Presentation Title

Presentation Subtitle

Lecture outlines

1. Ethics

2. Morals

3. Law

4. Advanced Directives

Introduction

1. Almost 15% of ALS calls in an urban system generated

ethical conflicts.

2. EMS providers reported ethical problems regarding

patient refusal of care , hospital destination and

advance directives.

Ethics versus morals

Ethics and morals are closely related concepts but

distinctly separate.

Morals: are the social, religious, or

personal standards of right and wrong

Ethics: are the rules or standards that govern the

conduct of members of a particular group or profession.

Medical ethics or bioethics

Medical ethics are also known as Bioethics.

Medical ethics : are ethics related to the practice and

delivery of health care.

Your understanding of medical ethics Must Be

consistent with the general codes of the health care

professional.

Ethical codes of the EMS profession

• Many Ethical Codes for health care professionals have

existed throughout history.

1. Oath of Geneva .

2. The Code of Ethics for Emergency Medical

Technicians.

3. ICARE program.

The oath of Geneva

Drafted by the World Medical Association in

1948.

Taken by medical students upon completion of

their studies, when they are about to enter the

medical profession.

The Code of Ethics for Emergency Medical

Technicians

Issued by the National Association of Emergency

Medical Technicians in 1978

Still in use .

Under this code the paramedic is obligated to the

following:

1. Conserve life, alleviate suffering, and promote health.

2. Provide services based on human need, with respect for

human dignity, unrestricted by considerations of

nationality, race, creed, or status.

3. Not use professional knowledge and skill detrimental

to the public good.

4. Respect and hold in confidence all information obtained in the

course of professional work unless required by law.

5. Understand and uphold the laws of citizenship, particularly when

working with other citizens and health professionals in

promoting efforts to meet the health needs of the public.

6. Maintain professional competence, and demonstrate concern for

the competence of other members of the medical profession.

7. Assume responsibility: in defining and upholding

standards of professional practice and education and

for knowing and upholding laws that affect the practice

of emergency medicine.

8. Have the responsibility to participate in the study of

and action on matters of legislation affecting the

profession and emergency service to the public.

9. Adhere to standards of personal ethics that reflect

credit upon the profession.

10. May contribute to research in relation to a commercial

product or service, but does not lend to professional

status to advertising, promotion, or sales.

11. Advertise professional services within the conformity

and dignity of the profession.

12. Does Not delegate a service to a person less qualified.

13. Work harmoniously with, and sustain confidence in, all

members of the health team.

14. Refuse to participate in unethical procedures, and

assume responsibility to expose incompetence or

unethical conduct in others to the appropriate authority.

The ICARE program

Developed by a group of EMS students and educators

Incorporates many of the finest qualities of EMS

professionals

ICARE: integrity, compassion, accountability, respect,

and empathy

Incorporate “ICARE” into the care you provide to you

patients.

Solving ethical dilemmas

Regardless of the ethical circumstances you may encounter, apply

three basic ethical concepts when making a decision:

1. First to do no harm .

2. To act in good faith and act in the patient’s best interest

3. Paramedics must be accountable for their actions at all times.

Ethical Problems

• Ethical violations occur when practitioners neglect or fail to meet

their moral obligations to their patients

• Ethical dilemmas arise when ethical reasons both for and against a

particular course of action are present and one option must be

selected.

• Ethical distress occurs when practitioners experience the

imposition of practice that provokes feelings of guilt, concern or

distaste

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?

Fundamental principles

1. Beneficence : The principle of doing good for the patient.

2. Nonmaleficence : The obligation not to harm the patient.

3. Autonomy : A competent adult patient’s right to determine what

happens to his or her own body.

4. Justice : Refers to the obligation to treat all patients fairly.

Copyright 2006 © Pearson Education Canada 1:6-19

An approachto ethical decision-making.

Ethical tests

1. Impartiality test : Asks whether you would be willing to

undergo this procedure or action if you were in the patient’s

place.

2. Universalizability test :Asks whether you would want this

action performed in all relevantly similar circumstances.

3. Interpersonal justifiability test :Asks whether you can defend

or justify your actions to others.

Is this type of ethical problem for which you have formed a rule or its similar that the rule could be

applied .

No , try to find an opinion that will buy you time to deliberate without putting

excessive risk to patient

No , apply the ethical tests

Yes , take the opinion

Yes , follow the rule .

Ethical Issues in Contemporary Practice

1. Resuscitation Attempts

2. Confidentiality

3. Consent

4. Allocation of Resources

5. Obligation to Provide Care

6. Teaching

7. Professional Relations

8. Research

Resuscitation Attempts

Do not resuscitate (DNR) orders come in various forms , all

must fulfill these criteria :

1. Reflect the patients wishes as to whether resuscitation

should be attempted and what it includes.

2. Must be seen and verified and signed by patient physcian.

3. Applied only to resuscitation scenarios, not living patients .

Confidentiality

• It is an obligation to every patient is to maintain the

information you obtained as a result

of your participation in the medical situation

confidential .

• No information should be released except with written

consent.

• Exception to written release:

1. Subpoena.

2. Other healthcare personnel treating patient.

3. Mandatory reporting (rape, abuse).

4. Insurance.

Consent

• Patients of legal age have the right to decide

what health care 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…

1. All patients could receive the same amount of attention.

2. Patients could receive resources based on need.

3. 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…

1. Has a responsibility to help others.

2. Is obligated to provide care without regard to the

ability to pay or other criteria.

3. 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:

1. Whether or not patients should be informed that a student is

working on them;

2. How many attempts a student should be allowed to have in

performing an intervention

Teaching

1. Clearly identify students as such.

2. The preceptor should, when appropriate, inform the patient of

the student’s presence and obtain the

patient’s consent.

3. 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:

1. The patient

2. The public

3. The physician medical director

4. His employer.

• Decisions should be:

1. In the patient’s best interests

2. Defendable

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.