Ethical challenges and action alternatives: Case reflections in ambulance care

Area of Science:

• Emergency medical services
• Clinical ethics
• Qualitative research

Background:

• Ambulance clinicians frequently encounter multifaceted challenges, including medical, caring, existential, and ethical dilemmas.
• Complex patient presentations necessitate holistic decision-making, balancing urgent medical needs with essential patient care.

Purpose of the Study:

• To explore the range of action alternatives considered and discussed during ethics case reflections.
• To understand how ambulance clinicians address care-related challenges in their practice.

Main Methods:

• A qualitative descriptive study design was employed.
• Conventional and summative content analysis were used to analyze data.
• Ethics case reflections were conducted with 78 ambulance clinicians in 14 groups, following a video-based scenario.

Main Results:

• Ethics case reflections generated a wide array of action alternatives for managing complex caring challenges.
• The findings indicate significant professional discretion and tacit competencies among ambulance clinicians.
• The reflection format proved suitable for discussing ethical issues beyond standard medical emergencies.

Conclusions:

• Ethics case reflection can improve ambulance clinicians' ethical decision-making, focusing on patient autonomy and holistic care.
• This method highlights potential caring approaches and illustrates diverse strategies for complex care situations.
• Further research is needed to explore the role of these reflections in articulating implicit attitudes and tacit competencies.