Physicians in the emergency department are usually faced with a lot of job related ethical challenges unlike in other medical departments. According to Littleton, V., et al. (2010) the era of technological advancement and cultural diversity, cases of ethical dilemmas have become more complicated.
There are competing rights and interests that arises in the emergency department, this usually puts the physician whom is very busy in an awkward position. There is a right of a patient to refuse medication when a thorough analysis of his/her decision making capacity shows that it’s not impaired. In this situation Merril Pauls, et al. (2004). puts that the physician has to explain carefully to the patients the consequences of his/her decisions. This right doesn’t limit the physician from administering emergency treatment in cases where the patients lack decision-making capacity. It is usually recommended that when a physician is faced with this dilemma (of a patient refusing medication) a full capacity assessment should be undertaken. This is usually not possible in practice especially in the emergency department. Therefore, a physician has to use a set of questions to screen the patient. A patient who will answer all this questions fully can be accepted to have decision making capacity and is allowed to exercise his rights. According to Merril Pauls, et al. (2004). example of these questions are;
- What is the nature of your current medical problem? (i.e., what is wrong with you?)
- What options are available to you? (i.e., do you know what your options are?)
- What's likely to happen if you accept the offered treatment? If you refuse it?
- What is your choice?
- Why have you made this choice?
Anothe ethical dilemma faced by physician is the duty of safeguarding patient’s privacy and his professional duty to the legal system. Before disclosing this private information there must be a clear indication of harm to the community if a physician doesn’t report this to the police. Furthermore, the law does not oblige the physician to disclose this confidential information to the authorities. The physician code of conduct and professional ethics allows them to keep this private knowledge of the patient private. This gives patient confidence in sharing important information that could allow the physician to provide correct medication.
Ethical theories and principles
According to Devettre (1995), ethics is concerned with what we choose to do intentionally with the recognition that the choices are implied to be either good or bad. The history of ethical theories is known to have been at the time of the great philosophers e.g. Socrates, Plato and others. One of the oldest theories that were used in the medical field was the natural law theory. This theory was connected with the God’s law and in this sense a person was required to act morally according to God’s rule. Under these criteria, in vitro fertilization and homosexuality would be considered unethical (Devettre, 1995; Pence, 2000).
Modern theories have moved away from this divine law related theories to more new approaches. Some of these theories are;
- Natural rights – people have right to life, or chose to die
- Justice as fairness - every person must have equal access to medical care unless unequal access favors the poor.
- Utilitarianism – this tries to show and support moral obligation that will bring more benefits to most people.
According to Savulescu (2007) modern philosophers advocate for a combination of the three theories of well-being, including "Mental" state theories, "Desire" fulfillment theories, and "Objective" list theories. There are principles, regulations, legislations, professional codes that govern the practice of medical professionals. Professional standards established by the board of medical practitioners and other boards in the medical field regulate the code of conduct of the physicians. Some of the applicable principles in the medical care are;
- Accountability - This is a basic ethical concept in health care and is defined as giving of account for responsibilities involved by the job assumed.
- Beneficence – oxford dictionary defines this as doing good, being generous. Littleton, V., et al. (2010) explains that, it is one of the basic medical ethical values which recognizes that there is a general obligation to protect individuals from harm and to ensure their welfare.
- Autonomy – freedom of the patient to make his/her own decision after receiving sufficient and understandable information from the physician.
- Justice – in the medical field, it is the fairness in equal distribution of health resources.
- Truthfulness and honesty – according to Littleton, V., et al. (2010), these two qualities are very controversial. Whether or not one should give precedence to the duty to do well or the duty to avoid harm depends on the decisions made by the individual.
Finally according to Mechanic, D. (1999, August), trust is prominent to the provision of health care because it is a setting characterized by uncertainty and an element of risk regarding the competence and intentions of the practitioner on whom the patient is reliant.