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Ethics in the trenches: preparing for ethical challenges in the emergency department

Published online by Cambridge University Press:  21 May 2015

Merril Pauls*
Affiliation:
Department of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS Department of Bioethics, Dalhousie University
Connie LeBlanc
Affiliation:
Department of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS
Sam Campbell
Affiliation:
Department of Emergency Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS
*
Department of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax Infirmary, Room 3-021, 1796 Summer St., Halifax NS B3H 3A7; fax 902 473-3617; [email protected]

Abstract

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Ethical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions.

Understanding the legal and ethical basis for advance directives allows emergency physicians to determine when the directives should be followed and when they should be questioned. Resource allocation decisions are among the toughest decisions emergency physicians make. Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient’s wishes, that it is achievable, and that competing claims for the same resource are considered.

Learning from others’ experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues.

Type
Controversies • Controverses
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

Further reading

Case 1

Sanders, AB.Advance directives. Emerg Med Clin N Am 1999;17:51926.Google Scholar
Sulmasy, DP, FitzGerald, D, Jaffin, JH.Ethical considerations. Crit Care Clin 1993;9:77589.CrossRefGoogle ScholarPubMed
Iserson, KV.Nonstandard advance directives: a pseudoethical dilemma. J Trauma 1998;44:13942.Google Scholar
Llovera, I, Mandel, FS, Ryan, JG, Ward, MF, Sama, A.Are emergency department patients thinking about advance directives? Acad Emerg Med 1997;4:97680.CrossRefGoogle ScholarPubMed
Llovera, I, Ward, MF, Ryan, JG, Lesser, M, Sama, AE, Crough, D, et al. Why don’t emergency department patients have advance directives? Acad Emerg Med 1999;6:105460.CrossRefGoogle ScholarPubMed
Malette v. Schulman, Ontario 1987, 43 C.C.L.T. 62, 47 D.L.R. (4th) 18, 17 F.T.R. 243 (Ont. H.C.).Google Scholar
Larkin, GL, Weber, JE, Moskop, JC. Resource utilization in the emergency department: the duty of stewardship. J Emerg Med 1998;16:499503.CrossRefGoogle ScholarPubMed
Weijer, C, Singer, PA, Dickens, BM, Workman, S.Dealing with demands for “inappropriate” treatment: medical futility and other approaches. In: Singer, PA, editor. Bioethics at the bedside. Ottawa: Canadian Medical Association; 1999. p. 10715.Google Scholar
Brody, B.Resuscitating a patient with no vital signs. In: Iserson, KV, Sanders, AB, Mathieu, D, editors. Ethics in emergency medicine. 2nd ed. Tucson: Galen Press Ltd.; 1995. p. 1927.Google Scholar
Marco, CA, Bessman, ES, Schoenfeld, CN, Kelen, GD.Ethical issues of cardiopulmonary resuscitation: current practice among emergency physicians. Acad Emerg Med 1997;4:898904.Google Scholar
Iserson, KV.Withholding and withdrawing medical treatment: an emergency medicine perspective. Ann Emerg Med 1966;28:514.Google Scholar
Rocker, G, Dunbar, S.Withholding or withdrawal of life support: the Canadian Critical Care Society position paper. J Palliat Care 2000;(16 Suppl):S5362.CrossRefGoogle Scholar