Out of hospital medical care is a constantly evolving concept. This especially rings true for resuscitations situations, as higher quality interventions and knowledge become more readily available. Although these benefits cannot be disputed, the paramedic more often than not can be put in a unique ethical and legal predicament. Before any attempt at resuscitation the paramedic must consider five ethical principles in order to determine whether the course of action is ethically acceptable in this patient’s situation. These are beneficence, non-maleficence, autonomy, justice and futility. However as health professionals, paramedics must also abide by legal documents such as standing orders, the Human Rights Act 1993, the Health and Disability Commissioner Act 1994 and the Code of Health and Disability Services Consumers' Rights 1996. For this reason paramedics can be exposed to conflicting resources, affecting their ability to make appropriate choices. This essay will discuss the above implications that a paramedic must consider in order to decide upon the treatment that will be of most benefit to the patient, particularly in a resuscitation situation. It will also outline the procedures that are currently in place in order to aid paramedics in their decisions. Beneficence is defined by Goldenberg (2009), as doing good unto others. In the context of resuscitation, beneficence ensures that the treatment provided is within the patient’s best interest. This includes the decision to either begin or terminate cardiopulmonary resuscitation (CPR), and allows the paramedic to consider whether aggressive resuscitation techniques would provide any benefit to that patient in the future (American Heart Association, 2010). Part of the Hippocratic Oath ‘above all to do no harm’ is the definition of non-maleficence (Pierscionek, 2008). In resuscitation non-maleficence is considered when the attempt to resuscitate someone is most likely to do more harm than benefit, either by prolonging their suffering or because the attempt is futile (Lippert, Raffay, Georgiou, Steen, & Bossaert, 2010). Situations like this often arise in patients who are terminally ill or have multiple co-morbidities. The patient’s right to self determination is recognised within the ethical principle of autonomy, and is considered to be one of the most important ethical values within medical care (Goldenberg, 2009).
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As described by American Heart Association (2010), a truly informed decision involves three steps. Firstly the patient receives and understands information about their condition, possible treatment options, and probable outcomes. Secondly the patient is able to paraphrase the previous information, articulating it in such a manner that the health professional feels they have taken on board the necessary points. Lastly the patient is able to deliberate the options previously outlined to them, and is able to make a cognitive decision with justification for their choice. In situations when the patient’s preference of treatment is unknown or uncertain, the health professional is able to treat emergency conditions until such information becomes available. Advance directives, living wills or a Do Not Attempt Resuscitation (DNAR) order are examples of information that can provide the health professional with insight into the patient’s wishes if they are unable to articulate their decisions for themselves (Lippert et al., 2010). A family member may also be able to make these decisions if the patient unexpectedly becomes incapacitated, however as stated previously they must meet the requirements of informed consent (American Heart Association, 2010). The principle of justice is defined by Lippert et al. (2010), as the ‘concern or duty to distribute limited health resources equally within a society’. This basically means that resuscitation, if provided, should be offered to those who will most likely benefit from it. This ensures that there is no bias or discrimination towards those who require resuscitation. Futility is defined by Petty, DeGarmo, Aitchison, Aitchison, Wang, Kharasch (2013), as only providing treatment that is beneficial to the patient, hence it is often associated with the ethical principles beneficence and non-maleficence. A situation where futility is often exercised is when relatives are present during resuscitation. Distressed relatives may ask you to ‘do whatever you can to save them’, but in some situations this is unethical as delaying a terminally ill patient’s anguish will not benefit them. The decision to terminate CPR and resuscitation efforts can be very complicated for paramedics. This decision is often aided by advice
As described by American Heart Association (2010), a truly informed decision involves three steps. Firstly the patient receives and understands information about their condition, possible treatment options, and probable outcomes. Secondly the patient is able to paraphrase the previous information, articulating it in such a manner that the health professional feels they have taken on board the necessary points. Lastly the patient is able to deliberate the options previously outlined to them, and is able to make a cognitive decision with justification for their choice. In situations when the patient’s preference of treatment is unknown or uncertain, the health professional is able to treat emergency conditions until such information becomes available. Advance directives, living wills or a Do Not Attempt Resuscitation (DNAR) order are examples of information that can provide the health professional with insight into the patient’s wishes if they are unable to articulate their decisions for themselves (Lippert et al., 2010). A family member may also be able to make these decisions if the patient unexpectedly becomes incapacitated, however as stated previously they must meet the requirements of informed consent (American Heart Association, 2010). The principle of justice is defined by Lippert et al. (2010), as the ‘concern or duty to distribute limited health resources equally within a society’. This basically means that resuscitation, if provided, should be offered to those who will most likely benefit from it. This ensures that there is no bias or discrimination towards those who require resuscitation. Futility is defined by Petty, DeGarmo, Aitchison, Aitchison, Wang, Kharasch (2013), as only providing treatment that is beneficial to the patient, hence it is often associated with the ethical principles beneficence and non-maleficence. A situation where futility is often exercised is when relatives are present during resuscitation. Distressed relatives may ask you to ‘do whatever you can to save them’, but in some situations this is unethical as delaying a terminally ill patient’s anguish will not benefit them. The decision to terminate CPR and resuscitation efforts can be very complicated for paramedics. This decision is often aided by advice