When this survey was compared to the similar survey in 2006, several important differences become noticeable. In 2006, the most important ethical issues in emergency medicine identified were access to care, end-of-life care, professional issues, stewardship of health care resources, and societal expectations. Although the top-two issues remain access to care and end-of-life decision making, the availability of psychiatric resources for patients and perceived third-party interference have risen to the third- and fourth-most important issues, respectively.

One area that was identified by respondents on two different open-ended questions (ethical issues and threats to professional longevity) was the general preoccupation with patient satisfaction. Companies like Press Ganey and related satisfaction tools are fraught with validity issues, survey sampling problems, and measurement error; these are problems over which emergency physicians have little, if any, control. Given that EM is perennially associated with high burnout rates and that emergency physicians link satisfaction scores to both ethical issues and career choice dissatisfaction, invalid metrics pose a serious threat to moral integrity and professional longevity among ACEP members.

Note: All authors are members of the ACEP Ethics Committee. To view the committee’s annual report and objectives, please click here.

Dr. Marco is professor of emergency medicine at Wright State University Boonshoft School of Medicine in Dayton, Ohio.

Dr. Venkat is Chair of the Ethics Committees of Allegheny General Hospital and Allegheny Health Network in Pittsburgh, Pennsylvania and Professor of Emergency Medicine, Drexel University College of Medicine.

Dr. Larkin is Professor & Chair of Emergency Medicine University of Auckland and Adjunct Professor New York University School of Medicine.

Dr. Brenner is an Associate Professor of Emergency Medicine at SUNY-Upstate Medical University in Syracuse, New York.

Dr. Nadeem is an Emergency Medicine Resident at the Baylor College of Medicine in Houston, Texas.

Dr. Limehouse is Associate Professor on the Clinician Educator track in The Department of Medicine at the Medical University of South Carolina, Charleston, South Carolina.

Dr. Knowles is the Director of Leadership and Advocacy with Integrative Emergency Services and core faculty at John Peter Smith Health Network Emergency Medicine Residency Program, Fort Worth, Texas.

Dr. Iserson, Professor Emeritus of Emergency Medicine at the University of Arizona, is currently Lead Physician, McMurdo Station, Antarctica.