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Ethics in Advanced Prehospital Care

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

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Ethics in Advanced Prehospital Care

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  1. Ethics in Advanced Prehospital Care

  2. Topics to Discuss • What are Ethics? • Where do Ethics Come From? • Principles for Resolving Ethical Conflicts • Specific Ethical Issues Facing Paramedics Today

  3. 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]

  4. 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

  5. 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?

  6. Principles for Resolving Ethical Conflicts • 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 patient • Primum non nocere • Autonomy: Patient’s right of self determination • Justice: Treat all patients fairly

  7. 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

  8. 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?

  9. 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

  10. Specific Ethical Issues Facing Paramedics Today • Confidentiality • State Laws • Greatest Good

  11. Specific Ethical Issues Facing Paramedics Today • Consent • Competent Patient Refusal • Patient or Legal Healthcare Decision-Maker Refusal of Specific Therapies

  12. Specific Ethical Issues Facing Paramedics Today • Allocation of Resources • True Parity • Need • Earned • Special

  13. 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

  14. 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?

  15. 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”

  16. 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

  17. 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

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