Ethical Problems in Emergency Medicine

John Jesus, MD, Chief Resident, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Clinical Instructor, Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA.

This book is designed to consolidate the relevant literature as well as the thoughts of professionals currently working in the field into a practical and accessible reference for the emergency medical technician, student, nurse, resident, and attending emergency physician. Each chapter is divided into four sections: case presentation, discussion, review of the current literature, and recommendations. Designed to serve simultaneously as a learning and reference tool, each chapter begins with a real case that was encountered in an ED setting. The case presentation is followed by a short discussion of the case, as if at a morbidity and mortality conference, by a panel of experienced attending physicians explaining how they would approach the ethical dilemmas associated with the case, and a review of the existing literature.

Contributors, ix
 
Preface, xiii
 
Section One: Challenging professionalism
 
1 Physician care of family, friends, or colleagues, 3
Taku Taira, Joel Martin Geiderman
 
2 The impaired physician, 15
Peter Moffett, Christopher Kang
 
3 Disclosure of medical error and truth telling, 27
Abhi Mehrotra, Cherri Hobgood
 
4 Conflicts between patient requests and physician obligations, 37
Shellie L. Asher
 
5 Judgmental attitudes and opinions in the emergency department, 47
V. Ramana Feeser
 
6 Using physicians as agents of the state, 57
Jeremy R. Simon
 
Section Two: End-of-life decisions
 

7 Family-witnessed resuscitation in the emergency department: making sense of ethical and practical considerations in an emotional debate, 69
Kirsten G. Engel, Arthur R. Derse
 
8 Palliative care in the emergency department, 79
Tammie E. Quest, Paul DeSandre
 
9 Refusal of life-saving therapy, 89
Catherine A. Marco, Arthur R. Derse
 
10 Revisiting comfort-directed therapies: death and dying in the emergency department, including withholding and withdrawal of life-sustaining treatment, 99
Raquel M. Schears, Terri A. Schmidt
 
11 Futility in emergency medicine, 117
Arthur R. Derse
 
Section Three: Representing vulnerable populations
 
12 The care of minors in the emergency department, 129
Chloë-Maryse Baxter
 
13 Chemical restraints, physical restraints, and other demonstrations of force, 139
Michael P. Wilson, Christian M. Sloane
 
14 Capacity determination in the patient with altered mental status, 149
Michael C. Tricoci, Catherine A. Marco
 
15 Obstetric emergency: perimortem cesarean section, 15
Kenneth D. Marshall, Carrie Tibbles
 
Section Four: Outside influence and observation
 
16 Non-medical observers in the emergency department, 169
Joel Martin Geiderman
 
17 Religious perspectives on do-not-resuscitate (DNR) documents and the dying patient, 179
Avraham Steinberg
 
18 Non-physician influence on the scope and responsibilities of emergency physicians, 187
Laura G. Burke, Jennifer V. Pope
 
19 Privacy and confidentiality: particular challenges in the emergency department, 197
Jessica H. Stevens, Michael N. Cocchi
 
Section Five: Emergency medicine outside the emergency department
 
20 Short-term international medical initiatives, 209
Matthew B. Allen, Christine Dyott, John Jesus
 
21 Disaster triage, 221
Matthew B. Allen, John Jesus
 
22 The emergency physician as a bystander outside the hospital, 237
Zev Wiener, Shamai A. Grossman
 
23 Military objectives versus patient interests, 247
Kenneth D. Marshall, Kathryn L. Hall-Boyer
 
Section Six: Public health as emergency medicine
 
24 Treatment of potential organ donors, 261
Glen E. Michael, John Jesus
 
25 Mandatory and permissive reporting laws: conflicts in patient confidentiality, autonomy, and the duty to report, 271
Joel Martin Geiderman
 
26 Ethics of care during a pandemic, 287
John C. Moskop
 
Section Seven: Education and research
 
27 Practicing medical procedures on the newly or nearly dead, 301
Ajay V. Jetley, Catherine A. Marco
 
28 Ethics of research without informed consent, 311
Dave W. Lu, Jonathan Burstein, John Jesus
 
Appendix: useful resources, 321
Alexander Bracey
 
Index, 325