Still more Everyday EMS Ethics – Gkemtp(it) is born

I’ve been on this kick lately for medical ethics in EMS. So, I’ve decided that “Everyday EMS Ethics” is going to be a featured area on my blog. I think that It’s annoying my wife Gkemtb who, by the way, is starting Paramedic school today and is now becoming Gkemtp(it). The (it) means, “in training”.

The unfortunate thing is that she’s now reading her paramedic textbook and she’s asking me ethical questions as she’s studying medical legal aspects of paramedicine. Tonight, she asked me this question:

Imagine you’re in the back of an ambulance with a patient on a long-distance transfer. During the transfer, the patient states to you: “I think that I’m ready for my life to end. I’ve had a good run and I’m just comfortable with the idea of the end of my life. If I die, don’t do anything to bring me back. I’m ready to go”.

 I said, “Well… it depends. Is the patient in his right mind?”, “How old is the patient?”, “is this a suicidal ideation? Or is this someone who might be getting ready to sign a DNR but hasn’t yet?”. She indicated that in her mind, it was an elderly person with a long medical history. If it was someone that was possibly mentally ill… the likelihood of which increases with decreasing age and better long-term prognosis, then I wouldn’t honor it just the same as you wouldn’t kill someone who asked you to kill them because they wanted to commit suicide. However, if it was, say, a long term brain cancer patient that had metastasized and was causing great pain… then it’s a different question. Ultimately, if I was the only person that the patient said it to, I would try to get them to say it in front of other witnesses. If that couldn’t happen, and the patient did in fact go into cardiac arrest… well then I would probably resuscitate them because I would never be able to prove that I acted in accordance with the patient’s wishes. But I wouldn’t like it. Please tell me what you would do, because heck, I don’t know…

The other thing she brought up was if I knew about the “Oath of Geneva” and um… I didn’t know about it.
A quick Google search brought it right up for me, so here it is:

Physician’s Oath

At the time of being admitted as a member of the medical profession:
  • I solemnly pledge myself to consecrate my life to the service of humanity;

  • I will give to my teachers the respect and gratitude which is their due;

  • I will practice my profession with conscience and dignity; the health of my patient will be my first consideration;

  • I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers;

  • I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;

  • I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;

  • I make these promises solemnly, freely and upon my honor.
According to the article I read on it, which surprisingly wasn’t from Wikipedia this time, and is located at ( this oath was adopted by the World Medical Association (A group made up of National Medical Associations… well, read it yourself:

The World Medical Association is an association of national medical associations. This oath seems to be a response to the atrocities committed by doctors in Nazi Germany. Notably, this oath requires the physician to “not use [his] medical knowledge contrary to the laws of humanity.” This document was adopted by the World Medical Association only three months before the United Nations General Assembly adopted the Universal Declaration of Human Rights (1948) which provides for the security of the person.

Paramedics come from physicians. Therefore, I believe that we are to honor much of the same ethical standards as they are. Healthcare is an honorable profession. We have the obligation to carry it on that way.

Sorry about the serious posts lately guys J I’ll go back to posting about driving fast and kneeling in poo soon.

  • mack505

    It's interesting that as paramedics we are encouraged to think clinically but usually not allowed to think ethically.

    In my state, this is unfortunately a no-brainer. No DNR=resuscitation. Period. If I don't, I can lose my livelihood or worse.

    I won't like it though, and I've been in similar situations. I tend to place blame for them firmly on the MDs, RNs, and discharge planners who haven't fully explored the issue with these patients before discharging them into my care.

    The same answer goes for the airway issue in your previous post. It doesn't matter what I know I can do; if the protocols or online MD don't allow it, I can't do it. Even if I get it right and the patient lives, I will lose my right to practice. If it goes wrong, there goes the house and maybe my freedom.

    So how do we solve this?