Ethics of emergency department cancer care

Abstract

Bioethical foundational theories (e.g., utilitarianism, deontology) and mid-level principles (e.g., autonomy, beneficence, nonmaleficence, distributive justice) as well as the virtues embodied in emergency medicine (e.g., truth telling) help guide clinicians through some of the most difficult situations they face. Emergency department (ED) patients with hematological-oncologic illnesses often present with knotty situations involving patient autonomy, decision-making capacity, surrogates and their decisions, end-of-life issues, or demands and concerns that involve bioethical dilemmas. Emergency physicians must be prepared to address these issues, with little time for reflection. Familiarity with the rapid decision-making model can help them find at least short-term resolutions. The model, based on case-based reasoning (casuistry), employs well-known ethical principles in a manner designed for emergency clinicians to use easily when ethical dilemmas present. Just as they prepare for other clinical situations, emergency physicians should also prepare to face bioethical dilemmas that will inevitably occur.