This document discusses ethics in emergency medical services. It defines ethics as encompassing right conduct and good life, based on societal beliefs rather than personal views. Paramedics face ethical issues regarding patient autonomy, providing care, and their professional and legal responsibilities. When ethical dilemmas occur, paramedics must determine the patient's best interests and rights based on standards of care, laws, and their role as physician extenders.

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Ethics in EMSEthics in EMS

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Ethics in EMSEthics in EMS

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EthicsEthics
Branch ofBranch of
philosophyphilosophy
 EncompassingEncompassing
right conduct andright conduct and
good lifegood life
 Broader thanBroader than
analyzing right andanalyzing right and
wrongwrong
 More importantMore important
than moral conductthan moral conduct

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In some ways:
 Based on religious
Principles “Do unto
others as you would
have others do unto
you”
 Based on spiritual
beliefs

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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

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Professional Values And Ethics
As EMRs and Paramedics, we value:
 Leadership - Service - Honor -
Integrity - Courage –Advocacy -
Responsibility to the Patient -
Accountability

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

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DiscussionDiscussion
 What legal/ethical issues does thisWhat legal/ethical issues does this
situation present?situation present?
 Would the nature of the call influenceWould the nature of the call influence
your thoughts?your thoughts?
 Are there any strategies that you canAre there any strategies that you can
use to help you determine the bestuse to help you determine the best
approach to take in this situation?approach to take in this situation?

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TerminologyTerminology
 EthicsEthics
– Standard for honorable behaviorStandard for honorable behavior
 MoralsMorals
– Social standards/customsSocial standards/customs
 UnethicalUnethical
– Fails to conform to moral principles,Fails to conform to moral principles,
values, standardsvalues, standards

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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.

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Personal AccountabilityPersonal Accountability
 ProfessionalProfessional
– StandardsStandards
 LegalLegal
– 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

12. Figure 5-1
EMS ProblemsEMS Problems——Rapid ApproachRapid Approach

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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

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Global ConceptsGlobal Concepts
 Provide patient benefitProvide patient benefit
 Avoid harmAvoid harm
 Recognize patient’s autonomyRecognize patient’s autonomy

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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

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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 careObligation 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 atDoes 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?

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Allocation of ResourcesAllocation of Resources
 Access to health insuranceAccess to health insurance
May define which medical servicesMay define which medical services
are covered or excludedare covered or excluded
 Treatment decisions made whenTreatment decisions made when
resources are inadequate to meetresources are inadequate to meet
needsneeds
 When rationing of care is required,When rationing of care is required,
it should be based on ethicallyit should be based on ethically
oriented criteriaoriented criteria

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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?

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ConfidentialityConfidentiality
 A fundamental right to privacyA fundamental right to privacy
 Conflict may arise between ethicsConflict may arise between ethics
and confidentiality if public health atand confidentiality if public health at
stakestake

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ConsentConsent
 Patient right to make decisionsPatient right to make decisions
regarding health careregarding health care
 Patient refusal of lifesaving care canPatient refusal of lifesaving care can
produce legal and ethical conflictsproduce legal and ethical conflicts

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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

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Care in Futile SituationsCare in Futile Situations
 An action is consideredAn action is considered futilefutile if it servesif it serves
no purpose or is completely ineffectiveno purpose or is completely ineffective
 When emergency care is being provided inWhen emergency care is being provided in
situations that may be futile, consult withsituations that may be futile, consult with
medical directionmedical direction
 It is generally agreed that CPR is futile forIt 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

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Obligation to Provide CareObligation to Provide Care
 Paramedic’s obligation is seldom anParamedic’s obligation is seldom an
issueissue

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Patient Advocacy andPatient Advocacy and
Paramedic 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 aboutPromote 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

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Role as Physician ExtenderRole as Physician Extender
 The paramedic must generally followThe paramedic must generally follow
the orders of the medical director orthe orders of the medical director or
the director’s designeethe director’s designee

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ConclusionConclusion
As a professional, the paramedicAs a professional, the paramedic
must conform to a standardmust conform to a standard
established by his or her level ofestablished by his or her level of
training and regional practice.training and regional practice.
Paramedics must abide by the lawParamedics must abide by the law
when ethical conflicts occurwhen ethical conflicts occur..

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Questions?Questions?