Bledsoe v1 ch08_lecture

Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Care: Principles & Practice
Volume 1, 5e
Chapter 8
Ethics in Paramedicine

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Preparatory (Medical-Legal and Ethics)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Competency
• Integrates comprehensive knowledge of EMS
systems, the safety and well-being of the
paramedic, and medical–legal and ethical issues,
which is intended to improve the health of EMS
personnel, patients, and the community.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Introduction
• Although ethical problems often have legal aspect,
most are solved in field and not in a courtroom.
• Ethical issues often begin with specific
circumstances; lead to broad general rules or
principles for behavior.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Morals: social, religious, or personal standards of
right and wrong.
• Ethics (moral philosophy): branch of philosophy;
addresses questions about morality.
– Rules or standards that govern conduct of members of
particular group or profession; how institutions should
function

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Relationship of Ethics to Law and Religion
– Ethics not the same as law.
– Laws much narrower focus than ethics.
– Law frequently has little or nothing to say about ethical
problems.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Relationship of Ethics to Law and Religion
– Law: impartiality, consistent procedures, methods to
identify and balance conflicting interests.
– Ethics cannot derive from single religion.
– Religion can enhance and enrich one's ethical
principles and values.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 8-1 The relationship of ethical and legal issues and medicine.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Making Ethical Decisions
– Ethical relativism: each person must decide how to
behave and whatever decision that person makes is
okay.
– Ethics and morality overlap.
– Professional ethics go beyond what one individual
thinks is right or wrong.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
– Reason and logic used; emotion excluded as much as
possible from decision-making process.
– Deontological method: people should just fulfill their
duties.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
– Consequentialism: actions can be judged as good or
bad only after we know consequences of those actions.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Codes of Ethics
– Honesty
– Objectivity
– Integrity
– Carefulness
– Openness
– Legality
– Confidentiality
– Responsible publication

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Codes of Ethics
– Responsible mentoring
– Respect for colleagues
– Social responsibility
– Nondiscrimination
– Competence
– Respect for intellectual property
– Human subjects protection

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Impact of Ethics on Individual Practice
– Paramedics exemplify principles and values of
profession.
– Understand and agree to abide by responsibilities
(implicit and explicit) of profession.
– Common sense helps in resolving conflicts.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• The Fundamental Questions
– What is in patient's best interest?
 Reassurance, relief from pain, prompt and safe transport
 Written statement of patient's desires
 Paramedic obligated to respect patient's desires

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• The Fundamental Questions
– Be cautious in accepting family's description of what
patient desires.
– State and local laws

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Fundamental Principles
– Beneficence: doing good.
 Paramedic's obligation to patient
– Maleficence: doing harm
– Nonmaleficence: not doing harm.
 Paramedic obligated to minimize risk as much as possible.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Fundamental Principles
– Autonomy: competent adult patient's right to determine
what happens to his own body.
 Treatment for medical illnesses and injuries
– Justice: paramedic's obligation to treat all patients
fairly.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
• Resolving Ethical Conflicts
– Institutional review boards (IRBs): protect rights of
subjects in research projects.
– To reason out ethical problem:
 State action in universal form.
 List implications or consequences of action.
 Compare them to relevant values.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
– Is current problem similar to other problems for which
you have already formulated rule?
– If yes, follow rule.
– If no, determine if you can buy time.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Overview of Ethics
– Impartiality test: would you be willing to undergo
procedure or action if in patient's place?
– Universalizability test: would you want action
performed in all similar circumstances?
– Interpersonal justifiability test: can you defend or justify
your actions to others?

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 8-3 A quick approach to new ethical problems.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Ethical Issues in Contemporary
Paramedic Practice
• Resuscitation Attempts
– Every state that has laws or rules regarding Do Not
Resuscitate (DNR) orders requires you to see order
and verify legitimacy.
– If patient alive, valid DNR order would not prevent you
from assessing patient and administering basic care.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
– Nonmaleficence says do no harm.
– Beneficence and nonmaleficence urge you to help
patient.
– DNR order must meet state and local requirements
regarding wording and witnesses.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
– Description of which interventions to be withheld, under
which circumstances
– Every patient entitled to reasonable measures intended
to make patient more comfortable (comfort care).
– Family and loved ones entitled to emotional support
from EMS providers.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
– When in doubt, resuscitate.
– Once you have verified validity of order and identity of
patient, you are obligated ethically (perhaps legally) to
cease resuscitation efforts.
– Follow your local protocols.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Confidentiality
– Obligation to patient to maintain confidential
information
– Every state has laws requiring reporting of certain
health facts.
 Births, deaths, particular infectious diseases, child neglect and
abuse, elder neglect and abuse

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Confidentiality
– Valid court order justification for breaching
confidentiality
– Clear threat by patient to specific person
– Probability of harm, magnitude of expected harm,
alternative methods of avoiding harm

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Consent
– Competent patient of legal age has fundamental right
to decide what health care he will receive and will not
receive.
– Doctrine of implied consent: patient unable to give
consent.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Allocation of Resources
– Civilian triage: most seriously injured receive most care
based on need.
– Military triage: help least seriously injured; produces
greatest number of soldiers who can return to duty.
– Resolving issue of allocation of scarce resources:
examine competing theories in light of circumstances
at hand.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Obligation to Provide Care
– Those who provide emergency care have special
obligation to help all those in need without regard to
ability to pay.
– Act in patient's best interest, even when against HMO's
economic interests.
– Good Samaritan statutes in every state in U.S.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Teaching
– Many paramedics act as preceptors or mentors in EMS
systems.
– Inform patients of presence of student.
– Request patient's consent before student performs
procedure.
– Student's skill level; difficulty of procedure; importance
of procedure

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Professional Relations
– As health care professional, paramedic answers to
patient.
– As physician extender, paramedic answers to physician
medical director.
– As employee (or volunteer), paramedic answers to
EMS system.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
– Physician orders something paramedic believes
contraindicated.
medically acceptable but not in patient's best interests.
medically acceptable, but morally wrong.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
– Ultimately, paramedic must determine how patient's
interests best served.
– Important for paramedic to understand that no matter
what decision he makes, he will have to defend it.
– Disagreements with physician orders happen rarely.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Practice
• Research
– Paramedics implement research protocols and gather
data.
– Goal of research: to help future patients by gaining
knowledge about specific intervention.
– Gain patient's expressed consent

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• As paramedic, you must learn to make ethical
decisions that will have an effect on you, your
patient, or others.
• Decision-making process should always be based
on patient's best interest.
• Patient's best interest includes more than
lifesaving procedures.
• Cultural sensitivity included in decision.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Patient has autonomy; right to determine what
happens to his own body, and can legally dictate
that.
• Clear distinction between ethics, religion, law even
though common ground between them.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Summary
• Your actions should be:
– Legal and within your scope of practice (justice)
– Helpful (beneficence)
– Not harmful (nonmaleficence)
– Direct wishes of patient (autonomy)

Bledsoe v1 ch08_lecture

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