ETHICS IN ADVANCED

PREHOSPITAL CARE
 Topics

 Ethics
 Morals
 Law
 Advanced Directives
 Introduction

 In one survey, almost 15% of ALS calls in an

urban system generated ethical conflict.
 In another survey, EMS providers
reported frequent ethical problems
related to patient refusals, hospital
destinations, and advance directives.
 Introduction

 Other aspects include patient

confidentiality, consent, the
obligation to provide care, and
research.
 MORALS

Social, religious, or personal

standards of right and wrong
 ETHICS

The rules or standards that govern the

conduct of members of a particular
group or profession
 Ethics VS. Morals
Ethics and morals are
closely related concepts
but distinctly separate.
Morals are the social,
religious, or
personal standards
Ethics are the rules or
standards that govern of right and
the conduct of members wrong
of a particular group or
profession.
Relationship of Ethical and Legal
Issues with Medicine
 Approaches to Making Ethical Decisions

 Ethical relativism suggests that

each person must decide how to
behave
and whatever decision that person
makes is okay.
 Some say, “Just do what is
right.”
 CHOICES
&
CONSEQUENCES
Approaches to Making Ethical Decisions

 The deontological method

suggests that people should
simply follow their duties.
 Followers of consequentialism
believe that actions can only be
judged after we know the
consequences.
 Code of Ethics
 Many organizations have  Very few provide solid
developed guidance on
a code of ethics over the
the kind of ethical
years for
their members. problems
 Most codes of ethics commonly faced by
address broad EMS Providers.
humanitarian concerns
and
professional etiquette.
 To gain and maintain the
respect of their colleagues and
their patients, it is vital that
individual paramedics exemplify
the principles and values of
their profession.
The single most important
question a paramedic has to
answer when faced with an
ethical challenge is:
WHAT IS IN THE PATIENT’S BEST
INTEREST?
 4 Principles to Resolve Ethical
Problems

 Beneficence is the principle of doing

good for the patient.
 Non-malfeasance is the obligation not
to harm the patient.
 Autonomy is a competent adult
patient’s right to determine what
happens to his or her own body.
 Justice refers to the obligation to
treat all patients fairly.
 An
approac
h
to
ethical
decision-
making.
 Quick Ways to Test Ethics
 Impartiality test---asks whether you would be
willing to undergo this procedure or action if you were
in the patient’s place.
 Universalizability test---asks whether you would
want this action performed in all relevantly similar
circumstances.
 Interpersonal justifiability test---asks whether you
can defend or justify your actions to others.
 Ethical Issues in Contemporary Paramedic
Practice

 Resuscitation Attempts
 Confidentiality
 Consent
 Allocation of Resources
 Obligation to Provide Care
 Teaching
 Professional Relations
 Research
 Resuscitation Attempts

Learn the local laws regarding

do not resuscitate (DNR) orders.

“When in doubt, resuscitate.”

 Confidentiality
 Your obligation to every patient is
to maintain as confidential the
information you obtained as a result
of your participation in the medical
situation.
 Reporting certain information such
as child neglect or elder abuse are
exceptions.
 Consent
 Patients of legal age have the
right to decide what healthcare
they will receive.
 Implied consent may apply in
cases where the patient is
incapacitated or unable to
communicate.
 Consent

 Patients are generally able to

consent or refuse care if they are
alert and oriented, aware of their
surroundings, and making sound
judgments.
 When leaving the patient, he or she must
understand the issues at hand and be able to
make an informed
decision.
 Allocation of Resources
 Several approaches to consider…
– All patients could receive the same amount of
attention.
– Patients could receive resources based on need.
– Patients could receive what someone has
determined they’ve earned.
Triage is a common field activity
that demonstrates one method of
allocating scarce resources.
 Obligation to Provide Care

 A paramedic…
– Has a responsibility to help others.
– Is obligated to provide care without regard to the
ability to pay or other criteria.
– Has a strong ethical obligation to help others even
while off-duty.
 Teaching

 Two possible ethical questions are raised

when a student is caring for patients:
– Whether or not patients should be informed that a
student is working on them;
– How many attempts a student should be allowed to
have in performing an intervention.
 To avoid problems…

 Clearly identify students as such.

 The preceptor should, when
appropriate, inform the patient of the
student’s presence and obtain the
patient’s consent.
 Take the student’s experience and
skill level into account and have a
pre-determined limit identified for the
number of attempts at a procedure.
 Professional Relations

 A paramedic answers to the

patient, the physician medical
director, and to his employer.
 Sometimes conflict arises
out of such relationships.
 Know your policies…and
communicate.
 Research
 EMS research is only in its infancy
but is essential to the advancement
of EMS.
 Strict rules and guidelines must be
followed when conducting patient
care-related studies.
 Gaining the patient’s consent is
paramount.
 QUESTION
 Your partner contacts a former patient to
ask for a date using the phone number from
the patient care report.
 What would you tell your partner and
supervisors?
 Is this immoral?
 Is this unethical?
 Is this illegal?
 QUESTION 1
1. What would you tell your partner and
supervisors?
2. Is this immoral?
3. Is this unethical?
4. Is this illegal?
 QUESTION 2
You arrive at a home where a 3 month old
baby who has obviously been dead for
several hours. The mother is hysterical and
begging you to “Please, do something”.
 QUESTION 2
 What would you do?

 Is this ethical?
 QUESTION 3
 The BioTel physician gives you orders for a
drug that you feel is inappropriate. You
explain your concern over the radio and the
physician still insists that you give the
medication.
 QUESTION 3
 What would you do?

 Is this ethical and legal?

 QUESTION 4
 You and your partner are caring for a 55
year old patient who is in respiratory arrest.
You have called for assistance and are told
it will be 10 minutes before assistance
arrives. The patient is intubated and is
stable as long as you ventilate regularly.
You are preparing for transport when
suddenely your partner collapses and is
pulseless.
 QUESTION 4
 What would you do?

 Is this ethical and legal?

 QUESTION 5
 Your are caring for a patient with an isolated
extremity fracture and BioTel refuses to
permit you to give the patient pain
medication.
 What would you do?
 Is this ethical and legal and moral?
 QUESTION 5
 What would you do?

 Is this ethical and legal and moral?

 QUESTION 6
 You are transporting a patient and her physician to
the hospital. The Patient was at an out patient
surgery center where she just underwent a
procedure. On the way to the hospital you notice
that the patient’s breathing is shallow and slow.
You verbalize the need to ventilate and you
quickly begin to gather the appropriate equipment.
The physician strongly disagrees with you.
 QUESTION 6
 What would you do?

 Is this ethical and legal?

 QUESTION 7
 You are transporting a patient and her physician to
the hospital. The Patient was at an out patient
surgery center where she just underwent a
procedure. On the way to the hospital you notice
that the patient’s breathing is shallow and slow.
You verbalize the need to ventilate and you
quickly begin to gather the appropriate equipment.
The physician strongly disagrees with you.
 Question 7
 What would you do?

 Is this ethical and legal?

 QUESTION 8
 Your cousin’s daughter is pregnant. She is
vomiting and is obviously dehydrated. Your
cousin does not have any health insurance
and asks you to get some supplies from
work in order to start an IV and give her
something for her vomiting.
 QUESTION 8
 What would you do?

 Is this ethical and legal?

QUESTIONS