ED managers face many ethical issues
While the Plan B controversy has dominated emergency medicine news lately, there are several other ethical issues that arise in the ED from time to time and can create conflicts for ED physicians and nurses.
Blood for a Jehovah's Witness is a classic issue, says Matthew T. Keadey, MD, medical director of the ED at Emory University Hospital in Atlanta. "It's challenging to be able work with the patient as well as the physician to see what the potential options would be, but as long as the patient is an adult and understands the risks and benefits, it's their right to make any decision they want," he explains.
Children, Keadey adds, are another story. "You usually need to get the hospital ethics committee involved, and often if it's deemed a danger to the child, most states have a statute that allows you to take temporary guardianship of the child for 72 hours until a magistrate can come down with ruling," he explains.
Here are other ethical issues you may encounter in your ED:
• Abortion.
Keadey says there are cases where ED staff need to perform an abortion to save the life of the mother. "If you are the only practitioner at the time, there needs to be a policy or protocol that says how [a practitioner who refuses to perform an abortion] should be handled," he says. If a member of the team has a religious problem, Keadey adds, the ED manager must be able to shift staff around.
• Female Muslims having pelvic exams done by a male.
"If it were a religious request, I would make an extra effort to fulfill the request within the limits of continuing to provide the same level of care to all my other patients," says Mark Debard, MD, an emergency physician at The Ohio State University Medical Center in Columbus. "I would not, however, go to the length of trying to find someone not on duty to perform the exam. The patient can then make their choice (about whether to have the exam performed by a male)."
• Coin rubbing (Vietnamese custom).
Coin rubbing involves a cultural belief that when you heat a coin and rub it across the afflicted parts of a person's body, it has a healing effect, Banja says. "When they present to an ED physician, if they see burn marks on a child they might suspect parental abuse, so you need to be aware of this practice," he says.
This is a Southeast Asian custom that is easily recognized by experienced emergency physicians, says Debard. "It is harmless and [minor burn marks] should be ignored," he says.
• Do-not-resuscitate (DNR) order.
The DNR is "perhaps the most common and difficult ethical issue with which we deal," says Debard. All states have specific laws on the subject, and it is essential that the emergency physician be familiar with their own state's laws and that they follow them scrupulously, he advises.
While the Plan B controversy has dominated emergency medicine news lately, there are several other ethical issues that arise in the ED from time to time and can create conflicts for ED physicians and nurses.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content