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Ethical Problems in Emergency Medicine: A Discussion-based Review



Ethical Problems in Emergency Medicine: A Discussion-based Review

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This book is designed to consolidate the relevant literature as well as the thoughts of professionals currently working in the field into a practical and accessible reference for the emergency medical technician, student, nurse, resident, and attending emergency physician. Each chapter is divided into four sections: case presentation, discussion, review of the current literature, and recommendations. Designed to serve simultaneously as a learning and reference tool, each chapter begins with a real case that was encountered in an ED setting. The case presentation is followed by a short discussion of the case, as if at a morbidity and mortality conference, by a panel of experienced attending physicians explaining how they would approach the ethical dilemmas associated with the case, and a review of the existing literature.

Contributors, ix

Preface, xiii

Section One: Challenging professionalism

1 Physician care of family, friends, or colleagues, 3
Taku Taira, Joel Martin Geiderman

2 The impaired physician, 15
Peter Moffett, Christopher Kang

3 Disclosure of medical error and truth telling, 27
Abhi Mehrotra, Cherri Hobgood

4 Conflicts between patient requests and physician obligations, 37
Shellie L. Asher

5 Judgmental attitudes and opinions in the emergency department, 47
V. Ramana Feeser

6 Using physicians as agents of the state, 57
Jeremy R. Simon

Section Two: End-of-life decisions

7 Family-witnessed resuscitation in the emergency department: making sense of ethical and practical considerations in an emotional debate, 69
Kirsten G. Engel, Arthur R. Derse

8 Palliative care in the emergency department, 79
Tammie E. Quest, Paul DeSandre

9 Refusal of life-saving therapy, 89
Catherine A. Marco, Arthur R. Derse

10 Revisiting comfort-directed therapies: death and dying in the emergency department, including withholding and withdrawal of life-sustaining treatment, 99
Raquel M. Schears, Terri A. Schmidt

11 Futility in emergency medicine, 117
Arthur R. Derse

Section Three: Representing vulnerable populations

12 The care of minors in the emergency department, 129
Chloë-Maryse Baxter

13 Chemical restraints, physical restraints, and other demonstrations of force, 139
Michael P. Wilson, Christian M. Sloane

14 Capacity determination in the patient with altered mental status, 149
Michael C. Tricoci, Catherine A. Marco

15 Obstetric emergency: perimortem cesarean section, 15
Kenneth D. Marshall, Carrie Tibbles

Section Four: Outside influence and observation

16 Non-medical observers in the emergency department, 169
Joel Martin Geiderman

17 Religious perspectives on do-not-resuscitate (DNR) documents and the dying patient, 179
Avraham Steinberg

18 Non-physician influence on the scope and responsibilities of emergency physicians, 187
Laura G. Burke, Jennifer V. Pope

19 Privacy and confidentiality: particular challenges in the emergency department, 197
Jessica H. Stevens, Michael N. Cocchi

Section Five: Emergency medicine outside the emergency department

20 Short-term international medical initiatives, 209
Matthew B. Allen, Christine Dyott, John Jesus

21 Disaster triage, 221
Matthew B. Allen, John Jesus

22 The emergency physician as a bystander outside the hospital, 237
Zev Wiener, Shamai A. Grossman

23 Military objectives versus patient interests, 247
Kenneth D. Marshall, Kathryn L. Hall-Boyer

Section Six: Public health as emergency medicine

24 Treatment of potential organ donors, 261
Glen E. Michael, John Jesus

25 Mandatory and permissive reporting laws: conflicts in patient confidentiality, autonomy, and the duty to report, 271
Joel Martin Geiderman

26 Ethics of care during a pandemic, 287
John C. Moskop

Section Seven: Education and research

27 Practicing medical procedures on the newly or nearly dead, 301
Ajay V. Jetley, Catherine A. Marco

28 Ethics of research without informed consent, 311
Dave W. Lu, Jonathan Burstein, John Jesus

Appendix: useful resources, 321
Alexander Bracey

Index, 325

“This outstanding work immediately becomes the standard textbook for ethics in emergency medicine, as the best competing text (<B><I>Ethics in Emergency Medicine</I></B>, 2nd edition, Iserson et al. (Galen Press, 1995)) is relatively out of date. It is a crucial resource for all emergency professionals and anyone with an interest in emergency medicine ethics. ”  (Doody’s, 30 August 2013)