1. Presentation Title Presentation Subtitle

2. Lecture outlines 1. Ethics 2. Morals 3. Law 4. Advanced Directives

3. Introduction 1.Almost 15% of ALS calls in an urban system generated ethical conflicts. 2.EMS providers reported ethical problems regarding patient refusal of care, hospital destination and advance directives.

4. Ethics versus morals  Ethics and morals are closely related concepts but distinctly separate.  Morals: are the social, religious, or personal standards of right and wrong  Ethics: are the rules or standards that govern the conduct of members of a particular group or profession.

5. Medical ethics or bioethics  Medical ethics are also known as Bioethics.  Medical ethics : are ethics related to the practice and delivery of health care.  Your understanding of medical ethics Must Be consistent with the general codes of the health care professional.

6. Ethical codes of the EMS profession Many Ethical Codes for health care professionals have existed throughout history. 1.Oath of Geneva. 2.The Code of Ethics for Emergency Medical Technicians. 3.ICARE program.

7. The oath of Geneva  Drafted by the World Medical Association in 1948.  Taken by medical students upon completion of their studies, when they are about to enter the medical profession.

8. The Code of Ethics for Emergency Medical Technicians  Issued by the National Association of Emergency Medical Technicians in 1978  Still in use.  Under this code the paramedic is obligated to the following:

9. 1.Conserve life, alleviate suffering, and promote health. 2.Provide services based on human need, with respect for human dignity, unrestricted by considerations of nationality, race, creed, or status. 3.Not use professional knowledge and skill detrimental to the public good.

10. 4.Respect and hold in confidence all information obtained in the course of professional work unless required by law. 5.Understand and uphold the laws of citizenship, particularly when working with other citizens and health professionals in promoting efforts to meet the health needs of the public. 6.Maintain professional competence, and demonstrate concern for the competence of other members of the medical profession. 4.Respect and hold in confidence all information obtained in the course of professional work unless required by law. 5.Understand and uphold the laws of citizenship, particularly when working with other citizens and health professionals in promoting efforts to meet the health needs of the public. 6.Maintain professional competence, and demonstrate concern for the competence of other members of the medical profession.

11. 7.Assume responsibility: in defining and upholding standards of professional practice and education and for knowing and upholding laws that affect the practice of emergency medicine. 8.Have the responsibility to participate in the study of and action on matters of legislation affecting the profession and emergency service to the public. 7.Assume responsibility: in defining and upholding standards of professional practice and education and for knowing and upholding laws that affect the practice of emergency medicine. 8.Have the responsibility to participate in the study of and action on matters of legislation affecting the profession and emergency service to the public.

12. 9.Adhere to standards of personal ethics that reflect credit upon the profession. 10.May contribute to research in relation to a commercial product or service, but does not lend to professional status to advertising, promotion, or sales. 11.Advertise professional services within the conformity and dignity of the profession. 9.Adhere to standards of personal ethics that reflect credit upon the profession. 10.May contribute to research in relation to a commercial product or service, but does not lend to professional status to advertising, promotion, or sales. 11.Advertise professional services within the conformity and dignity of the profession.

13. 12.Does Not delegate a service to a person less qualified. 13.Work harmoniously with, and sustain confidence in, all members of the health team. 14.Refuse to participate in unethical procedures, and assume responsibility to expose incompetence or unethical conduct in others to the appropriate authority. 12.Does Not delegate a service to a person less qualified. 13.Work harmoniously with, and sustain confidence in, all members of the health team. 14.Refuse to participate in unethical procedures, and assume responsibility to expose incompetence or unethical conduct in others to the appropriate authority.

14. The ICARE program  Developed by a group of EMS students and educators  Incorporates many of the finest qualities of EMS professionals  ICARE: integrity, compassion, accountability, respect, and empathy  Incorporate “ICARE” into the care you provide to you patients.  Developed by a group of EMS students and educators  Incorporates many of the finest qualities of EMS professionals  ICARE: integrity, compassion, accountability, respect, and empathy  Incorporate “ICARE” into the care you provide to you patients.

15. Solving ethical dilemmas  Regardless of the ethical circumstances you may encounter, apply three basic ethical concepts when making a decision: 1.First to do no harm. 2.To act in good faith and act in the patient’s best interest 3.Paramedics must be accountable for their actions at all times.

16. Ethical Problems Ethical violations occur when practitioners neglect or fail to meet their moral obligations to their patients Ethical dilemmas arise when ethical reasons both for and against a particular course of action are present and one option must be selected. Ethical distress occurs when practitioners experience the imposition of practice that provokes feelings of guilt, concern or distaste Ethical violations occur when practitioners neglect or fail to meet their moral obligations to their patients Ethical dilemmas arise when ethical reasons both for and against a particular course of action are present and one option must be selected. Ethical distress occurs when practitioners experience the imposition of practice that provokes feelings of guilt, concern or distaste

17. The single most important question a paramedic has to answer when faced with an ethical challenge is: WHAT IS IN THE PATIENT’S BEST INTEREST?

18. Fundamental principles 1.Beneficence : The principle of doing good for the patient. 2.Nonmaleficence : The obligation not to harm the patient. 3.Autonomy : A competent adult patient’s right to determine what happens to his or her own body. 4.Justice : Refers to the obligation to treat all patients fairly.

19. Copyright 2006 © Pearson Education Canada 1:6-19 An approach to ethical decision- making.

20. Ethical tests 1.Impartiality test : Asks whether you would be willing to undergo this procedure or action if you were in the patient’s place. 2.Universalizability test :Asks whether you would want this action performed in all relevantly similar circumstances. 3. Interpersonal justifiability test :Asks whether you can defend or justify your actions to others. 1.Impartiality test : Asks whether you would be willing to undergo this procedure or action if you were in the patient’s place. 2.Universalizability test :Asks whether you would want this action performed in all relevantly similar circumstances. 3. Interpersonal justifiability test :Asks whether you can defend or justify your actions to others.

22. Is this type of ethical problem for which you have formed a rule or its similar that the rule could be applied. No, try to find an opinion that will buy you time to deliberate without putting excessive risk to patient No, apply the ethical testsYes, take the opinion Yes, follow the rule.

23. Ethical Issues in Contemporary Practice 1.Resuscitation Attempts 2.Confidentiality 3.Consent 4.Allocation of Resources 5.Obligation to Provide Care 6.Teaching 7.Professional Relations 8.Research

24. Resuscitation Attempts Do not resuscitate (DNR) orders come in various forms, all must fulfill these criteria : 1.Reflect the patients wishes as to whether resuscitation should be attempted and what it includes. 2.Must be seen and verified and signed by patient physcian. 3.Applied only to resuscitation scenarios, not living patients. Do not resuscitate (DNR) orders come in various forms, all must fulfill these criteria : 1.Reflect the patients wishes as to whether resuscitation should be attempted and what it includes. 2.Must be seen and verified and signed by patient physcian. 3.Applied only to resuscitation scenarios, not living patients.

25. Confidentiality It is an obligation to every patient is to maintain the information you obtained as a result of your participation in the medical situation confidential. No information should be released except with written consent.

26. Exception to written release: 1.Subpoena. 2.Other healthcare personnel treating patient. 3.Mandatory reporting (rape, abuse). 4.Insurance.

27. Consent Patients of legal age have the right to decide what health care they will receive. Implied consent may apply in cases where the patient is incapacitated or unable to communicate.

28. Consent Patients are generally able to consent or refuse care if they are alert and oriented, aware of their surroundings, and making sound judgments. When leaving the patient, he or she must understand the issues at hand and be able to make an informed decision..

29. Allocation of Resources Several approaches to consider… 1.All patients could receive the same amount of attention. 2.Patients could receive resources based on need. 3.Patients could receive what someone has determined they’ve earned. Triage is a common field activity that demonstrates one method of allocating scarce resources.

30. Obligation to Provide Care A paramedic… 1.Has a responsibility to help others. 2.Is obligated to provide care without regard to the ability to pay or other criteria. 3.Has a strong ethical obligation to help others even while off-duty.

31. Teaching Two possible ethical questions are raised when a student is caring for patients: 1.Whether or not patients should be informed that a student is working on them; 2.How many attempts a student should be allowed to have in performing an intervention

32. Teaching 1.Clearly identify students as such. 2.The preceptor should, when appropriate, inform the patient of the student’s presence and obtain the patient’s consent. 3.Take the student’s experience and skill level into account and have a pre-determined limit identified for the number of attempts at a procedure.

33. Professional Relations A paramedic answers to: 1.The patient 2.The public 3.The physician medical director 4.His employer. Decisions should be: 1.In the patient’s best interests 2.Defendable

34. Research EMS research is only in its infancy but is essential to the advancement of EMS. Strict rules and guidelines must be followed when conducting patient care-related studies. Gaining the patient’s consent is paramount.