in Emergency Medicine, 2nd ed.
Eds: Kenneth V. Iserson, M.D., Arthur
M.D., Deborah Mathieu, Ph.D.
a legal introduction by: Alexander M. Capron, L.L.B.
do you decide whether a patient is "competent"?
do you do if your patient refuses necessary care?
far does the obligation of confidentiality extend in emergency
you need informed consent in emergency medical research?
are the obligations of the Good Samaritan statutes?
in advance for ethical dilemmas in Emergency Medical, Nursing, and
Prehospital practice. Case-based discussions, focused on a specific
area of ethical decision making, provide a straightforward approach
to a wide range of ethical issues. Among the areas addressed are:
autonomy, threatening situations, education and confidentiality,
and professional relationships. Learn to identify, refine, and apply
general moral principals to your practice. This book helps you make
decisions when seconds count!
PP. ISBN 1-883620-14-7
Catalog # 007 $39.95
in Emergency Medicine
Helps prepare you to face ethical dilemmas
in your emergency medical practice.
You Know . . .
· Which of the decisions you make involve ethical decisions?
· When must you break patient confidentiality?
· How do you decide whether your patient has the capacity
to make a healthcare decision?
· Which awake patients may not make their own health care
decisions? Who makes the decisions then?
· When and how should you use advance directives (Living
Wills, Durable Powers of Attorney for Healthcare)?
· What should you do when your patient refuses necessary
· When may you treat minors?
· How do professional etiquette differ from ethics?
· What unique ethical dilemmas to EMS providers face?
· Must you obtain informed consent emergency medical research?
· What confidentiality problems arise when dealing with
relatives, the police, EMS communications, telephone discussions,
and the media?
· What are prehospital advance directives? How do you use
· How do the ethical principles of autonomy and informed
consent affect emergency practitioners?
· When does self-preservation outweigh doing good for patients
in the ED and the EMS?
· How you should ethically practice, teach, and do research?
What do the Hippocratic Oath, American College of Emergency Physicians,
and other emergency medicine and international groups say about
in Emergency Medicine answers these questions and more.
Reviews of Ethics In Emergency Medicine, Second Edition.
informative, and extremely well referenced.
The editors have assembled some of the top ethicists in the field
for this compelling work. An eclectic mixture of perspectives makes
the case-reviews particularly appealing. The cases chosen cover
a wide breadth of topics leaving virtually no question unanswered.
The early chapters arm the reader with interesting background and
provide a workable approach to solving ethical dilemmas in Emergency
Medicine in general; the cases expand upon this formulation and
put flesh onto the principles and guidelines. Required reading for
all practitioners of the art and science of emergency medicine.
An important contribution to the field by the pioneers of emergency
Greg L. Larkin MD MS MSPH FACEP, Chair, Ethics Committee American
College of Emergency Medicine
Now in a significantly updated second edition, Ethics In Emergency
Medicine covers all of the major controversies in the field of Bioethics.
Ethics In Emergency Medicine has been revised and expanded to include
twice as many cases covering the topics of: Autonomy & Consent,
Education & Research, and Privacy & Confidentiality. The
list of contributors includes the most prestigious names in the
field of Bioethics. Ethics In Emergency Medicine is useful as a
textbook and as a reference book for emergency physicians, emergency
nurses, paramedics, hospital and clinic board members, attorneys
practicing tort law in the field of medicine, legislators dealing
with medical law, academics and students in the field of ethics,
and any interested general reader concerned with the subject of
bioethics. This book is essential reading to bring into focus today's
medical treatment and funding issues.
Book News, Inc.
The second edition of a casebook first published in 1986, for doctors,
nurses, paramedics, lawyers, social workers, philosophers, and hospital
administrators who have to make ethical decisions quickly. Cases
encompass autonomy and informed consent, education and research,
privacy and confidentiality, life-sustaining treatment, professional
relations, allocation of health care resources, quality of care,
and threatening situations.
1: Introduction: 1. General Introduction; 2. Unique Aspects of Ethics
in Emergency Medicine; 3. Legal Setting of Emergency Medicine; 4.
What is Ethics? 5. An Approach to Ethical Problems in Emergency
Section 2: Cases & Commentaries
6. Autonomy and Informed Consent
Informed Participation in Decisions (6-1); The Question of Competence
(6-2, 6-3, 6-4); Suicide (6-5, 6-6); Rights of Minors (6-7, 6-8);
Uncertain Diagnosis and the Uncooperative Patient (6-9); A Slight
Postmortem Disagreement (6-10); Impaired Decision Making (6-11,
6-12); Consent: Explicit and Presumed (6-13).
7. Education and Research
Research and Student Exploitation (7-1 ); Faculty-Student Relationships
(7-2); Paramedic Education (7-3); Practicing Procedures on the Newly
Dead (7-4); Human Subjects in Resuscitation Research (7-5); Human
Subjects in Trauma Research (7-6); Prehospital Research and Informed
Consent (7-7); Phase 4 Research Projects (7-8); 8. Privacy and Confidentiality
' legal Requirements for Notification (8-1); Answering Questions
from "Relatives" (8-2 to 8-5); Security of the Emergency
Medical Service System Radio Network (8-6); Police Information (8-7,
8-8); Request for Special Treatment (8-9); Potential Harm to a Third
Party (8-10); Calling other Emergency Departments about Suspicious
9. Life-Sustaining Treatment-Emergency Department.
Resuscitating a Patient with No Vital Signs (9-1); When Not to Resuscitate
(9-2, 9-3); Pediatric Patients-Do We Try too Hard? (9-4); Community
Standards for Resuscitation-are they Valid? (9-5); Organ Donation-the
Uncertain Donor (9-6); Organ Donation-the Willing Donor (9-7); A
Questionable Parental Request (9-8).
10. Life-Sustaining Treatment-Prehospital
Prehospital Do-Not-Resuscitate Orders (10-1,10-2); Medical Futility
(10-3); Disagreement on "Optimal" Treatment (10-4); Unauthorized
Lifesaving Procedures (10-5).
11. Professional Relations
Nurse-Physician Relationships (11-1); Conscientious Objections (Bad
Orders); (11-2); Telephone Orders from local Physicians (11-3);
Delegating Notification of Death to Others (11-4); Consultation
Dilemmas (11-5, 11-6); Referral Back to an Incompetent Primary Care
Provider (11-7); Referral to Specialists at Another Hospital (11-8);
The Questionably Impaired Health Care Professional (11-9, 11-10);
Relationship to Biomedical Companies (11-11, .11-12); Relationship
with Hospital and Community (11-13).
12. Allocation of Health Care Resources
The Manipulative Patient; the Irresponsible Family; and the Nursing
Home "Dump" (12-1 to 12-3); Allocation of Resources: Social
and Political Factors (12-4); Allocation of Resources: Economic
Factors (12-5); Fee-for-Service System of Care (12-6); Increased
Charges for Third-Party-Payer Patients (12-7); No Payment-Adult
or Child (12-8); "Gatekeeper's" Role (12-9, 12-10); Patient
Transfers (12-11); Patient-Requested laboratory Tests (12-12,12-13).
13. Quality of Care
Continuous Quality Improvement and Peer Review (13-1); Responsibility
to Monitor and Remedy Quality-of-Care Mistakes (13-2); Physicians'
Attitudes Toward Patients (13-3); Physician's Quality of life vs.
Patient Care (13-4); Solo Nurse in the Emergency Department (13-5);
Treating Cases Beyond Your Abilities (13-6); Telephone Consultations
with Health Care Providers or Others (13-7); Physician Calls re:
Do-Not-Resuscitate Orders (13-8); Denial of Antipregnancy Prophylaxis
to a Rape Victim (13-9).
14. Threatening .Situations
Resuscitation of an AIDS Patient (14-1); Failure-to-Stop laws and
Good Samaritan Behavior (14-2); A Desperate Flight (14-3); Patient
Confidentiality vs. the Rights of ED Personnel (14-4); ED Personnel's
Safety vs. a Duty to Treat (14-5); Prehospital Personnel's Safety
vs. a Duty to Treat; (14-6); Use of Patient Restraints (14-7); Wilderness
Section 3: Ethical Statements Pertaining to Medical Care
· Hippocratic Oath; Oath of Louis Lasagna; Emergency Medical
· Prayer of Maimonides; Flight Nurse's Creed; Declaration
· American Medical Association's Principles of Medical Ethics.
American Osteopathic Association's Code of Ethics; Canadian Medical
Association's Code of Ethics; Australian Medical Association's Code
· American Nurses Association's Code for Nurses; Emergency
Medical Technician's Code of Ethics;
· Emergency Nurses Association's Code of Ethics;
· Emergency Medicine Residents' Association's Principles
of Medical Ethics;
· International Council of Nurses' Code for Nurses;
· World Medical Association's International Code of Medical
· American Hospital Association's Patient's Bill of Rights;
Nuremberg Code; Declaration of Helsinki;
· American Medical Association's Ethical Guidelines for Clinical
· Regulations of the U.S. Department of Health and Human
Services on the Protection of Human Subjects.
· Prehospital Advance Directives.
· Arizona living Wills and Health Care Directives Act.
· Montana's Comfort One Protocol.
FIGURES & TABLES
Figure 1: Method for Ethical Decision Making.
Figure 2: A Rapid Approach to Ethical Problems.
Figure 3: Wilderness Medicine's Ethical Triangle.
Table 1: Differences between Emergency and Primary Care Practice.
Table 2: Elements of Consent.
Table 3: Elements of Decision-Making Capacity.
Table 4: Exceptions to the Infrmed Consent Rule.
Table 5: Factors Distinguishing the Cases.
Table 6: Consent for Minors.
Table 7: Reasons to Withhold Life-Preserving Treatments.
Table 8: Possible Relevant Differences between Mr. Brook & Mrs.
Table 9: Questions Affecting Treatment Decisions.
Table 10: Basis of Physician's Responsibility to Notify Family of
Table 11: Competing Views of Emergency Physicians' Obligations.
Table 12: Grounds to Determine a Patient's "Best Interest."
Table 13: Arguments for Treating a Patient in his Best Interest
and Contrary to his Demand for a Riskier Alternative.
Table 14: Advantages and Limitations of Quality Assurance Measurements.
Table 15: Physicians' Attitudes toward Patients.
Tabte 16: Methods of Escaping from Responsible Moral Decision Making.
Table 17: Are We Morally Obligated to Risk our Lives for Others?
Table 18: Sources of Risk to Rescuers.
Table 19: Fundamental Humanitarian Concerns.
Table 20: Economic Guidelines & Medical Etiquette in Medical
Sample Advance Directives
A Rapid Approach to Ethical Problems
PRACTICING PROCEDURES ON THE NEWLY DEAD
RIGHTS OF MINORS
ORGAN AND WHOLE-BODY DONATION CARDS
A Sample Protocol to Use When Speaking
versus Sudden, Unexpected Deaths (Table 1-1)
History of Biological Warfare