Upload
doug-mackay
View
98
Download
2
Tags:
Embed Size (px)
DESCRIPTION
Power Points for EMS Education
Citation preview
Barry Kidd 2010Barry Kidd 2010 11
Ethics in EMSEthics in EMS
Barry Kidd 2010Barry Kidd 2010 22
Ethics in EMSEthics in EMS
Barry Kidd 2010Barry Kidd 2010 33
EthicsEthics
Branch of Branch of philosophyphilosophy
Encompassing Encompassing right conduct and right conduct and good lifegood life
Broader than Broader than analyzing right and analyzing right and wrongwrong
More important More important than moral conductthan moral conduct
Barry Kidd 2010Barry Kidd 2010 44
In some ways: Based on religiousPrinciples “Do unto others as you wouldhave others do unto you” Based on spiritual beliefs
Barry Kidd 2010Barry Kidd 2010 55
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
Barry Kidd 2010Barry Kidd 2010 66
Professional Values And Ethics
As EMRs and Paramedics, we value: Leadership - Service - Honor -
Integrity - Courage –Advocacy - Responsibility to the Patient - Accountability
Barry Kidd 2010Barry Kidd 2010 77
ScenarioScenario
You are at your station, 2 weeks into You are at your station, 2 weeks into your first paramedic job, when you your first paramedic job, when you notice a paramedic from another notice a paramedic from another crew looking through the patient crew looking through the patient reports. He says he just wants to reports. He says he just wants to check out a call that your crew ran check out a call that your crew ran on his neighbor. on his neighbor.
Barry Kidd 2010Barry Kidd 2010 88
DiscussionDiscussion What legal/ethical issues does this What legal/ethical issues does this
situation present?situation present?
Would the nature of the call influence Would the nature of the call influence your thoughts?your thoughts?
Are there any strategies that you can Are there any strategies that you can use to help you determine the best use to help you determine the best approach to take in this situation?approach to take in this situation?
Barry Kidd 2010Barry Kidd 2010 99
TerminologyTerminology EthicsEthics
– Standard for honorable behaviorStandard for honorable behavior
MoralsMorals– Social standards/customsSocial standards/customs
UnethicalUnethical– Fails to conform to moral principles, values, Fails to conform to moral principles, values,
standardsstandards
Barry Kidd 2010Barry Kidd 2010 1010
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.
Barry Kidd 2010Barry Kidd 2010 1111
Personal AccountabilityPersonal Accountability
ProfessionalProfessional– StandardsStandards
Legal Legal – 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
Figure 5-1Figure 5-1
EMS ProblemsEMS Problems——Rapid Approach Rapid Approach
Barry Kidd 2010Barry Kidd 2010 1313
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
Barry Kidd 2010Barry Kidd 2010 1414
Global ConceptsGlobal Concepts
Provide patient benefitProvide patient benefit
Avoid harmAvoid harm
Recognize patient’s autonomyRecognize patient’s autonomy
Barry Kidd 2010Barry Kidd 2010 1515
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
Barry Kidd 2010Barry Kidd 2010 1616
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 care Obligation 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 at Does 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?
Barry Kidd 2010Barry Kidd 2010 1717
Allocation of ResourcesAllocation of Resources
Access to health insuranceAccess to health insuranceMay define which medical services May define which medical services
are covered or excludedare covered or excluded Treatment decisions made when Treatment decisions made when
resources are inadequate to meet resources are inadequate to meet needsneeds
When rationing of care is required, When rationing of care is required, it should be based on ethically it should be based on ethically oriented criteriaoriented criteria
Barry Kidd 2010Barry Kidd 2010 1818
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?
Barry Kidd 2010Barry Kidd 2010 1919
ConfidentialityConfidentiality
A fundamental right to privacyA fundamental right to privacy
Conflict may arise between ethics Conflict may arise between ethics and confidentiality if public health at and confidentiality if public health at stakestake
Barry Kidd 2010Barry Kidd 2010 2020
ConsentConsent
Patient right to make decisions Patient right to make decisions regarding health care regarding health care
Patient refusal of lifesaving care can Patient refusal of lifesaving care can produce legal and ethical conflictsproduce legal and ethical conflicts
Barry Kidd 2010Barry Kidd 2010 2121
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
Barry Kidd 2010Barry Kidd 2010 2222
Care in Futile SituationsCare in Futile Situations An action is considered An action is considered futilefutile if it serves if it serves
no purpose or is completely ineffectiveno purpose or is completely ineffective When emergency care is being provided When emergency care is being provided
in situations that may be futile, consult in situations that may be futile, consult with medical directionwith medical direction
It is generally agreed that CPR is futile for It 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
Barry Kidd 2010Barry Kidd 2010 2323
Obligation to Provide CareObligation to Provide Care
Paramedic’s obligation is seldom an Paramedic’s obligation is seldom an issueissue
Barry Kidd 2010Barry Kidd 2010 2424
Patient Advocacy andPatient Advocacy andParamedic 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 about Promote 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
Barry Kidd 2010Barry Kidd 2010 2525
Role as Physician ExtenderRole as Physician Extender
The paramedic must generally follow The paramedic must generally follow the orders of the medical director or the orders of the medical director or the director’s designeethe director’s designee
Barry Kidd 2010Barry Kidd 2010 2626
ConclusionConclusion
As a professional, the paramedic As a professional, the paramedic must conform to a standard must conform to a standard
established by his or her level of established by his or her level of training and regional practice. training and regional practice.
Paramedics must abide by the law Paramedics must abide by the law
when ethical conflicts occurwhen ethical conflicts occur..
Barry Kidd 2010Barry Kidd 2010 2727
Questions?Questions?