Ethical Requirements to the Patient
Ethical obligations to the patient exist in part from the parents or guardian of the patient, the medical care givers providing treatment to the patient (including the transport team), and the medical milieu of the patient (eg, hospital, clinic, ambulance).
Although the pediatric patient does not have the right of autonomy per se, all of the surrogate decision makers should adhere to the best interest standard.All ethical precepts should be considered and balanced against one another to determine an ethically appropriate approach to the patient. Both the short- and long-term consequences of transporting or not transporting a patient should be examined. The patient who is clearly dying and to whom further escalation of care would be futile may not be a candidate for transport. Similarly, that same patient may not wish to be transported. As much as possible, a patient has the right to participate in the decisionmaking role and to receive information. The American Academy of Pediatrics recommends that pediatric patients participate in decision making commensurate with their level of maturity, and assent should be sought to respect the pediatric patient's developing maturity and autonomy.
The virtues listed previously also will come into play. It is nearly impossible to have only one virtue considered to the exclusion of the rest, because virtues are often interdependent and interrelated. Furthermore, most patients are more concerned about feeling protected and cared for than they are about the technical abilities of their providers. Demonstrating compassion for the patient's pain, suffering, and circumstances takes courage, seeking to make the “right” decision and ignore or not be excessively swayed by the “correct” decision. To arrive at the right decision, integrity and honesty need to be considered: one's own personal and professional integrity as well as an honest assessment of the patient's condition.
The latter assumes a nonjudg- mental approach to the patient's medical needs. It also assumes the parents and guardians are never told anything false. However, caregivers should not speculate as to the prognosis or condition of the child, or indeed other patients. For example, “We'll take the best possible care of your child,” provides an honest and reassuring statement without speculating about uncertain outcomes. This evaluation of the patient's needs, in turn, may invoke the principles of beneficence, or “doing good” and nonmaleficence, or “first, do no harm.” These 2 principles should not be separated. In other words, nonmaleficence should not be used independent of beneficence.Usually, justice does not play a role in transport decisions. However, in the case of limited resources (eg, lack of organs for transplant, limited availability of extracorporeal life support systems, multiple patients needing transport, need for air transport where only ground is available), taking into account the likelihood of need, benefit and cost should be explored prior to undertaking a transport. Any ethical issue that requires that a controversial decision be made has implications regarding the relevant ethical precepts that should be carefully considered so that the best ethically justified argument for a particular decision is made.