presentation title presentation subtitle. lecture outlines 1. ethics 2. morals 3. law 4. advanced...
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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.
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.
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