You arrive at the site of a single-vehicle MVA. A man in his 80s was driving, his wife in the passenger seat. You assess the man as emergent and requiring transport. The man seems unconcerned about himself but keeps asking about his wife, who is dead. What do you tell him?

     How you answer this true scenario will depend, to a large extent, on whether you're a physician or an EMT. For a physician in this country, telling the truth is considered a paramount virtue. The American Medical Association says in its Principles of Medical Ethics that "A physician shall...be honest in all professional interactions."¹ Thus, a physician would either have to respond honestly or try to dissuade the asking of the question. The NAEMT's EMT Code of Ethics has no requirement regarding honesty or truth-telling;² thus, the EMT following only this code would ethically be free to bend the truth in order to ensure a more compliant patient. In the above case, the EMT told the driver that his wife was receiving the best possible care and that they had to concentrate on taking care of him. Although no outright lie was told, the truth was avoided.

     A 1992 study found that ethical conflicts arose in 14.4% of paramedic responses.³ These included issues involving informed consent, treatment of minors, research, resuscitation limits, patient competence, resource allocation, confidentiality, truth-telling and training. The EMT Code of Ethics was published in 1978 and has not been updated since. The medical ethics landscape, however, has changed a great deal, and new challenges have arisen.

     One reason that ethics in EMS have not received a great deal of attention is because bioethicists and other architects of healthcare ethics assume certain similarities among healthcare professions. For example, when examining ethical issues and solutions for public health, the natural tendency has been to look at ethics in medicine. Yet there are large differences between the fields, such as whom they serve (individuals vs. populations) and the autonomy of the individual provider.^4,5 The same assumption has been made in regards to ethics for EMS. A recent CE training article in an industry journal simply adopted the theories and ideals of medical ethics.⁶ Such a perspective assumes that EMS providers are merely physician extenders and ignores that a different practice environment requires a different approach to ethical issues.