Ethical issues are a common challenge for practicing emergency physicians. The ACEP Ethics Committee first surveyed ACEP members in 2006 on their views of the most common and challenging ethical issues they faced in clinical practice. Given the passage of time and the evolving nature of emergency medicine, the ACEP Board of Directors set an objective for the committee to reassess members’ views of the current application of the ACEP Code of Ethics and to discover what changing or additional ethical challenges confront practicing emergency physicians today.
The survey instrument was originally developed in 2006 by a panel of emergency physicians who are members of the ACEP Ethics Committee. To update the original survey, it was piloted among a focus group of 34 emergency physicians and revised based on their feedback. This updated survey reflects current issues and was delivered to 26,102 ACEP members by email on Feb. 12, 2016; it was available online until March 17, 2016. Reminders were published March 1–5, 2016, in ACEP’s Emergency Medicine Today eNewsBriefing.
The email survey had a total of 7,040 unique opens, representing a 27 percent open rate. A total of 1,006 participated (3.9 percent). Most participants were male (73 percent), and the most common practice environment was community (53 percent), followed by urban (32 percent), university affiliate (16 percent), university (12 percent), and rural (13 percent).
Respondents identified the most important ethical issues in their practice, in order, as access to care, end-of-life issues, psychiatric care, and third-party interference into the practice of medicine (see table below, uses the Likert Scale of 1=Not Important to 5=Most Important).
|Ethical Issue||Weighted Average
(Based on Likert Scale)
|Access to care||4.35|
|End-of-life issues/resuscitation/advance directives||4.30|
|Third-party interference into the practice of medicine||4.16|
|Decisional capacity/patient autonomy||3.96|
|Professional issues/interactions with colleagues/consultants||3.94|
|Stewardship of health care resources/costs of care||3.89|
|Medical errors and disclosure||3.87|
|Emergency Medical Treatment and Labor Act (EMTALA)||3.74|
|Societal expectation and portrayal of physicians||3.63|
|Against medical advice||3.45|
|Scope of practice issues||3.38|
|Expert witness testimony||3.36|
Respondents were also asked to comment in general on ethical issues in the practice of emergency medicine. The most common issues included the inappropriate influence of money, patient satisfaction driving patient care, end-of-life care, and disagreements with consulting physicians. The most common issues that have made respondents question their career choice or consider a career change or early retirement were third-party interference (hospital administration, regulations), patient satisfaction demands, and increased volume/complexity.
Most respondents indicated that they’re aware that ACEP has a Code of Ethics (see sidebar below) (n = 788; 79 percent). The elements they find the most challenging to implement are Principle 10 (“Support societal efforts to improve public health and safety, reduce the effects of injury and illness, and secure access to emergency and other basic health care for all”) and Principle 9 (“Act as responsible stewards of the health care resources entrusted to them”). Respondents indicated that they use ACEP Now articles, ACEP information papers, ACEP legislative advocacy issues, ACEP educational courses, and ACEP policies for assistance or education regarding ethical issues.