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Nowhere in your post do I see that you communicated your concerns with the ER staff and engaged in a discussion. You may not agree with the patient's decision, but it is not your decision to make, either. As others have said, autonomy is at the core of medical ethics. The patient's decision does not have to be the right one, only one they are competent to make. You don't have to agree with every decision a patient (or HPOA) makes. To whom, or what, are you protesting? Your follow up post indicates the ER staff tried to get him to stay. So who sees you stand tall against "The Man" by refusing to get in the back of the truck with the patient? Are you trying to tell the patient that you disagree so fervently with his decision that you will do nothing for him? A decision he has the eminent authority to make? So you basically took it out on your partner by sticking him with the run. It was a crappy thing to do. Good initiative, poor execution. Your first instinct should not be to foist the call on someone else. Your first instinct should be to shoulder that burden yourself. Share your concern with the patient and ER staff, share it with the patient, contact his family from home, or whatever. What will you do next time? Quit in protest? What will that solve? The only time you should dump a run on your partner is a) when he has better skills and the patient is sick enough to require them, your interaction with the patient is such that you don't feel you can provide good care, like if you got into a fight with him or she accused you once of sexual harassment, or c) it's his turn. A word on protest: it is better to change a poor system from within than just quit. People may care that you quit, but not enough to change anything. Quitting is certainly easier for you. What you did in this case, in a small way, was quit. 'zilla

Unfortunately, due to potential legal implications I do not feel like I could give medical advice over a public forum. I would suggest you discuss this with your medical provider. Sorry, I am not all that keen on giving medical advice on this forum regarding such a complicated situation. Good luck and take care. chbare.

Yes, you were wrong to protest it on principle, but you were not wrong to question it thoroughly on principle. I don't believe so, no. I believe that speaking with the pt about your concerns and with the doc if you felt it was appropriate was the right thing to do. But then, if it was truly the well informed pts wish, you should have taken him home. Yeah, you just don't know this yet. Somewhere in the paperwork was a paper signed by the doctor describing this pts medical need to be transported home by ambulance as opposed to private vehicle or taxi. The pts doc asked for it and your company was/will be paid for it. So do you then feel that the pt would have been better served by you and the EMS community had be been made to take a Taxi home? Long waits, embarrassing needs, perhaps unpleasant smells? A stranger and non medical professional to help him into his home and tuck him into bed? You're right, the pt IS going home, do you feel that we have advocated for him by making that journey as painful and embarrassing as possible? Do no harm is certainly the halo that surrounds our little profession, though being a pt advocate certainly hovers up there right next to. Your patient wanted to go home. You were called to care for this pt. If you felt that there were things about his/her condition that they didn't understand before going home then I believe that you were obligated to make them aware. If you felt that they were altered and not able to advocate for themselves, you were unquestionably obligated to do so. In this case you knew the pts wishes yet wished to thwart them as they made you uncomfortable, and that is the point that I believe you went off into the ditch. See? Yes, if the pt was mentating appropriately, then following his wishes was the right thing to do. No, it's not. You are not ultimately to do what you're told, you are ultimately to do exactly what you're doing now, which is learn to make the most competent, medically, morally and ethically sound decisions that you know how to the benefit of your pts regardless of your feelings. Will you end up in a shit storm because of it? Likely. When I was fired from my last job one of the last things the manager said is, "You do good medicine, it's just not paramedic medicine. We're not supposed to make people better, we're just supposed to save them if they're dying." I didn't know it then, but getting fired was exactly the right thing for me as I refuse to work in such a way. I, as well as the others in this thread I'm guessing, find the morals and ethics of EMS to be at least as challenging as the medicine. I think that its possible that you read the replies from those that have been doing this longer than you and see that this is a simple decision for them, or me. It's not, it's only that we've had a few more days to think about it. I know how vitally important this topic is to those that have posted answers for you because I can see that their answers were not canned. They have thought about these issues from every angle, over many patients, had a bunch of broken hearts while developing the answers that you've been given. So please don't see them as flippant. I was called to a lady during my FI at a new job a while back. She was in her late 80s, had been released from the hospital a few days before and her L lower leg was hugely swollen. She had been diagnosed with cellulitis which had now caused her entire lower leg to turn bright tomato red, hot as hell as well as cause her to present with general early stage sepsis. She was certainly going to die if she didn't choose to go to the hospital. We were not called by her but by a neighbor I believe... She was mentating clearly, language quick and concise, much more intelligent and well educated than myself and many of my coworkers, and simply didn't want to go to the hospital because she knew that when she showed up that they would see that she was not becoming better, was unable to care for herself, would involve social services and she would be forced into a nursing home, her greatest horror. And she was prepared to die, in fact may have even welcomed it. As a pt advocate, I wanted to refuse her, believe it or not. My instructions had been thorough up to and including, "Do you understand that it is my sincere belief that if you don't come with me today that we will be collecting your dead body from this chair within the next day or two? Not sicker, but dead.?" "If you have anyone that cares for you then you have no right to make such a foolish and selfish decision!" Lady, "I have no one that cares for me, no children, my family is all dead." Etc. Didn't softball her. But, as I was new at this service I chose to involve (after nearly an hour of effort) the police, my supervisors and social services to show them that I am in fact a team player. The police put her on a hold, I think, with social services signing off on it as her guardian, we took her to the hospital where she was treated and transfered to a nursing home who found her dead secondary to suicide a few weeks later. Oprah maybe would praise my efforts, but the bottom line is that this woman knew her own mind, she had a human right to choose to live and/or die at where she chose, yet me and a bunch of other yahoos decided to 'do the right thing' and make her die miserably. Major bruise to my paramedic spirit. You worry that you helped this pt make a decision that would bring them harm, and that is simply not true. You helped, or your partner did at least, this person carry out the decisions that they had made for themselves. Two completely different things. I love the fact that this is giving you heartache. I love the fact that you're pissed off that people don't seem to care about this patient. And I'm confident that if you are strong enough to have convictions and stand by them, a rarity in EMS, that you are going to be a fucking rock star medic. Dwayne I can promise you that it's an even shittier feeling knowing that you've taken someone in the last days of their lives and physically forced them to live out those days in a manner that they despise. It occurs to me that we haven't, in all of this learned conversation, considered the bullshit factor here. The truth is that some pts want to stay in the hospital. They like it, and the care that they receive, there much better than they like home or a nursing facility. But the truth of the matter is that we simply can't afford to keep everyone there that would like to stay. As I reread your post it sounds like it is possible that this pt was giving the answers he believed that he needed to give to be too sick to go home or to a nursing home but yet sick enough to stay in the hospital. I can't think of a single pt that I've had that TRULY wanted to go home that would admit to not being able to care for themselves. It's almost always the opposite. They are swearing that they can (as in the leg lady) when I know damned good and well that they can't. Just a thought... Dwayne