Ethical conflicts in the prehospital setting.
OBJECTIVE
To assess the range of ethical conflicts that confront prehospital care providers.


METHODS
Convenience sample, from October 1989 to January 1990.


METHODS
An urban advanced life support emergency medical service that transports approximately 3,000 patients per month.


METHODS
Six hundred seven paramedic responses were analyzed by a single observer. An ethical conflict was identified when the paramedic faced a dilemma about what "ought to be done" and the paramedic's values conflicted or potentially conflicted with the patient's. Cases with potential ethical consequence were brought to experts in medical ethics and epidemiology for further analysis and classification.


RESULTS
Ethical conflicts arose in 14.4% of paramedic responses (88 of 607 cases). Twenty-seven percent of the conflicts involved issues of informed consent, such as refusal of treatment or transport, conflicts of hospital destination, treatment of minors, and consent for research. Difficulties regarding the duty of the paramedics, usually under threatening circumstances, accounted for 19% of the dilemmas encountered. Requests for limitation of resuscitation accounted for 14%. Other circumstances that presented ethical conflicts involved questions of patient competence (17%), resource allocation (10%), confidentiality (8%), truth telling (3%), and training (1%).


CONCLUSIONS
The data demonstrate a range of ethical conflicts in the prehospital setting and point to areas in which policy needs to be developed. The data also can be used in a prehospital ethics curriculum for paramedics and physicians. Because case sampling was not strictly random, absolute conclusions should not be drawn regarding the frequency of the dilemmas.
Adams
J G
JG
Wilford Hall USAF Medical Center, Lackland Air Force Base, TX.
Arnold
R
R
Siminoff
L
L
Wolfson
A B
AB
D026686:Beneficence; D003219:Confidentiality; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians; D004992:Ethics, Medical; D015276:Health Care Rationing; D006801:Humans; D007258:Informed Consent; D008020:Life Support Care; D016743:Mental Competency; D033242:Minors; D033282:Parental Consent; D018579:Patient Selection; D010414:Pennsylvania; D026684:Personal Autonomy; D040841:Resource Allocation; D016414:Resuscitation Orders; D012945:Social Values