Article in Medicine
An editorial reflecting on challenges faced by doctors and health care professionals in providing emergency care (especially in war zones). The focus is on the moral dimensions of emergency medicine, including a concise statement of principles.
 
 
 

Ethical principles and challenges to the provision of emergency medicine

Dr Roger P Worthington

In response to recent world events, it may be an appropriate time to consider the need for ethical principles that specifically govern the provision of emergency medicine. In some instances, the total lack of security for healthcare professionals and their patients, such as recently existed in Eastern Aleppo, poses an existential threat to the provision of medical care. [1], [2], [3] Furthermore, with injuries that are the direct result of the Syrian conflict, emergency care is going to be impacted the most. This situation is beyond the imaginings of most ordinary people, and the gravity of the situation is hard to take in, with medical staff not only putting their lives on the line day after day, but having to work in extreme, challenging conditions. Fine words will do nothing to ameliorate a situation such as this, but given that the basic tenet of emergency medicine is to protect human life and relieve suffering (whether brought about through accident, illness, natural or man-made disasters), the moral implications of this escalating problem demand special attention.

Principles that have long been in place pertaining to health as a human right are simply too broad to have practical validity, [4] especially in a war zone, but if the international community were to define core ethical principles specifically relating to the provision of emergency medicine, then if/when they are flouted, at the very least they could be taken as evidence of unethical conduct to be cited in future investigations. [5] Such principles could be defined and utilised in two ways: inserted as a preamble to clinical guidelines for emergency medicine, and/or posted publicly in emergency medical departments. [6] While it would be naïve to suppose that something this simple will change human behaviour, all the same, it could serve as a reminder of what the enterprise is all about.

Here is a possible wording:

Emergency medicine is about the protection and preservation of human life, underpinned by humanitarian principles; the ethics of care in emergency medicine poses responsibilities on medical staff that are worthy of respect by individuals and by the wider international community.

The choice of words can be argued, and while it could be said that all forms of health care are humanitarian, such a statement would have political overtones and again be too broad to be of much practical value. However, since emergency medicine differs from other forms of medicine, and facilities for its provision are at the epicentre of most major hospitals, it is not unfitting for emergency departments to have their moral purpose clearly stated and there for all to see. Even in less extreme situations than those currently prevailing in Syria, a public statement of such principles would serve to remind the public who use such services that medical professionals striving to provide emergency medical care should not be threatened or abused. [7]

References

  1. http://www.nytimes.com/2016/11/21/world/middleeast/aleppo-syria-bombs-hospital.html?emc=edit_th_20161121&nl=todaysheadlines&nlid=58548405
  2. http://www.who.int/hac/crises/syr/en/
  3. https://www.msf.org.uk/country/syria
  4. http://www.un.org/en/universal-declaration-human-rights/
  5. http://www.nytimes.com/2016/11/22/opinion/doctors-should-stand-against-trump-reviving-torture.html?_r=0
  6. http://media.elsevierhealth.com.au/media/blfa_files/Emergency_Medicine_6th_edition_978072954146 6_Fulde.pdf
  7. http://emj.bmj.com/content/15/4/262.short
  8. References accessed Nov 24, 2016
 
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About the Author 

Roger P Worthington
Medical educator and policy consultant based in London (UK). PhD from State University of New York at Buffalo (Philosophy). Adjunct faculty

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