A question of ethics

[thrutheashes]

I had the opprotunity to be a part of a very informative in-service dealing with pediatric patients yesterday, that was hosted by a Medical Director form another area. However one part of the in-service is not sitting well with me and I would like some feed back on what others think. He stated that it is "ok to lie to get pt's to come to hospital, but not if you are trying to get out of transporting the patient." Personally I do not agree with this statement. As EMS PROFESSIONALS, I don't believe we should be, nor does our code of ethics allow us to, lie to our patients. As well, we make one lie on scene, and if things snow ball, we may well be having our own character called into question, which then has other people's ability to trust us compromised as well. Is it worth it? So I ask the people in these forums, Is it ok to lie to pt's? If so when? Or am I over thinking this entire thing?Thanks.

[fireflymedic]

Lying to a patient - absolutely not. Now using persuasion of things that might possibly happen should they choose not to come with you to the hospital, a totally different issue. Even if the chance is remote or unlikely, I find it well within my bounds to say yes this may happen to you if you don't come with us. If I have to do the dance if I seriously think a patient needs to go I will. Now there is one exception to this rule :

A disoriented or elderly confused patient - some of them can be a challenge to convince to go due to financial concerns, confusion, or just plain stubborness. Also, many are afraid that if they leave their home they won't be able to return to it and would rather die within their home than be placed in a nursing home. Especially if they are having difficulty caring for themselves. I don't lie per se - but dance around the truth a bit - I'll say they'll do their best to get you back home even if I know it's highly unlikely that person will be returning - you never know ! But I don't believe in ever flat out lying to a patient just to get what is productive for you. That's just bad form.

[VentMedic]

I had the opprotunity to be a part of a very informative in-service dealing with pediatric patients yesterday, that was hosted by a Medical Director form another area. However one part of the in-service is not sitting well with me and I would like some feed back on what others think. He stated that it is "ok to lie to get pt's to come to hospital, but not if you are trying to get out of transporting the patient." Personally I do not agree with this statement. As EMS PROFESSIONALS, I don't believe we should be, nor does our code of ethics allow us to, lie to our patients. As well, we make one lie on scene, and if things snow ball, we may well be having our own character called into question, which then has other people's ability to trust us compromised as well. Is it worth it? So I ask the people in these forums, Is it ok to lie to pt's? If so when? Or am I over thinking this entire thing?Thanks.

Each situation will be different. If I have seen the lab results for a child and they show the child has inoperable CA but hasn't been told yet, I may lie and say I haven't seen the results. This goes for IFT, Specialty and the ED as well as in the hospital. If I have CF patient who wants to know about certain experimental meds and then wants to know if he qualifies, even though I know he doesn't because of a previous discussion in his care rounds, I will not tell him I know if he does or doesn't.

If I have to do a little role playing with an elderly patient because of dementia, I have no problem to do what it takes if the person needs to go the the ED or take a treatment. If you have even worked in a LTC facility, you can tell someone it is Tuesday 2010 a hundred times and they will still be on Saturday 1920. I can be anyone for Bette Davis to Captain Hook if that is who they see me as in their mind regardless of how many times I identify myself. My ambulance can be a train, plane or cruise ship if that is what they want it to be.

Some EMT(P)s also can not accept death themselves and will lie to the patient that "you'll be good a new" even the person's body parts are no longer attached or where they should be just so they don't have to deal with a difficult situation themselves. Some EMT(P)s will take a cold stiff SIDS baby into their ambulance and race to the hospital telling the parents the hospital will be able to do something. I do find fault with that but then not everyone handles death the same way or has the training/education and protocols to deal with these situations.

I will not tell a child a needle stick doesn't hurt. I will not make promises of candy and delights at the hospital. I also will not go against the wishes of the parents as to what the child should and should not know if it is not necessary.

However, I have pretended not to notice things and have made up some excuse to separate the child who is battered from his parents to get him medical help and into protective custody. The same for a battered spouse be it male or female.

[JTpaintball70]

However, I have pretended not to notice things and have made up some excuse to separate the child who is battered from his parents to get him medical help and into protective custody. The same for a battered spouse be it male or female.

This is a completely different issue altogether. This is one of the times that you do what it takes to protect your patient.

[VentMedic]

This is a completely different issue altogether. This is one of the times that you do what it takes to protect your patient.

What's the difference if you lie in this situation or lie to the patient about something else?

Families of certain cultures want us to lie the spouse of an elderly family member all the time. Sometimes they also do not want anybody to even tell the patient how sick they are and that is all in the name of "protection" as well. I personally believe a person and their spouse has the right to know but often the medical profession will abide by the wishes of the family in some cultures.

[Mateo_1387]

Lying to a patient - absolutely not. Now using persuasion of things that might possibly happen should they choose not to come with you to the hospital, a totally different issue. Even if the chance is remote or unlikely, I find it well within my bounds to say yes this may happen to you if you don't come with us. If I have to do the dance if I seriously think a patient needs to go I will. Now there is one exception to this rule :

A disoriented or elderly confused patient - some of them can be a challenge to convince to go due to financial concerns, confusion, or just plain stubborness. Also, many are afraid that if they leave their home they won't be able to return to it and would rather die within their home than be placed in a nursing home. Especially if they are having difficulty caring for themselves. I don't lie per se - but dance around the truth a bit - I'll say they'll do their best to get you back home even if I know it's highly unlikely that person will be returning - you never know ! But I don't believe in ever flat out lying to a patient just to get what is productive for you. That's just bad form.

I agree that lying to a patient (in most circumstances) is not the professional method to 'get someone to the emergency room'. We had a thread here recently that discussed points similar to this one and I cannot find it. Anyways, I will repeat what I said in that thread. For starters, I will post the definition of coercion.

co⋅erce [koh-urs]

–verb (used with object), -erced, -erc⋅ing.

1. to compel by force, intimidation, or authority, esp. without regard for individual desire or volition: They coerced him into signing the document.

2. to bring about through the use of force or other forms of compulsion; exact: to coerce obedience.

3. to dominate or control, esp. by exploiting fear, anxiety, etc.: The state is based on successfully coercing the individual.

Pay special attention to number 3. Exploiting fear, anxiety, etc, to dominate or control. In essence, getting the patient to do what we think is best for them. Another way to say it, and this one of my favorites which was stolen from DwayneEMTP, 'gifting them with our advocacy'.

We, as professionals, have an obligation to respecting the freedom of choice concerning our patient's bodies (if they are capable of making decisions for themselves). We, as professionals, have no right or obligation to scare patients into going to the hospital because we know or think it is best for them. The decision is and should be their decision to make. Telling patients things such as 'you will die if you do not come with us', especially being a small remote chance, is coercion at its finest. Informing patients about complications of their medical condition is one thing, using those complications to promote your agenda is something entirely different.

The same holds true for those who threaten medical procedures. 'Wake up or I will put a big needle in your arm' or 'tell me what pills you took or I will have to shove a tube through your nose to your stomach' or 'you will die if you do not hold still' etc are all forms of coercion. We should honestly take a look at how we talk to patients. Sure, compliance may be easier if you use coercion. Taking a moment to talk to your patient, explain to them the why behind why something is warranted go a whole lot further with patient interactions than using some of the above phrases.

Matty

[itxtme]

This is a completely different issue altogether. This is one of the times that you do what it takes to protect your patient.

I completely disagree; if you lie to a patient, you lie to them! I wonder if the OP's colleague has been taken out of context. I agree that there are times where the truth must be bent for the benefit of the pt. In those scenarios we all do it. There are degrees to the lies that you tell, and that is what VentMedic is getting at, but when a definitive benefit to the patient exists most health professionals tell the odd white lie to aid in the best outcome for their patient!!

[Eydawn]

Lying, falsifying information or coercing a patient are all great big ethical no-no's in my book. The hardest thing for many EMS providers to accept is the patient's right to make stupid decisions. They have the right of refusal as long as they are alert, awake, and oriented...

There is a sincere difference between honest education about potential consequences and using "scare tactics" to make them do what you want. You can educate until you are blue in the face; if the answer is no, then it is no. The exception to this would be a situation where you know that something is profoundly off with the patient, and you consult online medical control to get a legal "medical hold" in which you can supersede the patient's wishes. But then it is on the doctor's responsibility, and you have to paint a pretty good picture of whatever the funky situation is for a doctor to be willing to back that decision.

Selective omission, as far as I see it, is much preferable to falsification, but only in certain circumstances. I think Vent covered that idea pretty thoroughly.

I think the statement that has been called into question was honest and sincere in its intent, but poorly worded... I think what the educator probably meant was to emphasize encouraging care with whatever means you had available in order to increase the odds of good patient outcome. I don't think he was endorsing just flat out lying and scaring the crap out of people to get them in the ambulance all the time. I also think he was emphasizing that you shouldn't downplay something because you don't want to transport. In other words, I think I understand the purpose of the statement but disagree with how the message was delivered.

Wendy

CO EMT-B

[ccmedoc]

I would imagine the answer to the lying question would depend entirely on the ethical construct you associate with. Virtue ethics, deontological ethics,utilitarianism,ethical relativism, etc.....to each his own.

I had the opprotunity to be a part of a very informative in-service dealing with pediatric patients yesterday, that was hosted by a Medical Director form another area. However one part of the in-service is not sitting well with me and I would like some feed back on what others think. He stated that it is "ok to lie to get pt's to come to hospital, but not if you are trying to get out of transporting the patient." Personally I do not agree with this statement. As EMS PROFESSIONALS, I don't believe we should be, nor does our code of ethics allow us to, lie to our patients. As well, we make one lie on scene, and if things snow ball, we may well be having our own character called into question, which then has other people's ability to trust us compromised as well. Is it worth it? So I ask the people in these forums, Is it ok to lie to pt's? If so when? Or am I over thinking this entire thing?Thanks.

It would appear that the Medical control director was advocating a very paternalistic approach...saving people from themselves, as it were...

were there any examples of this misplaced advocacy (lies to get them to the hospital)????

Edited January 20, 2010 by ccmedoc

[DwayneEMTP]

I hate absolutes, and have in fact found that any time that I try and construct one the EMS Gods swoop down and make me look like a bigger shithead than usual.

Never palm the breast in a 12 lead, never lie...never, never, always, always, yadda, yadda.

I believe it all resolves around your moral and ethical intent.

Tonight I had a breathing difficulty patient. Long time COPD, lung sounds silent in all fields, resps of 36 and shallow. Despite all of my best efforts, BVM through my CPAP and emptying my med bag into him via one route or another he was crumping very, very fast.

He asked, "goin'........................to............die?" I said, "No worries brother, we're pushing it back. Can't you feel it?" But yeah, there was almost no doubt in my mind that he was going to die before I got him to the hospital. He didn't, thanks in almost no part to me, but what I really didn't want to do was tell the truth, add to his axiety and increase my already shitty position.

So those that believe that lying is 'always' bad...was the better answer then, "Yeah man, I'm afraid you're going to die, I just can't get ahead of this thing.'?

Whatcha think?

Dwayne