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    Paternalism vs. Patient Autonomy in Emergency Situations

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    SCENARIO: An individual is brought into an ED with many injuries post car wreck. He had no identification and he was alone when his car went off the road and crashed. Surgery will be necessary, but the extent of the injuries are not yet known. Although he is in excruciating pain, the ED physician orders only minimal pain medication. He wants the patient to be coherent and able to assist in the decision-making necessary for his care rather than be comfortable and unable to participate in the decision-making process. What are the ethical concerns raising by this practice?

    Argue BOTH sides of the issue, and include ethical theories/principles.
    Please include paternalism vs. patient autonomy and the theory of "first do no harm" and the theory of beneficence.

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    The position of an ED physician is unique as he/she must "respond promptly and expertly, without prejudice or partiality, to the need for emergency medical care" (American College of Emergency Physician [ACEP], 2009, "Principles of ethics", para. 2) as well as "respect the rights and strive to protect the best interests of their patients" (ACEP, 2009, "Principles of ethics", para. 2) including respecting the patient's autonomy. In this scenario, by providing quick respond to acute illness and injuries the ED physician complies with the theory of beneficence as the treatment prescribed prevents or minimizes pain and suffering (ACEP, 2009).

    The dilemma stands on the facts that even though the patient needs surgery, the extent of the injuries is not known thus the situation can be considered either urgent or life threatening by the physician. In this scenario is clear that the ED physician considered this an urgent situation where the treatment could be delayed without serious harm until the ...

    Solution Summary

    The solution involves a detailed discussion of the paternalism, patient autonomy and the principle of 'do not harm' ethical theories/principles as they apply to the delivery of care in emergency situations. The implications of the ED practitioner's decision and the patient's right are also included in the discussion.