Emergency medical services are a source of hope and restoration, which makes them the most valuable and respected among all other medical services. Ethical standards and codes of conduct are the fundamental factors, which govern delivery of emergency services. However, due to their high demand for prompt actions, there are numerous chances of ethical concerns and moral questions. The ethical concerns are based moral foundations and implications of society. This is the reason why there is a need to create a standardized way, offering guidance and defining things for the sake of professionalism. Emergency services, being a crucial part of the healthcare industry, do not offer much time for discussions and consultations. Every step should always be linear; it should be taken with absolute respect to the ethical foundations of this practice, such as confidentiality, justice, fairness, informed consent as well as moral obligations. Due to numerous fundamental challenges caused by moral pluralism, there is a need for an initiation of a central referencing platform that defines all aspects of medical emergency service delivery. Protection of patients’ privacy is a responsibility entrusted to the emergency services personnel by the ethical standards guiding the profession, as well as the medical codes of conduct.
There have always been questions about ethical responsibilities of many professions. However, of late, there has been a growing concern regarding the manner in which emergency medical services are rendered to members of the public. Hastily offered emergency medical services and their subsequent requirements call for the necessity to make several ethical decisions within a short period of time and with or without consultations (Friend, 2012). The fact is that physicians are allowed to make decisions without prior knowledge of the medical history of patients. Therefore, they create a room for mistakes and judgmental actions, raising ethical concerns. As a result, negligence and discrimination coupled with greed for money have been at the top of the list of complaints.
The objectives of this paper explore the ethical foundation of the emergency services, the definition of unique responsibilities where ethics is critically necessary, as well as emergency physician-patient relationship. Finally, the paper will offer an alternative solution to some of the challenges in the patient-physician relationships. The underlying themes in the analysis are ethical foundations of emergency services, the uniqueness in responsibilities of EMS personnel, the relationship between patients and physicians, virtues in emergency medicine, as well as the alternative solution recommendation to moral pluralism. Ethical standards and codes of conduct are the fundamental factors driving delivery of emergency services, without compromising the dignity of the profession and its stakeholders.
As the world becomes more and more technologically advanced, ethical issues continue arising whereby people use technology and other advancements to erode social and professional responsibilities. The issue becomes even more crucial when it relates to the field of medicine where absolute care and confidentiality are demanded. The increase in technology and upgrade of the contemporary medicine, sophistications of patients, societal clustering on the basis of social status, growing interest in human and civil rights, as well as rising cost of health care services are some of the primary factors (Friend, 2012). The medical field where emergency services are offered is a sector in the economy that demands absolute responsibility and professionalism in every step taken by all stakeholders.
Emergency medicine is any activity that is carried out before the patient can check into a health facility. This immediate medical care, geared towards saving a person’s life or reducing suffering, can be performed either at home or on their way to the hospital. In this situation, reasoning and decision making are the most essential aspects since every involved party has to work out their best strategy without consultations or with disregard for any pre-existing conditions. According to the medical code of conduct, no patient is supposed to be stripped of their dignity even during their point of death (Jecker, 2010). It means that every action should ensure that nothing personal is revealed to non-parties when a person is receiving emergency treatment, especially outside a health facility. However, most of the time, actions taken to save a life partly fail to meet ethical requirements since not all physicians and their assistants follow ethical foundations of the profession.
Moral pluralism is an idea that presupposes existence of several channels of consultancy within the medical industry (Jecker, 2010). Due to the diversity of the rendered services, there are things that require guidance from different platforms. For instance, there are medical ethics that apply to all levels, and there are those which only apply to specific disciplines within the industry. There are codes of conduct that are taught in professional schools during the training of medical personnel, while those who specialize in emergency services have to undergo different sets of training (Friend, 2012). All these aspects are connected with a body of knowledge that governs the medical industry with pluralism effects on specific aspects.
Social norms are primary determinants in the medical services, especially in the emergency medicine, where society takes great responisbility. For example, society teaches children certain virtues; some of those values are also learned in schools while others can only be taught through religion. Moral pluralism compromises ethical standards in instances where individuals define actions in different terms, but expect the same outcome. There have been different unsuccessful attempts to create a standard source of guidance and consultation platform for related medical services in order to eliminate the adverse effects of moral pluralism. However, nature has its way of holding things back, since everything has its advantages and disadvantages.
Emergency personnel have their specified duties that are only available within the scope of emergency situations and not in any other level of medical procedures. It makes these people some of the most dependable professionals since their services are not meant for improvement, but for the stability of life conditions. The unique setting of these services may bring up different ethical concerns. Considering the fact that this is a department that deals with acute medical conditions and life-threatening injuries, physicians have to make quick decisions based on their experience and the existent situation (Friend, 2012). However, not every aspect of help is morally acceptable, not to mention a socially upright one. Patients requiring emergency treatment are often unable to participate actively in making decisions since some of them are torn between pain and death, making the physician the only sober and dependable party. Due to this basic misfortune, it is not ethically possible to satisfy social and moral needs of the person, and in most cases, it may result in misunderstanding between a doctor and a patient.
One fundamental aspect in the medical field that emergency services lack is the availability of the existing information regarding the medical conditions of patients during the first few hours of the response (Jecker, 2010). It makes it difficult for the medical personnel offering pre-hospital services to identify the possible causes of sudden illness or to know for sure what should not be done to a particular patient, among other things. For instance, there are people who suffer from acute allergies that should not be compromised by treatment of other diseases. This is vital information that is required by the medical personnel offering emergency services, but, unfortunately, it is not always available. Due to such information deficiency, physicians are forced to conduct confidential tests on patients without seeking consent, and might discover issues that are not meant to be discussed in such instances (Nelson, Venkat, & Davenport, 2014). It is unethical to carry out a secret medical test on a patient in spite of a probable benefit of its outcome. This is prohibited by medical ethics and codes of conduct.
As it has been mentioned above, the emergency services sector involves a unique practice within the medical environment with its distinctive and intact moral challenges. To respond precisely and appropriately to some of these moral and ethical challenges, emergency physicians need to have adequate knowledge of their moral concepts and principles governing moral reasoning. Character traits, morally ethical attitudes, and ethical dispositions, defined in ethical theories as virtues, are as paramount for moral actions as skills and knowledge for individuals (Nelson, Venkat, & Davenport, 2014). Anyone who works according to virtues is motivated to act in a manner that supports their moral beliefs and ideals. Hence, such a person turns into a significant role model for society. Therefore, it is imperative to positively identify, nurture and promote those moral virtues required by the emergency physicians. Every profession is guided by a certain form of fundamental practices that dictate the course of action, and the EMS department is not an exception. Fostering these virtues would be taken as a kind of moral vaccination to the profession against pitfalls that are inherent in the emergency medical practice. Two most fundamental virtues in the practice of emergency medical responses are justice and courage.
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Courage is the ability and strength to carry out an obligation, regardless of the perceived risks. The duty of an emergency respondent is to take the risk and assure patients of their safety and recovery without compromising the system (Jecker, 2010). The work of emergency medical respondents involves assuming personal responsibility in matters of health and doing everything humanly possible to comprehend and control the situation. It is courage that makes an emergency physician venture into a war zone armed with a first aid box instead of a rifle in order to take care of the wounded. Due to this virtue, professional bodies managing the EMS practice have established an understanding with security forces; thus, anyone offering services should be protected and assured of their safety as they struggle to help those in desperate need of health attention. Thus, EMS providers must act with responsibility and impartiality when delivering their services in order to be regarded as neutral parties as well as to be protected (Friend, 2012).
Justice or fairness is the other virtue critical for provision of medical services. Its aim is to offer such patients the necessary health care. Justice involves offering services without referring to the social status of the person, as well as acting with equality among all the available cases. Emergency services involve saving lives. According to the code of ethics, no one possesses a more expensive or valuable life than the others, neither is there someone who is not worth living (Nelson, Venkat, & Davenport, 2014). In emergency medical services, both culprits and their victims have an equal right to medical attention; thus, justice and fairness drive actions within the practice. EMS does not involve passing judgments on those who are supposed to be assisted, and involves even those who attempt to commit suicide. Every medical condition demands equal attention, and no one should be denied their right to healthcare.
Emergency medical services require impartiality, where the personnel has to equally serve people, without gauging situations based on their favoritism. In case there is an accident that involves many casualties, the EMS team is expected to use professionalism in giving priority to those who are more critically injured, and not to those who, in their opinion, should be attended first. Favoritism is the genesis of unfair treatment and unethical practice within the medical field. Other virtues required in the EMS profession include resilience, vigilance, and honesty. One has to be honest when offering emergency services, since the recipient of such services trusts and believes in every step undertaken in their favor. There are small chances of consultation within the first few steps when the situation is critical. Hence, it depends on any decision or advice issued by the professional in charge. Resilience is required to make the EMS professionals composed and competent in their actions regardless of the possible clinical chaos (Nelson, Venkat, & Davenport, 2014). These people are required to be flexible and attentive all the time, as well as aware of their personal health status, so that individual issues may not impede service delivery. Resilience assists them in recovering from shocks brought by diverse severe medical conditions and outcomes of previous emergencies.
This relationship is supposed to be the driver of the events that take place during the delivery of emergency services. There must be cooperation between the parties, which have to show mutual confidence. This relationship acts in the center of all moral obligations and responsibilities within medical service delivery. During the provision of emergency services, patients are considered to be the key stakeholders; thus, all the attention should be directed to their complaints and sentiments, since every activity is aimed to help them. There is also a challenge of inconsistency in EM services since different situations call for different measures. It means that consistent consultation is required before major decisions are adopted (Jecker, 2010).
Emergency teams act and behave in a manner that yields positivity for the sake of their victims and not for business or personal interest. Beneficence encourages personnel to offer an emergency response to make sure that all efforts are aimed at helping the patient before anything else can be discussed or adopted. Thus, it is the duty of the person in charge of emergency service delivery to make sure that nothing is done against the will or the best interest of the patient. Otherwise, it will be against the principle of beneficence. Confidentiality and respect are the fundamental drivers in the principle of beneficence since the best interest of the patient can only be achieved by making sure their personality and privacy are not compromised (Friend, 2012).
Nonmaleficence is the principle, which demands that no harm ought to be done to the victim or anyone else in need of emergency services. Moreover, it predetermines that a minimal or no pain should be caused by the actions aimed to help the patient. It means that the condition of the person by the time the emergency response is offered should only improve and not become more painful than it was initially. All the activities should adopt a well-considered step with no subsequent pain or harm(Nelson, Venkat, & Davenport, 2014). Emergency physicians are trained on how to handle issues without inflicting pain on the victims. Therefore, any person who is not trained should not represent themselves in such activities as professionals. Any insignificant pain can be a major determinant of the situation outcome, which means that every emergency service personnel should always adhere to the principle of nonmaleficence.
According to the code of conduct guiding the emergency and medical services delivery, every adult patient has a right to accept, propose or reject an offered health care. This is called patient autonomy, and must be respected at all cost by those in charge of offering such services. This principle is guided by the doctrine of informed consent, where every decision must be communicated to the patient before it can be executed, no matter the benefit it is expected to yield. Since every move is meant to helpful to the patient, according to the principle of beneficence, informed consent must be exercised at all stages of treatment (Nelson, Venkat, & Davenport, 2014). It gives the patient an opportunity to offer suggestions and also raise crucial details that could determine the next course of actions. However, there are instances where informed consent is overruled and actions are taken without seeking permission from the patient. Such instances include a medical condition that is considered a risk to the public health. For example, a patient diagnosed with a contagious disease, such as Ebola or Hepatitis B, may not have many chances of giving consent to the medical practitioners, since their delay in consultation might create a risk to other people around them. Other than such particular circumstances, informed consent and patient autonomy should be respected and adhered.
In emergency medicine practice, many details revealed throughout the process should be kept between the giver and the receiver, not involving unnecessary third parties. This is the ethical principle of confidentiality and privacy. There are those patients who would prefer to maintain their issues as personal as possible, without making friends or family members aware, just because of their own reasons (Jecker, 2010). Such requests are supposed to be respected by the physicians attending to such people. Thus, health care professionals should not negotiate with patients about their medical issues. In such case, personal medical issues should be ethically treated with much confidentiality. Some aspects are supposed to be known only by one physician in a team, who should not discuss it with his colleagues, while others have to be revealed only to the family of the patient and not to the patient.
Considering the above-explained concepts within the emergency medical services, some issues need to be implemented in order to make the practice more ethical and socially acceptable. It is believed that most ethical questions are raised in instances when medical practitioners lack adequate knowledge about handling assorted incidents. Thus, there should be a universal training for all the people dealing with emergencies. A person trained to handle injuries should be adequately trained to handle disease outbreaks as well. These health care workers should be also trained on how to handle fire incidents as well as drowning situations. It helps to ensure that such a person can help people who are in need despite complication of their situations. Negligence is one of the issues that raise ethical questions within emergency services. However, at times, it occurs not because of unwillingness, but because of the lack of facilities and training to handle situations.
To eliminate a possibility of negligence, there is a need to ensure that the emergency department is fully prepared, having trained personnel and the equipment to handle every possible situation where people are in need of urgent medical attention. For example, an emergency department should have the equipment to help in fighting the fire while taking care of the affected. Nevertheless, due to the challenge of moral pluralism, many issues hinder the delivery of service, raising ethical concerns regarding the emergency services. There should be a standardized central training that serves as the point of reference for all health care professionals, even if there will be other ethical codes of conduct that govern different services. It is needed to ensure that everybody involved in an emergency situation understands a common way of coping with difficult issues. Hence, it will reduce chances of conflicts.
There are many diverse ethical concerns within the practice of emergency medicine services based on their moral foundations and social implications. That is why there is a desperate need to develop a standardized way of defining things for the sake of professionalism and patient satisfaction, without compromising morality. Emergency services are known to be the most crucial part of medical care. They do not give much time for discussions between parties. Every move engaged should always be linear, adhering to the ethical foundations of the practice. Health care professionals are obliged to maintain confidentiality, informed consent, and moral obligations. Due to the challenges posed by moral pluralism in the medical industry, there is a need for a standard referencing point aimed to define every aspect of service delivery in an attempt to eliminate social and ethical conflicts. Ethical standards and codes of conduct are the fundamental factors, driving the delivery of emergency services. Protection of patients’ dignity, clearly stipulated in the medical codes of conduct and the ethical standards guiding the profession, is a key responsibility of the emergency services personnel. However, different situations cause different concerns, based on the immediate decisions made by the respondents. Hence, there is a vital need for the creation of a standardized reference system.
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