Ethical Problems in Emergency Medicine – A Discussion–based Review

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 Chloe-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