EMS Ethics - Key Concepts for Prehospital Healthcare Providers Part One

Ethics play a crucial role in the field of Emergency Medical Services (EMS), where decisions must often be made quickly and under pressure. 

As prehospital care responders, EMS providers are frequently faced with challenging situations that require a strong understanding of ethical principles to ensure that patient care is delivered effectively and compassionately. 

Ethics in EMS encompass various concepts that guide providers in respecting patient rights, ensuring informed decision-making, and protecting their confidentiality, all while striving to do good and avoid harm. 

This piece outlines part one of essential ethical principles that every EMS provider should understand to provide the highest standard of care in prehospital settings.

1. Autonomy

Also known as self-determination, autonomy refers to the right of the patient to make decisions about their own medical care. In EMS, we often encounter this ethical concept when well-meaning family members attempt to supersede the wishes of a patient who is otherwise capable of making their own choices. 

Aside from situations where an inability to make appropriate decisions has been demonstrated (e.g. threat of suicide), a patient who is alert, oriented, and able to comprehend the gravity of their situation has the right to determine the course of their own medical care.

2. Informed Consent

A patient exercising autonomy can only make appropriate decisions regarding their medical care if they possess enough information to make informed choices. 

It is, therefore, the ethical obligation of EMS providers to present a full and accurate picture to our patients of the risks and benefits of their self-determined healthcare decisions.

3. Confidentiality

Information received while in a patient-provider relationship must remain protected from those who do not need to know. Consequences for the negligent disclosure of private medical information include embarrassment to the patient; the erosion of trust between EMS providers and the public we serve; and hefty fines to the agency. 

In the case of HIPAA violations, fines can be as high as $50,000 per infraction, with a maximum penalty of $1.5 million per year.

4. Beneficence

The term beneficence describes actions that are carried out for the benefit of others. Administering D50 to a hypoglycemic patient while on the scene, instead of immediately transporting them to the hospital while unconscious, is an example of beneficence in EMS. 

In this situation, providing IV dextrose with the knowledge that the patient could very likely return to consciousness and be left safely in their home is beneficial in terms of lower cost to the patient, and less of their time wasted waiting for an unnecessary ER evaluation.

5. Non-Maleficence

Primum Non Nocere - first, do no harm - is the original guiding principle of medicine. If faced with a choice between doing nothing or taking an action that will cause more harm, the correct decision in most cases is to take no action. 

Similarly, if inaction would likely result in harm befalling a patient, EMS providers are obligated to take appropriate steps for the protection of those in our care.

Conclusion

Ethical considerations are integral to the practice of EMS and are essential for maintaining trust between providers and the communities they serve. By adhering to ethical principles such as autonomy, informed consent, confidentiality, beneficence, and non-maleficence, EMS providers ensure that they are making decisions that respect patient rights and promote well-being. 

Understanding and applying these concepts helps providers navigate the complex and often unpredictable nature of prehospital care, ultimately leading to better patient outcomes and a more ethical healthcare environment. 

As the field of EMS continues to evolve, ongoing education and reflection on ethical practices will remain vital for all providers.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed August 9, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Iserson, K. V. (2006)  Ethical Principles - Emergency Medicine. Emergency Medicine Clinics of North America 24(3): 513 - 545   Accessed August 9, 2024

Larkin G. L. & Fowler, R. L. (2002) Essential Ethics for EMS: Cardinal Virtues and Core Principles. Emergency Medicine Clinics of North America 20 (4): 887-911. Accessed August 9, 2024

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Moskop, J. C. (2006) Informed Consent and Refusal of Treatment: Challenges for Emergency Physicians. Emergency Medicine Clinics of North America 24 (3): 605-618. Accessed August 7, 2024

National Association of Emergency Medical Technicians (2013) Code of Ethics for EMS Practitioners. Accessed August 7, 2024

Winston, B. & Moskop, J. C. (2014) A Review of the Updated NAEMT Code of Ethics. Journal of Emergency Medical Services 39 (6): 50-53 Accessed August 9, 2024