ethics in ems

Barry Kidd 2010Barry Kidd 2010 11

Ethics in EMSEthics in EMS


Ethics in EMSEthics in EMS


EthicsEthics

Branch of Branch of philosophyphilosophy

Encompassing Encompassing right conduct and right conduct and good lifegood life

Broader than Broader than analyzing right and analyzing right and wrongwrong

More important More important than moral conductthan moral conduct


In some ways: Based on religiousPrinciples “Do unto others as you wouldhave others do unto you” Based on spiritual beliefs


Who Defines Ethics

Not you Not based on

personal beliefs Based on societal

beliefs Industry /

Profession

Code Ethics Coordinator /

instructor rule Supervisor /

Employer Courts Varies (some) by

ethnicity / culture


Professional Values And Ethics

As EMRs and Paramedics, we value: Leadership - Service - Honor -

Integrity - Courage –Advocacy - Responsibility to the Patient - Accountability


ScenarioScenario

You are at your station, 2 weeks into You are at your station, 2 weeks into your first paramedic job, when you your first paramedic job, when you notice a paramedic from another notice a paramedic from another crew looking through the patient crew looking through the patient reports. He says he just wants to reports. He says he just wants to check out a call that your crew ran check out a call that your crew ran on his neighbor. on his neighbor.


DiscussionDiscussion What legal/ethical issues does this What legal/ethical issues does this

situation present?situation present?

Would the nature of the call influence Would the nature of the call influence your thoughts?your thoughts?

Are there any strategies that you can Are there any strategies that you can use to help you determine the best use to help you determine the best approach to take in this situation?approach to take in this situation?


TerminologyTerminology EthicsEthics

– Standard for honorable behaviorStandard for honorable behavior

MoralsMorals– Social standards/customsSocial standards/customs

UnethicalUnethical– Fails to conform to moral principles, values, Fails to conform to moral principles, values,

standardsstandards


Codes of EthicsCodes of Ethics

ProfessionalProfessional– EMR/Paramedic Code of EthicsEMR/Paramedic Code of Ethics– PAC Principles of Medical EthicsPAC Principles of Medical Ethics

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.


Personal AccountabilityPersonal Accountability

ProfessionalProfessional– StandardsStandards

Legal Legal – Often overlaps with ethicalOften overlaps with ethical

MoralMoral– Emotion not reliableEmotion not reliable– Rational decision making usefulRational decision making useful– Can’t base decisions only on others’ Can’t base decisions only on others’

opinionsopinions– Ethical “rules” can guide behaviorEthical “rules” can guide behavior

Figure 5-1Figure 5-1

EMS ProblemsEMS Problems——Rapid Approach Rapid Approach


Ethical Tests in Health CareEthical Tests in Health Care

What is in the patient’s best interest?What is in the patient’s best interest?

What does the patient want?What does the patient want?

Balance bothBalance both


Global ConceptsGlobal Concepts

Provide patient benefitProvide patient benefit

Avoid harmAvoid harm

Recognize patient’s autonomyRecognize patient’s autonomy


Resolving Ethical DilemmasResolving Ethical Dilemmas

Health care communityHealth care community– Establish standards of careEstablish standards of care– Research/treatment protocolsResearch/treatment protocols– Review decisions/educateReview decisions/educate

PublicPublic– Passing lawsPassing laws– Public policyPublic policy– Self-determination documentsSelf-determination documents


Contemporary Ethical IssuesContemporary Ethical Issues Paramedics will face ethical issuesParamedics will face ethical issues These often relate toThese often relate to

– Right to self-determination (autonomy) Right to self-determination (autonomy) – Obligation to provide patient care Obligation to provide patient care

(beneficence)(beneficence) Paramedic must answer:Paramedic must answer:

– What is in the patient’s best interest?What is in the patient’s best interest?– What are the patient’s rights?What are the patient’s rights?– Does the patient understand the issues at Does the patient understand the issues at

hand?hand?– What is the paramedic’s professional, legal, What is the paramedic’s professional, legal,

and moral accountability?and moral accountability?


Allocation of ResourcesAllocation of Resources

Access to health insuranceAccess to health insuranceMay define which medical services May define which medical services

are covered or excludedare covered or excluded Treatment decisions made when Treatment decisions made when

resources are inadequate to meet resources are inadequate to meet needsneeds

When rationing of care is required, When rationing of care is required, it should be based on ethically it should be based on ethically oriented criteriaoriented criteria


Decisions Surrounding ResuscitationDecisions Surrounding Resuscitation

Available documentationAvailable documentation– Advance directivesAdvance directives– Living willsLiving wills– Other self-determination documentsOther self-determination documents

What does patient want?What does patient want?

What does family want?What does family want?


ConfidentialityConfidentiality

A fundamental right to privacyA fundamental right to privacy

Conflict may arise between ethics Conflict may arise between ethics and confidentiality if public health at and confidentiality if public health at stakestake


ConsentConsent

Patient right to make decisions Patient right to make decisions regarding health care regarding health care

Patient refusal of lifesaving care can Patient refusal of lifesaving care can produce legal and ethical conflictsproduce legal and ethical conflicts


Other Ethical PrinciplesOther Ethical Principles

Care in futile situationsCare in futile situations

Obligation to provide careObligation to provide care

Advocacy and accountabilityAdvocacy and accountability

Role as physician extenderRole as physician extender


Care in Futile SituationsCare in Futile Situations An action is considered An action is considered futilefutile if it serves if it serves

no purpose or is completely ineffectiveno purpose or is completely ineffective When emergency care is being provided When emergency care is being provided

in situations that may be futile, consult in situations that may be futile, consult with medical directionwith medical direction

It is generally agreed that CPR is futile for It is generally agreed that CPR is futile for patients with obvious signs of death:patients with obvious signs of death:– DecapitationDecapitation– Rigor mortisRigor mortis– Tissue decompositionTissue decomposition– Extreme dependent lividityExtreme dependent lividity


Obligation to Provide CareObligation to Provide Care

Paramedic’s obligation is seldom an Paramedic’s obligation is seldom an issueissue


Patient Advocacy andPatient Advocacy andParamedic AccountabilityParamedic Accountability

Educate patients to effect system changeEducate patients to effect system change

Base decisions on medical, not financial, Base decisions on medical, not financial, considerationsconsiderations

Inform patients of health care reform initiativesInform patients of health care reform initiatives

Promote patient access to information about Promote patient access to information about state-of-the-art technologies and treatmentstate-of-the-art technologies and treatment

Promote fairness and equality in health carePromote fairness and equality in health care


Role as Physician ExtenderRole as Physician Extender

The paramedic must generally follow The paramedic must generally follow the orders of the medical director or the orders of the medical director or the director’s designeethe director’s designee


ConclusionConclusion

As a professional, the paramedic As a professional, the paramedic must conform to a standard must conform to a standard

established by his or her level of established by his or her level of training and regional practice. training and regional practice.

Paramedics must abide by the law Paramedics must abide by the law

when ethical conflicts occurwhen ethical conflicts occur..


Questions?Questions?

ethics in ems

Healthcare

provide careobligation

base decisions

moral principles

generally

obvious signs

art technologies

physician

regional practice