Paramedic Care: Principles & Practice Ethics in EMS PDF

Paramedic Care: Principles & Practice Sixth Edition Chapter 8 Ethics in EMS Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (Me...

Paramedic Care: Principles & Practice Sixth Edition Chapter 8 Ethics in EMS Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Standard Preparatory (Medical-Legal and Ethics) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved 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. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (1 of 13) 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (2 of 13) Relationship of Ethics to Law and Religion – Ethics not the same as law ▪ Laws much narrower focus than ethics, and are often more objective in nature ▪ Law frequently has little or nothing to say about ethical problems Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (3 of 13) Relationship of Ethics to Law and Religion – Ethics not the same as law (cont ) inued ▪ Law: – Impartiality, consistent procedures, methods to identify and balance conflicting interests ▪ Ethics cannot be derived from single religion – While a law can be written quickly, ethics develop over great periods of time ▪ Religion can enhance and enrich one's ethical principles and values Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 8-1 The relationship of ethical and legal issues to medicine. Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (4 of 13) Making Ethical Decisions – Ethical relativism: ▪ Each person must decide how to behave and whatever decision that person makes is okay – Deontological method: ▪ People should just fulfill their duties – Consequentialism: ▪ Actions can be judged as good or bad only after we know consequences of those actions – Utilitarianism is a subtype—doing the most good for the greatest number of people Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (5 of 13) Codes of Ethics – Many organizations have drafted a code of ethics – They typically address the following areas ▪ Honesty ▪ Objectivity ▪ Integrity ▪ Carefulness ▪ Openness ▪ Legality ▪ Confidentiality ▪ Responsible publication Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (6 of 13) Codes of Ethics – Many organizations have drafted a code of ethics – They typically address the following areas (cont ) inued ▪ Responsible mentoring ▪ Respect for colleagues ▪ Social responsibility ▪ Nondiscrimination ▪ Competence ▪ Respect for intellectual property ▪ Human subjects protection Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (7 of 13) 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (8 of 13) 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 ▪ Be cautious in accepting family's description of what patient desires ▪ Be familiar with pertinent state and local laws Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (9 of 13) Fundamental Principles – Autonomy: ▪ Competent adult patient's right to determine what happens to their own body – That is, treatment for medical illnesses and injuries – Beneficence: ▪ Doing good – This is the paramedic's obligation to patient Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (10 of 13) Fundamental Principles (cont ) inued – Maleficence: ▪ Doing harm, opposite of beneficence – Nonmaleficence: ▪ Not doing harm – Paramedic obligated to minimize risk as much as possible – Justice: ▪ Paramedic's obligation to treat all patients fairly Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (11 of 13) Resolving Ethical Conflicts – Institutional review boards (IRBs): protect rights of subjects in research projects – To reason out ethical problem: 1. State action in universal form 2. List implications or consequences of action 3. Compare them to relevant values Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (12 of 13) Resolving Ethical Conflicts – To reason out ethical problem (cont ) inued 4. Is current problem similar to something you have dealt with before? – If yes, follow that rule – If no, determine if you can buy time to consider an alternative solution 5. If the answer to #4 is overall “no” then apply a known ethical decision-making rule Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Figure 8-3 A quick approach to new ethical problems. (© Based on Iserson, K. V., et al. Ethics in Emergency Medicine. 2nd ed. Tucson, AZ: Galen Press, 1995.) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Overview of Ethics (13 of 13) Ethical decision-making rules – 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? Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (1 of 11) 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 ▪ When in doubt, resuscitate ▪ Once you have verified validity of order and identity of patient, you are obligated to cease resuscitation efforts ▪ If concern arises, follow your local protocols Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (2 of 11) 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (3 of 11) Confidentiality – Scene/Ambulance Photography ▪ Generally, photography and videography are legal when they occur in public place ▪ Capturing images in the back of the ambulance is open to debate ▪ Many EMS providers have lost their jobs due to posting inappropriate patient/patient care photos to social media Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (4 of 11) Boundaries – Limits that establish the lines between a medical provider and patient ▪ Boundaries can be crossed both intentionally and unintentionally – A patient or provider can cross boundaries – If a patient crosses a boundary, it is up to the provider to halt the incident Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (5 of 11) Boundaries (cont ) inued – Examples of patients at risk for boundary violations ▪ Female gender ▪ Personality disorders ▪ Has history of childhood or physical abuse ▪ Wants “to keep secrets” – Boundary violations can occur when there is confusion between the needs of the EMS practitioner and the needs of the patient Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (6 of 11) Boundaries (cont ) inued – Boundary maintenance ▪ The paramedic is responsible for maintaining professional boundaries ▪ The paramedic should avoid trigger situations ▪ Professional sexual misconduct is an extremely serious (usually criminal) violation ▪ Watch for “red flag” behaviors Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (7 of 11) Allocation of Resources – Often EMS practitioners don’t think of themselves as guardians of finite 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (8 of 11) 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 the United States Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (9 of 11) Teaching – Many paramedics act as preceptors or mentors in EMS systems – Inform patient of presence of student – Request patient's consent before student performs procedure – Student's skill level; difficulty of procedure; importance of procedure Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (10 of 11) Professional Relations – Even in the most perfect of circumstances, ethical conflicts can occur due to competing interests ▪ As health care professional, paramedic answers to the patient ▪ As physician extender, paramedic answers to the physician medical director ▪ As employee (or volunteer), paramedic answers to the EMS system Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Ethical Issues in Contemporary EMS Practice (11 of 11) 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 Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Summary (1 of 2) 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 has autonomy; right to determine what happens to their own body, and can legally dictate that Maintain professional boundaries Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Summary (2 of 2) At all times, your actions should be: – Legal and within your scope of practice (justice) – Helpful (beneficence) – Not harmful (nonmaleficence) – Resulting from the direct wishes of patient (autonomy) Copyright © 2023, 2017, 2013 Pearson Education, Inc. All Rights Reserved Copyright This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted. The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials. 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