Back in the Fall of 2023, we discussed ethics in a broad sense and went back to the basics. This week I wanted to continue that conversation and discuss some hypothetical scenarios -- these cases below are all fiction and have been made up solely for the purposes of debate at your local agency -- you know, the talk that happens at the table.
Our profession has a long-standing oath as well as a code of ethics that has been well established and adopted for nearly 50 years now. In every decision we make, we should always consider it solely centered around the benefit of patients. We should also abstain from whatever is deleterious and mischievous. We have the trust of the public and we should never compromise that -- remember they let us enter their homes and personal space, pretty much without question.
Below are (3) distinctly different scenarios that you can think through. You can review these on your own, but it is encouraged to discuss these cases amongst a larger group because your peers may express an opinion that is different than your own. Perspective is everything, and it's a good thing to hear from those who may not think exactly like we do.
Your patient was working on a construction crew putting a new roof on a two-story commercial building and fell fracturing his right femur. All other findings indicate that this is the only injury of concern. Your protocols allow for the use of opiate pain medications, and morphine is the only analgesic you have on board. Your patient is in significant pain and would benefit from this treatment. In gathering the patients' medical history, he tells you he is taking buprenorphrine a medication to assist with heroin addiction. What do you do?
Your patient is a 55-year-old male with a chief complaint of sudden onset chest pain, but no history of cardiac problems. Upon arrival you find your patient sitting in a tripod position with labored breathing. Your crew is made up of (2) EMT's. You have been trained that NTG administered sublingually provides significant benefits to a patient with acute coronary syndrome. You determine that this patient requires rapid transport to the hospital. During transport your patient suddenly loses consciousness and remains in that condition until you transfer care to the ED staff. While returning from the call, your partner informs you that he administered one NTG tab before the patient went unresponsive. Your partner asked you to review the report and you recalled that NTG was not listed in his treatment section. How do you approach this dilemma?
Your predominantly volunteer department responds with paid personnel Monday through Friday during the day. Your chief had indicated that your crew is not to be taken OOS for mutual aid EMS calls for the surrounding volunteer department when they are unable to get a crew. You are listening to the common dispatch channel and hear a call for the adjacent jurisdiction for a single car MVA with one reported ejection and one reported entrapment. The call is 1/2 mile outside of your response area. You are fairly confident the only volunteer agency will not be able to assemble a crew as most of them are working during the day. After some delay, your unit is asked to respond. Your departments' policy indicates that your townships volunteer staff with handle all mutual aid calls, even when paid personnel are at the station. You and your paramedic partner are eager to respond and are certain your skills will prove useful given the dispatch information, do you respond and violate your department's written guidelines?
Rarely will scenarios like the above end up in a 100% consensus amongst the larger group -- however, it is good to talk about these scenarios now, as odds are - you are faced with ethical dilemmas every shift. Regardless, keep fighting the good fight and never lose sight of the fact that our professional status as EMT's is maintained and enriched by the willingness of the individual practitioner (YOU) to accept and fulfill obligations to society and other medical professionals. NEVER use your professional knowledge and skills is any enterprise that is detrimental to the well-being of the public who looks to us daily in their darkest hours.
The above scenarios were used in conjunction and with permission of medical ethics professionals Michael Sherron and Catherine Sherron, Ph.D from Thomas More University
December 9, 2024
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC
Comments