Ethical Problems in Emergency Medicine

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, ixPreface, xiiiSection One: Challenging professionalism1 Physician care of family, friends, or colleagues, 3Taku Taira, Joel Martin Geiderman2 The impaired physician, 15Peter Moffett, Christopher Kang3 Disclosure of medical error and truth telling, 27Abhi Mehrotra, Cherri Hobgood4 Conflicts between patient requests and physician obligations, 37Shellie L. Asher5 Judgmental attitudes and opinions in the emergency department, 47V. Ramana Feeser6 Using physicians as agents of the state, 57Jeremy R. SimonSection Two: End-of-life decisions7 Family-witnessed resuscitation in the emergency department: making sense of ethical and practical considerations in an emotional debate, 69Kirsten G. Engel, Arthur R. Derse8 Palliative care in the emergency department, 79Tammie E. Quest, Paul DeSandre9 Refusal of life-saving therapy, 89Catherine A. Marco, Arthur R. Derse10 Revisiting comfort-directed therapies: death and dying in the emergency department, including withholding and withdrawal of life-sustaining treatment, 99Raquel M. Schears, Terri A. Schmidt11 Futility in emergency medicine, 117Arthur R. DerseSection Three: Representing vulnerable populations12 The care of minors in the emergency department, 129Chloë-Maryse Baxter13 Chemical restraints, physical restraints, and other demonstrations of force, 139Michael P. Wilson, Christian M. Sloane14 Capacity determination in the patient with altered mental status, 149Michael C. Tricoci, Catherine A. Marco15 Obstetric emergency: perimortem cesarean section, 15Kenneth D. Marshall, Carrie TibblesSection Four: Outside influence and observation16 Non-medical observers in the emergency department, 169Joel Martin Geiderman17 Religious perspectives on do-not-resuscitate (DNR) documents and the dying patient, 179Avraham Steinberg18 Non-physician influence on the scope and responsibilities of emergency physicians, 187Laura G. Burke, Jennifer V. Pope19 Privacy and confidentiality: particular challenges in the emergency department, 197Jessica H. Stevens, Michael N. CocchiSection Five: Emergency medicine outside the emergency department20 Short-term international medical initiatives, 209Matthew B. Allen, Christine Dyott, John Jesus21 Disaster triage, 221Matthew B. Allen, John Jesus22 The emergency physician as a bystander outside the hospital, 237Zev Wiener, Shamai A. Grossman23 Military objectives versus patient interests, 247Kenneth D. Marshall, Kathryn L. Hall-BoyerSection Six: Public health as emergency medicine24 Treatment of potential organ donors, 261Glen E. Michael, John Jesus25 Mandatory and permissive reporting laws: conflicts in patient confidentiality, autonomy, and the duty to report, 271Joel Martin Geiderman26 Ethics of care during a pandemic, 287John C. MoskopSection Seven: Education and research27 Practicing medical procedures on the newly or nearly dead, 301Ajay V. Jetley, Catherine A. Marco28 Ethics of research without informed consent, 311Dave W. Lu, Jonathan Burstein, John JesusAppendix: useful resources, 321Alexander BraceyIndex, 325

“This outstanding work immediately becomes the standard textbook for ethics in emergency medicine, as the best competing text (Ethics in Emergency Medicine, 2nd edition, Iserson et al. (Galen Press, 1995)) is relatively out of date. It is a crucial resource for all emergency professionals and anyone with an interest in emergency medicine ethics. ”  (Doody’s, 30 August 2013)