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INTRODUCTION

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There can be no greater calling or higher standard for ethical behavior than that assumed by the physician. Our obligation to our patients is paramount and society expects that we conduct ourselves within this standard. We enjoy great privilege as part of our maintenance of these standards and likewise we are held emphatically to these expectations as well. There is little room for lenience among us when these standards are compromised. This is appropriate as the effect on patients, colleagues, and entire organizations can be profound. Public trust and decades of ethical investment may be compromised by the actions of a single transgressor.

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The importance of these standards cannot be overstated. This is reflected in the innumerable organizational codes of ethical behavior as well as in federal, state, and local statutes. As physicians the most generally applicable reference is the American Medical Association’s Code of Medical Ethics.1 In keeping with the focused nature of this text we will constrain our discussion to how these principles affect the ethical management and oversight of EMS organizations.

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OBJECTIVES

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  • Discuss principles of ethical management and medical oversight (honesty, responsible mentoring, maintaining objectivity, respect for colleagues, integrity, social responsibility, carefulness, nondiscrimination, openness, competence, legality, respect for intellectual property, confidentiality, human subjects’ protection, responsible publication).

  • Define fiduciary responsibility, and discuss how this relates to EMS administrators and medical directors.

  • Describe work place harassment and how it affects individuals and an agency as a whole.

  • Describe the duty to report, as it relates to illegal acts, unethical conduct, and impaired providers.

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MEDICAL ETHICS

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EMS physicians have the same ethical obligations as other health care providers. These are applied in a wide variety of circumstances, including during individual patient encounters, mass casualty incidences, and in management of medical oversight of an EMS system. Adhering to the expected medical code of conduct requires personal attention and a keen attention to EMS provider education. The protocol-driven nature of much of prehospital medical care can lead to unintentional violations of ethical standards.

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Nonmaleficence: (Primum non nocere) “first do no harm.” Acting in a way as to minimize risk to the patient rather than focusing on therapeutic interventions. It is important to emphasize this concept when considering protocol and procedure development. Some protocols and dogmatic approaches to clinical situations may lead to unnecessary interventions if too general of an approach is advocated or prescribed in the protocol. Routine placement of IV catheters may be an example of a potentially harmful intervention that could be overly prescribed based on wording of a protocol.

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Beneficence: acting in a manner that in one’s best judgment will benefit the patient. This concept is core to all areas of health care and must be constantly reinforced as the driving principle behind every act by every physician and EMS provider in the system.

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