ETHICAL CHALLENGES IN EMERGENCY MEDICAL SERVICES AND ETHICAL REASONING AMONG EMERGENCY CARE PROVIDERS

Abstract

Introduction: Emergency care providers must make fast decisions and treat patients urgently to prevent death and permanent disabilities. Because of the nature of this work common ethical issues can become more complicated in these settings. Aim: To assess both the ethical issues that emergency care providers encounter and the ethical reasoning they use to resolve these issues. Materials and methods: An anonymous, self-administered questionnaire was sent to 739 emergency care providers in the city of Mugla, Turkey. The questionnaire collected demographic data, information on the type and frequency of ethical issues encountered, and the ethical reasoning used to resolve these issues. Results: Of the 503 emergency care providers whose questionnaires were included (68% response rate), 53% of the participants were emergency medical technicians, 25% were nurses, 12% were physicians, and 11% were paramedics. When asked about the resources used to identify ethical issues in daily emergency practice, the responses included intuition (26%), observation of others (24%), the law (16%), and their ethics education (15%). Frequently encountered ethical issues included truth-telling (26%), triage (25%), duty to treat (23%), competency of patients (23%), and informed consent (17%). Many of the participants had never encountered ethical issues related to organ transplantation (55%), patient privacy/confidentiality (47%), and do-not-resuscitate orders (42%). When asked how they resolved ethical issues, 43% avoided doing harm to the individual, 42% acted beneficially toward others, and only 8% acted for their own benefit. Conclusions: This study provided important data on the ethical issues encountered by emergency care providers and the ethical reasoning used by them. These results could be used to prepare ethical education programs and to establish codes of ethics for emergency services.