Ethical Problems in Emergency Medicine

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.

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, ixPreface, xiiiSection One: Challenging professionalism1 Physician care of family, friends, or colleagues, 3Taku Taira, Joel Martin Geiderman2 The impaired physician, 15Peter Moffett, Christopher Kang3 Disclosure of medical error and truth telling, 27Abhi Mehrotra, Cherri Hobgood4 Conflicts between patient requests and physician obligations,37Shellie L. Asher5 Judgmental attitudes and opinions in the emergency department,47V. Ramana Feeser6 Using physicians as agents of the state, 57Jeremy R. SimonSection Two: End-of-life decisions7 Family-witnessed resuscitation in the emergency department:making sense of ethical and practical considerations in anemotional debate, 69Kirsten G. Engel, Arthur R. Derse8 Palliative care in the emergency department, 79Tammie E. Quest, Paul DeSandre9 Refusal of life-saving therapy, 89Catherine A. Marco, Arthur R. Derse10 Revisiting comfort-directed therapies: death and dying in theemergency department, including withholding and withdrawal oflife-sustaining treatment, 99Raquel M. Schears, Terri A. Schmidt11 Futility in emergency medicine, 117Arthur R. DerseSection Three: Representing vulnerable populations12 The care of minors in the emergency department, 129Chloë-Maryse Baxter13 Chemical restraints, physical restraints, and otherdemonstrations of force, 139Michael P. Wilson, Christian M. Sloane14 Capacity determination in the patient with altered mentalstatus, 149Michael C. Tricoci, Catherine A. Marco15 Obstetric emergency: perimortem cesarean section, 15Kenneth D. Marshall, Carrie TibblesSection Four: Outside influence and observation16 Non-medical observers in the emergency department, 169Joel Martin Geiderman17 Religious perspectives on do-not-resuscitate (DNR) documentsand the dying patient, 179Avraham Steinberg18 Non-physician influence on the scope and responsibilities ofemergency physicians, 187Laura G. Burke, Jennifer V. Pope19 Privacy and confidentiality: particular challenges in theemergency department, 197Jessica H. Stevens, Michael N. CocchiSection Five: Emergency medicine outside the emergencydepartment20 Short-term international medical initiatives, 209Matthew B. Allen, Christine Dyott, John Jesus21 Disaster triage, 221Matthew B. Allen, John Jesus22 The emergency physician as a bystander outside the hospital,237Zev Wiener, Shamai A. Grossman23 Military objectives versus patient interests, 247Kenneth D. Marshall, Kathryn L. Hall-BoyerSection Six: Public health as emergency medicine24 Treatment of potential organ donors, 261Glen E. Michael, John Jesus25 Mandatory and permissive reporting laws: conflicts in patientconfidentiality, autonomy, and the duty to report, 271Joel Martin Geiderman26 Ethics of care during a pandemic, 287John C. MoskopSection Seven: Education and research27 Practicing medical procedures on the newly or nearly dead,301Ajay V. Jetley, Catherine A. Marco28 Ethics of research without informed consent, 311Dave W. Lu, Jonathan Burstein, John JesusAppendix: useful resources, 321Alexander BraceyIndex, 325