Emergency Medicine and the Ethical Dilemmas

Every one of us has relied on a medical professional at least a few times in our lives. When we get seriously ill, or suffer a serious injury, we put our health in the hands of doctors, nurses, and pharmacists, fully expecting to be treated with a certain degree of professionalism and safety. Unfortunately, sometimes the expected care is not given, or not given to the extent which the ailment requires. In these situations, we can feel blindsided, confused, even taken advantage of.

There are many components to a hospital or medical facility. All of them are necessary to have a properly functioning environment. The emergency department of a hospital is a fast paced world. You have to be constantly on your toes and prepared for whatever may come through the doors. There are many people that work in an emergency room to make it run smoothly. Techs, nurses, CNA’s, LVN’s, and doctors all work side by side to help those who are critically injured. Without all these people it would be complete chaos.

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

When faced with a tough, and timed emergency situation, there are many directions a heath care provider can go in from there. They can freeze, act improperly, or not quick enough, but some will also act professionally and correctly perhaps saving a patient's life. What determines the direction a health care provider will take is their experience. From knowledge to observation, a medical professional can learn the most efficient ways to work. But one way in particular, past medical experiences and the patient, provider relationship, can influence the decisions a health care provider will make. This can be demonstrated by both Atul Gawande, author of Complications: A Surgeon’s Note on an Imperfect Science, and within Courtney Davis’s The

When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

In this article, the authors investigated the vulnerabilities in emergency department to internal medicine patient transfers through self-administered surveys of all emergency medicine house staff. More specifically, the survey investigated adverse events due to faulty communications during handoffs. According to this survey, 29% of the emergency staff reported either an adverse or near-miss event due to errors during handoffs. Furthermore, the survey respondents identified inaccurate or incomplete information, cultural and professional conflict, crowding, and many other factors as the contributors to handoff errors. By identifying specific contributors to handoff errors, this article serves as guidance for handoff intervention.

“Hospitals are not only required to care for emergency patients, but they also are required to do so in a timely fashion” (Pozgar, 2010, p. 272). “Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the emergency department. An on-call physician who fails to respond to a request to attend a patient can be liable for injuries suffered by the patient because of his or her failure to respond” (Pozgar, 2010, p. 271). Under the doctrine of Respondeat Superior, hospitals are also liable for the actions of physicians working or on-call in their emergency department.

The EMS providers tries to persuade the patient in various ways, explaining to him the importance of receiving treatment and what may happen if he does not receive this treatment, as well as trying to get help from his relatives or one of his friends to convince. If the patient refuses and insists on not receive treatment or not to be transported to the hospital, the paramedic will ask for help from law enforcement or shift in charge as they are witness to this

The career field I am in Is Emergency medical services and fire service. One of the major ethical issues I've come across is the refusal of care. Depending on the person's injury and they have the right to refuse the help we have to offer. The factors that go along with this is, the person must be legally competent to make their own choices, meaning their not under the influence of drugs or alcohol, or have an injury that impairs there capabilities. They have to be 18 years of age, if they are not 18, they must either be a parent themselves or emancipated. Along with those they must also understand the risks of refusal which is provided to them.

Healthcare professionals will be faced with ethical dilemmas throughout their career, particularly in the hospital environment. Having an education regarding professional healthcare ethics will provide some direction in how to best address these dilemmas at a time when either the patient or their family is in need of making decisions for themselves or their family member. It can be difficult for healthcare professionals to weigh professional protocol against their own personal beliefs and ethical understandings when determining critical care for their patient.

Today, overcrowding affects the viability of emergency departments across this county (Derlet, 2002). Emergency department overcrowding refers to an excess of patients in the treatment areas exceeding ED capacity. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), over one half of all sentinel event cases of morbidity and mortality resulting from delays in treatment occur in hospital emergency departments. Emergency department overcrowding has been cited as a contributing factor in 31% of these sentinel event cases. (Trzeciak & Rivers, 2003). Consequently, overcrowding affects persons who suffer an unexpected severe illness or injury requiring time sensitive emergency treatment. Therefore, patients must

Emergency Medical Services are provided in rare circumstances that caught victim unaware of attention to their body, family, and their homes. Thus, the administration of EMS can expose patient negatively and affect

Unique ethical issues arise in the practice of emergency medicine, and common ethical problems are often more difficult to address in the emergency department than in other medical settings (Pauls, McRae, Campbell & Dungey, 2004). I have worked in Emergency rooms myself both in a combat zone and in garrison where we would provide care to civilian contractors. McAfee health clinic ER was a quiet place but when we received patients it was serious. The population there were of an older group with obvious obesity problems consequently, cardiac patients, diabetes, and falls were our main problems. This base was an extremely small community and everyone knew each other therefore, it is why protecting patient privacy was even more of a major goal

Everyday, healthcare professionals are faced with ethical dilemmas in their workplace. These ethical dilemmas need to be addressed in order to provide the best care for the patient. Healthcare professionals have to weigh their own personal beliefs, professional beliefs, ethical understandings, and several other factors to decide what the best care for their patient might be. This is illustrated in Mrs. Smith’s case. Mrs. Smith is an 85 year old who has suffered from a large stroke that extends to both of her brains hemispheres which has left her unconscious. She only has some brain stem reflexes and requires a ventilator for support. She is unable to communicate how she wishes to proceed with her healthcare. Mrs. Smith’s children, Sara and Frank have different views regarding their mother’s plan of care. The decision that needs to be made is whether to prolong Mrs. Smith’s life, as Sara would like to do, or stop all treatments and care, as Frank feels his mother would want. In the healthcare field, there are situations similar to this case that happen daily where moral and ethical judgment is necessary to guide the decision that would be best for the patient. The purpose of this paper is to explore and discuss, compare and contrast the personal and professional values, ethical principles, and legal issues regarding Mrs. Smith’s quality of life and further plan of care.

This has been held with regard to the provision of emergency medical treatment in Pt.Parmananda Katara vs. Union of India. (44) It has been held that held that it is the professional obligation of all doctors to aid injured people immediately in an effort to preserve life. This medical aid should be extended without waiting for legal formalities to be complied with by the police under Cr.P.C. Article 21 of the Constitution puts the obligation on the State to preserve life and states that this important obligation of medical aid by doctors should not be impeded by any law or State action.