Ethical dilemmas with little time for reflection: A discussion of the ethics of out-of-hospital refusals
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Keywords

Ethics
Autonomy
Beneficence
Paternalism
Informed Consent
Emergency Medicine

How to Cite

1.
Galozo B, MacDonald B. Ethical dilemmas with little time for reflection: A discussion of the ethics of out-of-hospital refusals. Australasian Journal of Paramedicine [Internet]. 2021Oct.12 [cited 2021Oct.19];18. Available from: https://ajp.paramedics.org/index.php/ajp/article/view/909

Abstract

In this article, we consider an approach for ethical decision-making for refusals in the out-of-hospital environment. Autonomy and beneficence are discussed as the two ethical principles central to guiding paramedic decision-making in this context. We describe some situations where the two principles may come into conflict and where the working paramedic may be faced with an ethical dilemma. These cases may involve temptations of medical paternalism, which we argue ought to be avoided if possible. A discussion on navigating between autonomy and beneficence will be presented in order to help paramedics sort through dilemmas when these principles conflict. We argue that when these principles are in conflict, autonomy should primarily be respected – however, we will examine situations where the principle of autonomy cannot be applied and the paramedic should either attempt to rectify the patient’s capacity for autonomous decision-making, or, if not possible, proceed with the principle of beneficence.

https://doi.org/10.33151/ajp.18.909
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References

Beauchamp TI, Childress JF. Principles of biomedical ethics. 7th edn. New York: Oxford University Press; 2013, p.13.

Shuman AG, Barnosky AR. Exploring the limits of autonomy. J Emerg Med 2011;40:229. doi:10.1016/j.jemermed.2009.02.029

Groll D. Medical paternalism - part 2. Philos Compass 2014;9:195. doi:10.111/phc3.12110

Mill JS. On liberty. Indianapolis: Hackett; 1978, p.9.

O’Neill O. Autonomy and trust in bioethics. Cambridge: Cambridge University Press; 2002, p. 145-9.

Beauchamp TI, Childress JF. op cit., p. 2025.

Beauchamp TI, Childress JF. ibid. p. 150.

Beauchamp TI, Childress JF. ibid. p. 215.

Groll D. Medical paternalism - part 1. Philos Compass 2014;9:186-93. doi:10.111/phc3.12111

Rothman D. Strangers at the bedside: a history of how law and bioethics transformed medical decision making. New York: Routledge; 2017, p. 91-100.

Groll D. Medical paternalism - part 2. op cit., p.198.

Beauchamp TI, Childress JF. op cit., p. 124-25.

Eyal N. Stanford encyclopedia of philosophy. Stanford: Metaphysics Research Lab, Stanford University; 2019. Informed consent. Available at: https://plato.stanford.edu/archives/spr2019/entries/informed-consent/ [Accessed 5 October 2020].

Shuman AG, Barnosky AR. op cit., p. 230. doi:10.1016/j.jemermed.2009.02.029

Beauchamp TI, Childress JF. op cit., p. 117.

Mental Health Act 1996 (B.C., Canada). Available at: www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/00_96288_01#section22

The Lanterman-Petris-Short Act 1967 (Ca, U.S.A.). Available at: https://leginfo.legislature.ca.gov/faces/codes_displayexpandedbranch.xhtml?tocCode=WIC&division=5.&title=&part=1.&chapter=&article=

Mental Health Act 2007 (NSW, Aus). Available at: https://legislation.nsw.gov.au/view/html/inforce/current/act-2007-008#ch.3

Mental Health Act 1983 (U.K.) Available at: www.legislation.gov.uk/ukpga/1983/20/contents

Ladd RE. Patients without choices: the ethics of decision-making in emergency medicine. J Emerg Med 1985;3:152. doi.org/10.1016/0736-4679(85)90048-4

Palmar RB, Iserson KV. The critical patient who refuses treatment: an ethical dilemma. J Emerg Med 1997;15:729. doi:10.1016/s0736-4679(97)00157-1

Beauchamp TI, Childress JF. op cit., p. 119-120.

Beauchamp TI, Childress JF. ibid. p. 131.