Ethical issues in emergency medical service operations - Research Paper Example

? Ethical Issues in Emergency Medical Service Operations Over years, there has been impressive growth in the field of pre-hospital medicine. With the continued growth in the body of knowledge, the challenges of pre-hospital emergency medical care have become more operational as compared to medical (American Academy of Orthopedic Surgeons, 2011). Appropriate care, efficient response, expeditious transport and safety have become fundamental components in pre-hospital emergency medical care. In these operations, more providers continue to face ethical dilemmas with regard to the principles of justice, beneficence and respect for autonomy which would be focused in this paper. The major issues that arise from the ethical dilemmas involving these principles discussed in this paper include limiting resuscitation, informed consent, confidentiality and duty to provision of care. Introduction The emergency medical services have their operations guided by the law. However, legal guidance could fail to provide the solutions to arising problems as many situations fail to be addressed by the law as observed by Tintinalli, Cameron and Holliman (2010). Furthermore, a great variation could exist in the laws that govern one state to another. As such, the ethical theory gives a universal standard approach to giving solutions. The law could also be ambiguous hence fail to give clear guidance or could be quite specific hence applicable to cases that are substantially similar. Ethics would thus be critical in addressing the ethical imperatives that obligate emergency medical services. With the pre-hospital providers charged with the duty of interacting and negotiating with the patients and counsel those who need to be counseled, potential ethical issues arise. American Academy of Orthopedic Surgeons, AAOS (2011) categorizes these ethical dilemmas into three fundamental premises: the principle of justice requires that the system be equitable and fair; the principle of beneficence dictates that actions and interactions be undertaken with the consideration of the best interest of the patient; and finally respect for autonomy requires the honoring of the wishes and requests of the patient. With formal training not being adequate on its own to prepare the EMS providers to handle ethical dilemmas, experience would provide greater knowledge, guided by well-defined policies. Limiting resuscitation efforts In essence, EMS should be made available to everybody in need, including the terminally ill requiring to be transported to the appropriate hospital for alleviative care. The EMS providers require ways to honor the wish of patients to avoid employment of cardiopulmonary resuscitation, CPR and limit intubation (AAOS, 2011). This has been a complex issue with requests for limited resuscitation confronting providers in various forms. Acceptable directives should guarantee that withheld resuscitation draws support from the informed wishes from informed customers. To help in identification of patients who do not require resuscitation, various mechanisms have been developed by EMS systems. These allow consistent, legal, written and recognizable statements as valid indication of patient’s wishes not to have intubation or CPR in cases of cardiac arrest, with the aim being to maximize patient autonomy and minimize ambiguity. EMS providers should familiarize themselves with these documents and be recognizable to the provider and specific in the interventions that should be withheld. In many cases, verbal requests would be dishonored as they do not have the capacity to clearly represent the patient’s informed decision. But Tintinalli et al. (2010) observe the exception to this when the relative has durable power of attorney giving the mandate to make healthcare decisions. Being a legally recognized patient’s proxy and decision maker, such persons have the powers to request the withholding of resuscitation. This argument thus indicates that resuscitation could be ethically withheld. Nonetheless, for the providers with minimal experience, this could present certain complexities. For cases which present doubts on the legitimacy for withholding resuscitation, then proper maneuvers should be followed. But in clear circumstances where the EMS acknowledges the directives, such should be accepted. Marques-Baptista et al. (2010) observe that for optimal communication, “no CPR/no intubation” order should be exhibited. Acceptable directives written in advance should be standardized and propagated by the EMS. Informed consent Patients, even in emergency situations would express their preferences and make demands on their preferred interventions and hospital destinations. This calls for development of policies and protocols to deal with such issues and providers trained to deal with these circumstances while respecting the autonomy of the patient and the beneficence obligation. The pre-hospital EMS providers operate in accordance to the request and consent of the patient. This would particularly be complicated in cases where the patient did not call for help but has been attended to by providers eager to assist. Pre-hospital EMS providers should respect the will of the customer and await customer’s explicit or implicit consent before they execute any procedures. Operation under implied consent has been cited as being simpler (Tintinalli et al., 2010). Consent in the context of law or the emergency rule presumes the patient’s consent in case of inability of expression due to injury or illness. As such, treatment should proceed in emergent cases where prevention of disability or loss of life rules. Dilemma occurs in cases of patients refusing to consent to care. Acute medical cases could deter the patient’s ability to consent. In such cases, withholding care based on the impulsive refusal would not serve the interests of the patient (Tintinalli et al., 2010). Unreasonable refusal for care could come from mentally ill patients, patients with intracranial injury, metabolic derangements and drug and alcohol intoxication. It however becomes difficult at times to determine whether the refusal by a pre-hospital patient represents an informed decision. In most emergency medical services, the challenge has been to determine the acceptable patient refusals. At a minimum, these patients should demonstrate understanding of their illnesses and recognize the risk involved in refusing care (AAOS, 2011). For patients who do not meet this criteria, further intervention should be undertaken. This means that EMS providers should have the ability to assess the decision making ability of the patients. The greater the potential harm, the greater the patient should have the ability to make decisions. Confidentiality In the EMS operations, there exist various threats to the confidentiality of the patient. Within a short period of time, EMS providers access critical patient information. Inappropriately releasing or indiscriminately discussing such information could cause legal and ethical threats (AAOS, 2011). All the information that the EMS personnel encounter while undertaking their operations should be treated as privileged and confidential. Such information should only be shared with those directly involved in the care of the patient. Even casual communication with persons not involved directly in the care of the patient should be avoided. Tintinalli et al. (2010) bring up an interesting perspective implying that if such a discussion would be for educational purposes and does not identify the patient, then ethical conflict would not be deemed to exist. Thus appropriate education and clear policy would be important in promoting optimum standards in EMS provision. Duty to provide care In as much as EMS providers have the duty to provide care to the patient and protect life, they have no obligation to risk their lives so as to care for such patients. No responsibility requires them to put their own safety and health at risk so as to benefit another (Marques-Baptista et al., 2010). Nonetheless, hazardous circumstances should be anticipated and when they occur, peace officers should be able to give their support. It would also be the duty of EMS personnel to ensure that attainment of appropriate training standards, acceptable and consistent with the community. Similarly, continued education should ensure that quality service has been rendered. Conclusion This paper provides critical insights into the ethical issues facing the operations in EMS setting. Based on the three principles of ethics – respect for autonomy, justice and beneficence – ethical issues involved in resuscitation efforts, informed consent, duty to provide care and confidentiality as discussed indicates the need for adequate training among the EMS providers. Some of these areas have not been covered under law and requires the ethical judgment of the EMS provider in adopting the appropriate course of action. As such, ethical obligations serve to protect the interest of the patient, encouraging action for the good of the patient. References American Academy of Orthopedic Surgeons (2011). Emergency care and transportation of the sick and injured. 10th ed. London, UK: Jones and Bartlett Publishers International. Marques-Baptista, A., Ohman-Strickland, P., Baldino, K. T., Prasto, M. & Merlin, M. A. (2010). Utilization of warning lights and siren based on hospital time-critical interventions. Prehospital and Disaster Medicine, 25 (4), 335 – 339. Tintinalli, J. E., Cameron, P. & Holliman, C. J. (2010). EMS: a practical global guidebook. Shelton, CT: People’s Medical Publishing House. Read More