Chapter 64
Ethical challenges
Dave W. Lu,
James G. Adams,
Dave W. Lu
Search for more papers by this authorJames G. Adams
Search for more papers by this authorDave W. Lu,
James G. Adams,
Dave W. Lu
Search for more papers by this authorJames G. Adams
Search for more papers by this authorBook Editor(s):David C. Cone MD,
Jane H. Brice MD, MPH,
Theodore R. Delbridge MD, MPH,
J. Brent Myers MD, MPH,
David C. Cone MD
Professor of Emergency Medicine
Yale University School of Medicine, New Haven, Connecticut
Search for more papers by this authorJane H. Brice MD, MPH
Professor of Emergency Medicine
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Search for more papers by this authorTheodore R. Delbridge MD, MPH
Executive Director
Maryland Institute for Emergency Medical Services Systems, Baltimore, Maryland
Search for more papers by this authorJ. Brent Myers MD, MPH
Chief Medical Officer ESO Associate Medical Director
Wake County EMS, Raleigh, North Carolina
Search for more papers by this authorFirst published: 18 August 2021
Summary
Ethical issues are present in every EMS clinician-patient encounter. They become more poignant in the prehospital setting where decisions often need to be made in a time-sensitive manner and without all the necessary information available. These unique aspects of prehospital care may make decisions surrounding complex ethical issues challenging and stressful for clinicians. EMS physicians and practitioners can nonetheless successfully manage common ethical dilemmas that arise in their practice with a thorough understanding of core ethical principles. This chapter presents specific prehospital situations in which ethical questions frequently arise and offers guidance to assist in decision making.
References
- Becker TK , Gausche-Hill M , Aswegan AL , et al. Ethical challenges in emergency medical services: controversies and recommendations . Prehosp Disaster Med . 2013 : 1 – 10 .
- Beauchamp TL , Childress JF . Principles of Biomedical Ethics . 8th ed. New York : Oxford University Press , 2019 .
- Magauran BG Jr. Risk management for the emergency physician: competency and decision-making capacity, informed consent, and refusal of care against medical advice . Emerg Med Clin North Am . 2009 ; 27 : 605 – 14 .
- Buchanan A . Mental capacity, legal competence and consent to treatment . J R Soc Med . 2004 ; 97 : 415 – 20 .
- Chow GV , Czarny MJ , Hughes MT , Carrese JA . CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting . Chest . 2010 ; 137 : 421 – 7 .
- Woolley S. Jehovah's Witnesses in the emergency department: what are their rights? Emerg Med J . 2005 ; 22 : 869 – 71 .
- Mullen J . Protecting patients and the prudent layperson standard : American College of Emergency Physicians . Available at: https://www.acep.org/how-we-serve/sections/democratic-group-practice/news/september-2019/protecting-patients-and-the-prudent-layperson-standard/ . Accessed August 26, 2020.
- Hauswald M . Can paramedics safely decide which patients do not need ambulance transport or emergency department care? Prehosp Emerg Care . 2002 ; 6 : 383 – 6 .
- Silvestri S , Rothrock SG , Kennedy D , Ladde J , Bryant M , Pagane J . Can paramedics accurately identify patients who do not require emergency department care? Prehosp Emerg Care . 2002 ; 6 : 387 – 90 .
- Eastwood K , Smith K , Morgans A , Stoelwinder J . Appropriateness of cases presenting in the emergency department following ambulance service secondary telephone triage: a retrospective cohort study . BMJ Open . 2017 ; 7 : e016845 .
- National Association of EMS Physicians . EMS provider determinations of necessity for transport . Prehosp Emerg Care . 2011 ; 15 : 546 .
- National Association of EMS Physicians . Termination of resuscitation in nontraumatic cardiopulmonary arrest . Prehosp Emerg Care . 2011 ; 15 : 542 .
- Mancini ME , Diekema DS , Hoadley TA , et al. Part 3: Ethical issues: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care . Circulation . 2015 ; 132 : S383 – 96 .
- National Association of EMS Physicians, American College of Surgeons Committee on Trauma . Withholding of resuscitation for adult traumatic cardiopulmonary arrest . Prehosp Emerg Care . 2013 ; 17 : 291 .
- Lu DW , Guenther E , Wesley AK , Gallagher TH . Disclosure of harmful medical errors in out-of-hospital care . Ann Emerg Med . 2013 ; 61 : 215 – 21 .
- Sattar R , Johnson J , Lawton R . The views and experiences of patients and health-care professionals on the disclosure of adverse events: a systematic review and qualitative meta-ethnographic synthesis . Health Expect . 2020 ; 23 : 571 – 83 .
- Mello MM , Gallagher TH . Malpractice reform–opportunities for leadership by health care institutions and liability insurers . N Engl J Med . 2010 ; 362 : 1353 – 6 .
- Mastroianni AC , Mello MM , Sommer S , Hardy M , Gallagher TH . The flaws in state 'apology' and 'disclosure' laws dilute their intended impact on malpractice suits . Health Aff (Millwood) . 2010 ; 29 : 1611 – 9 .
- Schmidt TA , Abbott JT , Geiderman JM , et al. Ethics seminars: the ethical debate on practicing procedures on the newly dead . Acad Emerg Med . 2004 ; 11 : 962 – 6 .
- Sperling D . Breaking through the silence: illegality of performing resuscitation procedures on the “newly-dead.” Ann Health Law . 2004 ; 13 : 393 – 426 .
- Rebers S , Aaronson NK , van Leeuwen FE , Schmidt MK . Exceptions to the rule of informed consent for research with an intervention . BMC Med Ethics . 2016 ; 17 : 9 .
- Nichol G , Powell J , van Ottingham L , et al. Consent in resuscitation trials: benefit or harm for patients and society? Resuscitation . 2006 ; 70 : 360 – 8 .
- Carlson JN , Zive D , Griffiths D , et al. Variations in the application of exception from informed consent in a multicenter clinical trial . Resuscitation . 2019 ; 135 : 1 – 5 .
- Baren JM . Ethical dilemmas in the care of minors in the emergency department . Emerg Med Clin North Am . 2006 ; 24 : 619 – 31 .
- Consent for emergency medical services for children and adolescents . Pediatrics . 2011 ; 128 : 427 – 33 .
