Emerging Ethical Conflicts and Management

Introduction

Medical care occurs between health care providers and patients. While delivering emergency medical care, a health professional has to deal with challenges like unpredictable patient profiles, emergency conditions, and administration of care in a non-medical area. Emergency medical care is an important aspect of hospital-based care. The urge to act quickly, limited time constraints to consider medical and ethical aspects of a case or situation, and an absence of prior knowledge about the patients make it more complex and demand the healthcare providers to have adequate knowledge of ethical practices, giving positive treatment outcomes.

What Are the Ethical Conflicts Encountered in Delivering Emergency Care and How Are They Managed?

1. Ethical Issues Related to the Process Prior to Medical Interventions:

Justice:

• Justice is a primary ethical principle that expects caregivers to be as fair as possible with their patients. It becomes challenging when there are many emergency calls and not enough resources to address the problems.

• Measures should be taken to provide equal care to each and every individual.

Problems Associated with Finding an Address:

• Finding an address in a limited time period demands an effective technical support infrastructure.

• Hence, it is important to have strong and effective technical support to provide prehospital emergency care, and the delay in the treatment of emergency patients can be prevented.

• Although it may appear as a basic technical issue, it also becomes an important ethical issue related to the basic principle of beneficence or nonmaleficence.

Stigmatization:

• Stigmatization does occur with respect to individuals' diseases, locations, and the social or cultural criticism that accompanies them. Stigmatization occurs socially and culturally in prehospital emergency caregivers (PECs') minds even before the initiation of medical care.

• Examples include administering care to alcoholics, drug addicts, sex workers, and terminal cancer patients.

• Before first contact is made, stigmas in PECs' minds can affect the care to be given in such cases.

Interventions in Dangerous Situations:

• The delivery of medical care becomes more challenging for emergency teams in dangerous prehospital setting conditions like war zones, traffic accidents, and highly targeted explosion areas and raises ethical conflicts.

Safe Driving:

• It is important to follow general traffic rules while driving an emergency service ambulance. Speeding while driving to reach the destination in a short span of time sometimes places the driver’s and the patient’s lives at risk.

• Emphasis should be placed on ensuring the safety of both the (prehospital caregivers) PEC and the patient being driven to the emergency care unit.

2. Ethical Issues Related to the Treatment Process:

Beneficence or Nonmaleficence:

• Serves as a basic principle of ethical medical practice.

• It becomes the responsibility of every PEC to value every individual's psychological and emotional state.

Triage:

• Triage is considered one of the most important ethical issues encountered in the emergency medicine department.

• The main challenge lies in evaluating and selecting the criteria.

• The emphasis is on maximum benefit. However, it is very subjective and becomes difficult to standardize the meaning of maximum benefit.

• The caregiver needs to act wisely and accordingly in such cases.

Refusal of Treatment:

• PECs face ethical issues in a case of treatment refusal by the patients in two aspects: beneficence and respect for patient autonomy.

• The main point lies in assessing the patient's decision-making capacity.

• However, it is difficult to properly assess this capacity in a short period of time.

Refusal of Transport to Hospital:

• PECs face challenges in convincing the patients, especially when they do not want to go to the hospital, and thus it affects their duties.

• The patients feel comfortable with medical interventions at home. However, the emergency crew will not agree with this as the medical care will be compromised.

Dealing With Difficult Patients:

• The term difficult patient refers to those who are intoxicated with alcohol or drugs and those who are terrified, scared, or agitated.

• Effective communication skills are vital to deal with such patients and hence enhance patient outcomes.

Informed Consent:

• Informed consent is one of the most common ethical issues and conflicts encountered by PECs.

• It is a valuable professional practice when the patient can make his/her own healthcare decision. However, in some prehospital settings, the patient is not in a situation to make a decision.

• The competency of the patient is important with regard to informed consent.

Patient Privacy and Confidentiality:

• The prehospital emergency setting involves a patient's home or place of work.

• In such cases, PECs need to pay more attention to protecting the privacy and confidentiality of the patient.

• It is the responsibility of a PEC to maintain privacy with regard to the individual's health information, privacy, physical condition, private life, and lifestyle. This also applies to the rights of a person who has died or who is newly dead.

Telling the Truth:

• PECs are supposed to be honest with their patients.

• It is more important to deliver medical care than to explain the procedure to the patient, even if the PEC is unsure of whether the patient will understand the procedure clearly.

• This being an ethical issue is a legal one as well; thus, PECs should be aware of the rules and regulations of their respective localities.

3. Ethical Issues Related to the End of Life and Care:

1. Terminal Stage Patients:

• Prehospital emergency care is necessary for terminal-stage patients.

• Such scenarios demand effective communication skills, which are as important as medical care.

• PECs need to deal with the expectations of the patients as well as of the relatives concerning medical care delivery wisely.

2. Initiation of Prehospital Cardiopulmonary Resuscitation (CPR):

• Patients' potential for long-term survival is preferred for CPR.

• However, it cannot be determined at an early stage. The medical decision in such situations should be made within seconds.

• If patients benefit from resuscitation, they can regain consciousness and resume their life activities.

3. Withholding or Withdrawal of CPR:

• The obvious clinical signs of death or fatal trauma help in determining whether to withhold CPR or not.

• However, in some ambulance services, there will be no doctors, and assessing the signs of death will be the duty of paramedics, which poses challenges in conducting prehospital CPR.

• Generally, CPR will be terminated after 30 to 45 minutes if it proves to be unsuccessful.

Conclusion:

Prehospital emergency medicine settings offer more challenges to healthcare providers in delivering optimal medical care when compared to a conventional hospital setup. In prehospital emergency medicine, all patients and situations are unique, and the ethical considerations in dealing with such cases become unique as well. There is no quick formula for the right action and emotion in an emergency setup. Therefore, PECs (prehospital emergency caregivers) should have adequate ethical knowledge to provide better treatment outcomes in an emergency setup.