Ethical Problems in Emergency Medicine

John Jesus, MD, Chief Resident, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Clinical Instructor, Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA. Peter Rosen, MD, FACS, FACEP, Director of Education, Beth Israel Deaconess Medical Center; Senior Lecturer in Medicine, Harvard Medical School, Boston, MA, USA. Shamai A. Grossman, MD, MS, FACEP, Vice Chair for Resource Utilization; Director, Cardiac Emergency Center, Division of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School, Boston, MA, USA. Arthur R. Derse, MD, JD, FACEP, Director, Center for Bioethics and Medical Humanities, Julia and David Uihlein Professor of Medical Humanities; Professor of Bioethics and Emergency Medicine, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA. James G. Adams, MD, Professor and Chair, Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA. Richard Wolfe, MD, Chief of Emergency Medicine, Beth Israel Deaconess Medical Center; Associate Professor of Medicine, Harvard Medical School, Boston, MA, USA.

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