Topics to Discuss What are Ethics? Where do Ethics Come From?...

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