Morals, Ethics and Paramedicine

Now before we start talking about morals and ethics in paramedicine, we must first understand the difference between morals and ethics. Morals and ethics both try to determine how one should act in a difficult situation, however; morals refer to social, religious, or personal standards or right and wrong. Ethics, on the other-hand, refers to the rules or standards that govern the conduct of members of a particular group or profession.

It might be tempting to just look at the law for standards of conduct, and though ethics are related to the law, they are not at all the same thing. Whereas the law is mostly concerned with what is wrong, and punishes people for doing things they aren't supposed do, ethics is concerned with doing what is right. As such, the law often has nothing to say on ethical quandaries. Ethics and law do have some related factors though. For instance, both require impartiality, consistency, logic and the balancing conflicting interests.

Religion is another area that may be able to answer our ethical dilemmas. The problem is that there are so many different religions and views, how do we determine which is appropriate? If two people have different religious beliefs, both providing different answers to an ethical dilemma, who is right? Or, are they both right? It is true that religion can enhance and enrich a person's ethical principals and values, but I hope that you can now see why it cannot always be relied on to provide the necessary answers to ethical problems.

Codes of ethics have been developed by a number of organizations (ex. Paramedic Association of Canada) in order to provide their practitioners with guidelines to help with ethical decisions. The PAC has developed a National Code of Ethics for prehospital care. The purpose of this is to:
-Define and clarify ethical principals.
-Identify the basic moral commitments of prehospital emergency medical practitioners.
-Serve as a source for education and reflection.
-Serve as a tool for self-evaluation and peer review.

It is important to note that values are generally the broad ideals for proper prehospital care. The standards refer to moral obligations of the paramedic based on prehospital values. Standards are generally more specific than values.

The National code of ethics from the PAC list three ethical problems faced by paramedics.
-Ethical violations occur when practitioners neglect or fail to meet their moral obligations to their patients.
-Ethical dilemmas arise when reasons both for and against a particular action are present and a decision must be reached.
-Ethical distress occurs when practitioners are in a situation that provokes feelings of guilt, concern or distaste.

Because the guidelines provided by a code are often broad, they very rarely address specific problems or situations. In these cases, it is up to the paramedic to determine the proper action. In order to accomplish this there are a few steps which should be taken:

1. Figure out exactly what the problem is. What are you looking to do, who does it involve, and what are the conditions.

2. List all the implications and consequences of the action, both positive and negative.

3. Compare all the consequences with relevant values that pertain to the case.

Often these values reference the four fundamental principals of bioethics (ethics applied to the human body). These principals are:
-Beneficence - doing good for the patient
-Nonmalfeasence - do no harm to the patient
-Autonomy - the competent adult patient's right to determine what happens to their own body
-Justice - the obligation to treat all patients fairly

Unfortunately, the paramedic in the field does not have time to sit down and go through those steps. In the field, the paramedic may look back on past events and situations to determine whether or not they have already formulated a rule that fits a given situation. If not, there are three tests that can help to quickly solve ethical dilemmas.
-Impartiality Test - Would you be willing to undergo the procedure in the patients place?
-Universalizability Test - Is this the action you would want preformed in all similar circumstances?
-Interpersonal Justifiability Test - Can you appropriately defend and/or justify your actions to others?

Using these, a paramedic can quickly make decisions in difficult situations, enabling the best possible patient care.