Ethics of Emergency Department Cancer Care

Chapter

Abstract

Bioethical foundational theories (e.g., utilitarianism, deontology) and mid-level principles (e.g., autonomy, beneficence, nonmaleficence, distributive justice) as well as the virtues embodied in emergency medicine (e.g., truth telling) help guide clinicians through some of the most difficult situations they face. Emergency department (ED) patients with hematological-oncologic illnesses often present with knotty situations involving patient autonomy, decision-making capacity, surrogates and their decisions, end-of-life issues, or demands and concerns that involve bioethical dilemmas. Emergency physicians must be prepared to address these issues, with little time for reflection. Familiarity with the rapid decision-making model can help them find at least short-term resolutions. The model, based on case-based reasoning (casuistry), employs well-known ethical principles in a manner designed for emergency clinicians to use easily when ethical dilemmas present. Just as they prepare for other clinical situations, emergency physicians should also prepare to face bioethical dilemmas that will inevitably occur.

Keywords

Bioethics Medical ethics Values Ethical dilemmas Rapid decision-making model Autonomy Beneficence Nonmaleficence Justice Bioethics Committees 

References

  1. 1.
    American College of Emergency Physicians Ethics Committee. Code of ethics for emergency physicians. Dallas, TX: ACEP; 1997.Google Scholar
  2. 2.
    Iserson KV. Principles of medical ethics. In: Marco C, Schears R, editors. Clinical ethics in emergency medicine. Cambridge: Cambridge University Press; 2015.Google Scholar
  3. 3.
    Iserson KV, Heine C. Bioethics. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen’s emergency medicine: concepts and clinical practice. 7th ed. Philadelphia, PA: Mosby; 2013. p. e33–46.Google Scholar
  4. 4.
    Larkin GLL, Iserson KV, Kassutto Z, Freas G, Delaney K, Krimm J, et al. Virtue in emergency medicine. Acad Emerg Med. 2009;16:51–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Pirkei Avot 2:5 (Book of Principles) 200–220 AD.Google Scholar
  6. 6.
    Iserson KV. Ethical principles—emergency medicine. Emerg Med Clin North Am. 2006;24(3):513–45.CrossRefPubMedGoogle Scholar
  7. 7.
    Arras JD. A method in search of a purpose: the internal morality of medicine. J Med Phil. 2001;26:643–62.CrossRefGoogle Scholar
  8. 8.
    Kuczewski M. Methods of bioethics: the four principles approach, casuistry, communitarianism. http://www-hsc.usc.edu/~mbernste/tae.methods.kuczewski.html.
  9. 9.
    Beauchamp TL, Childress JF. Principles of biomedical ethics. 1st ed. New York, NY: Oxford University Press; 1979.Google Scholar
  10. 10.
    Iserson KV, Biros M, Holliman CJ. Ethics of international emergency medicine. Acad Emerg Med. 2012;19:683–92.CrossRefPubMedGoogle Scholar
  11. 11.
    Schloendorff v Society of New York Hospital, 105 NE 92, 93, 1914.Google Scholar
  12. 12.
    Drane JF. Competency to give an informed consent. JAMA. 1984;252(7):925–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Iserson KV. The three faces of “yes”: consent for emergency department procedures. Am J Bioethics. 2007;12:42–5.CrossRefGoogle Scholar
  14. 14.
    Iserson KV. A simplified prehospital advance directive law: Arizona’s approach. Ann Emerg Med. 1993;22(11):1703–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Iserson KV. Nonstandard advance directives: a pseudoethical dilemma. J Trauma. 1998;44(1):139–42.CrossRefPubMedGoogle Scholar
  16. 16.
    Iserson KV. The rapid ethical decision-making model: critical medical interventions in resource-poor environments. Camb Q Healthc Ethics. 2011;20(1):108–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Iserson KV, Sanders AB, Mathieu DR, editors. Ethics in emergency medicine. 2nd ed. Tucson, AZ: Galen Press, Ltd; 1995.Google Scholar
  18. 18.
    Iserson KV, Goffin F, Markham JJ. The future functions of ethics committees. HEC Forum. 1989;1(2):63–76.CrossRefPubMedGoogle Scholar
  19. 19.
    Iserson KV. Withholding and withdrawing medical treatment: an emergency medicine perspective. Ann Emerg Med. 1996;28(1):51–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Boisaubin EV, Lynch GR, Dresser R. Hypercalcemia of advanced malignancy: decision making and the quality of death. Am J Med Sci. 1991;301:314–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Popularized by Dr. Edward Livingston Trudeau (1848–1915), but also cited as a 15th century folk saying.Google Scholar
  22. 22.
    Spivey WH, Abramson NS, Iserson KV, MacKay CR, Cohen MP. Informed consent for biomedical research in acute care medicine. Ann Emerg Med. 1991;20:1251–65.CrossRefPubMedGoogle Scholar
  23. 23.
    Iserson KV. Has emergency medicine research benefited patients? An ethical question. Sci Eng Ethics. 2007;13:289–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Iserson KV. Physician ethics in human research: the role of medical publications. Ann Emerg Med. 1990;19:828.CrossRefPubMedGoogle Scholar
  25. 25.
    Bounes V et al. Quality of publications in emergency medicine. Am J Emerg Med. 2013;31:297.CrossRefPubMedGoogle Scholar
  26. 26.
    Landesman BM. Physician attitudes toward patients. In: Iserson KV, Sanders AB, Mathieu DR, et al., editors. Ethics in emergency medicine. 2nd ed. Tucson, AZ: Galen Press, Ltd; 1995. p. 350–7.Google Scholar
  27. 27.
    Moskop JC, Iserson KV. Triage in medicine—part II: underlying values and principles. Ann Emerg Med. 2007;49(3):282–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Kubler-Ross E. On death and dying. New York, NY: Macmillan; 1969.Google Scholar
  29. 29.
    Novack DH, Detering BJ, Arnold R, et al. Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA. 1989;261:2980–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Iserson KV. Grave words: notifying survivors about sudden unexpected deaths. Tucson, AZ: Galen Press, Ltd.; 1999.Google Scholar
  31. 31.
    Iserson KV. Pocket protocols: notifying survivors about sudden unexpected deaths. Tucson, AZ: Galen Press, Ltd.; 1999.Google Scholar
  32. 32.
    Korsch BM, Negrete VF. Doctor-patient communication. Sci Am. 1972;227:66–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Emergency MedicineUniversity of Arizona, TucsonTucsonUSA

Personalised recommendations