Emergency medicine clinics of North America
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Good Samaritan Acts are those in which aid is rendered to a needy victim of injury or sudden illness. No antecedent relationship exists with the good samaritan, and no remuneration is anticipated. Emergency physicians have an ethical obligation beyond that of other citizens to provide aid in such situations of medical need; professional and legal standards support that obligation.
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Ethical issues in emergency medicine often are accompanied by legal issues. Although the legal aspects of an ethical problem are important factors to take into consideration, the law may not directly address the problem, and following the law does not always ensure an ethical outcome. Emergency physicians should have an understanding of ethics and law, understand the legal aspects of bioethical issues in emergency medicine, and finally have a guide to analyze ethical issues, including the consideration of legal issues that may have an impact on the case.
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Different types of advance directives invite varying interpretation from emergency care professionals. As informed consent of a patient is not always possible to procure in emergency situations, advance directives can provide useful guidelines for clinicians' decision-making processes regarding individual patient care. Specifically communicated instructions establish a course of aggressive or nonaggressive treatment, while general wishes leave the emergency department physician to assume an innate understanding of individual patients while undertaking an active role in decision-making for that patient's care. This article explores the relationship between advance care directives and the emergency department.
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There is a wide variety of ethical issues and dilemmas involving resuscitation, the act of restoring life to a patient in cardiorespiratory arrest. Decisions must be made rapidly and often must be based on suboptimal levels of information available at the time. Certain issues should be considered when one is making decisions in the resuscitation arena, including positive-aspects of resuscitation, not only the possibility of restoring life to the patient but also providing a sense of closure and resolution of guilt for the survivors. During and following resuscitative efforts, the psychologic and emotional well-being of the survivors should also be given close attention.
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End-of-life care, as it merges with emergency medicine, raises as many ethical issues as it does clinical judgments. The role of the ED physician as it pertains to end-of-life treatment options encompasses a vast array of variables that should nevertheless center on patient welfare. The choice between ethical responses and trained reactions is an ever-present reality in emergency medicine, and the instinct to perform aggressive procedures may overshadow the professional purpose to inform, comfort, counsel, and treat. The exercise of clinical judgment should be balanced by previously reasoned ethical conduct codes when it comes to end-of-life emergent care.