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Ethics in the trenches: Part 2. Case studies of ethical challenges in emergency medicine

Published online by Cambridge University Press:  21 May 2015

Merril Pauls ,
Andrew McRae ,
Sam G. Campbell  and
Paul Dungey
Merril Pauls*
Affiliation:
Departments of Emergency Medicine and Bioethics, Dalhousie University, Halifax, NS; Queen Elizabeth II Health Sciences Centre, Halifax, NS
Andrew McRae
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
Sam G. Campbell
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS; Queen Elizabeth II Health Sciences Centre, Halifax, NS
Paul Dungey
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, Ont
*
Dept. of Emergency Medicine, Queen Elizabeth II Health Sciences Centre, Halifax Informary, Rm. 3-021, 1796 Summer St., Halifax NS B3H 3A7; [email protected]

Abstract

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Unique ethical issues arise in the practice of emergency medicine, and common ethical problems are often more difficult to address in the emergency department than in other medical settings. This article is Part 2 of the Series “Ethics in the Trenches” and it presents and analyses 2 cases — each dealing with an ethical challenge that emergency physicians are likely to encounter. The first case deals with patient refusal of care. When a patient refuses recommended care, the emergency physician must ensure the patient’s decision is informed and that the patient comprehends the implications of his or her choice. The second case deals with patient involvement in criminal activities. Emergency physicians often encounter patients who have engaged in illegal activities. Although certain activities must be reported, physicians should be mindful of their responsibility to protect patient privacy and confidentiality.

Keywords

bioethicsemergency medicinerefusal of careconfidentiality
Type
Controversies • Controverses
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 5 , September 2004 , pp. 363 - 366
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Pauls, M, LeBlanc, C, Campbell, S.Ethics in the trenches: preparing for ethical challenges in the emergency department. Can J Emerg Med 2002;4(1):45–8.Google Scholar
2.Malette v. Shulman [1990] 67 D.L.R. 4th 321, 327 (Ontario, Can.). Available: http://aix1.uottawa.ca/~srodgers/1227syl.html (accessed 2004 July 29).Google Scholar
3.Beauchamp, TL, Childress, JF.Principles of biomedical ethics. 4th ed. Toronto (ON): Oxford University Press; 1994. p .125.Google Scholar
4.Palmer, RB, Iserson, KV.The critical patient who refuses treatment: an ethical dilemma. J Emerg Med 1997;15(5):729–33.CrossRefGoogle ScholarPubMed
5.Geiderman, JM.Ethics seminars. Consent and refusal in an urban American emergency department: two case studies. Acad Emerg Med 2001;8(3):278–81.Google Scholar
6.Thewes, J, FitzGerald, D, Sulmasy, DP.Informed consent in emergency medicine. Emerg Med Clin N Am 1996;14(1):245–54.Google Scholar
7.Larkin, GL, Marco, CA, Abbott, JT.Emergency determination of decision-making capacity: balancing autonomy and beneficence in the emergency department. Acad Emerg Med 2001;8(3):282–4.Google Scholar
8.Siegel, DM.Consent and refusal of treatment. Emerg Med Clin N Am 1993;11(4):833–40.Google Scholar
9.Etchells, E, Sharpe, G, Elliott, C, Singer, PA.Capacity. In Singer, PA, editor. Bioethics at the bedside: a clinician’s guide. Ottawa (ON): Canadian Medical Association; 1999. p.17–24.Google Scholar
10.Mayer, D.Refusal of care and discharging difficult patients from the emergency department. Ann Emerg Med 1990;19(12):1436–46.Google Scholar
11.Controlled Drugs and Substances Act. S.C., 1996, c. 19. Sect 2.1 and 5.2. Available: http://laws.justice.gc.ca/en/c-38.8/37013.html (accessed 2004 July 27).Google Scholar
12.Criminal Code of Canada. R.S., 1985, c. C-46. Sect 21.1(b) and 21.1(c). Available: http://laws.justice.gc.ca/en/C-46/40746.html (accessed 2004 July 27).Google Scholar
13.Part III. 1Disposal of controlled substances. Controlled Drugs and Substances Act. S.C., 1996, c. 19. Sect 24–28. Available: http://laws.justice.gc.ca/en/c-38.8/37013.html (accessed 2004 July 27).Google Scholar
14.Marshall, M, von Tigestrom, B.Health information. In: Downie, J, Caulfield, T, Flood, CM, editors. Canadian health law and policy. 2nd ed. Markham (ON): Butterworths Canada Ltd; 2002.Google Scholar
15.Kleinman, I, Baylis, F, Rodgers, S, Singer, P.Bioethics for clinicians: 8. Confidentiality. CMAJ 1997;156(4):521–4.Google Scholar
16.Irvine, JC.The physician’s other duties: good faith and confidentiality. In: Sneiderman, B, Irvine, JC, Osborne, PH, editors. Canadian medical law. An introduction for physicians and other health care professionals. Toronto (ON): Carswell; 1999.Google Scholar
17.Beauchamp, TL, Childress, JF.Professional–patient relationships. In: Principles of biomedical ethics. 5th ed. Oxford (UK): Oxford U.P; 2001.Google Scholar
18.Marshall, M, von Tigestrom, B.Privacy, confidentiality and the regulation of health information. In: Dykeman, , editor. Canadian health law practice manual. Markham (ON): Butterworths; 2000.Google Scholar