What Are Physicians’ Ethical Responsibilities to Respond to Medical Emergencies?

Discussion

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Otolaryngologist-head and neck surgeons are well qualified by training and experience to evaluate and manage certain emergencies—notably, airway obstruction, facial trauma (including fractures and lacerations), disorders of the balance mechanisms, and acute infectious diseases of the soft tissues of the head and neck and aerodigestive tract. Most practitioners in our specialty have little or no reservation when it comes to responding to requests for urgent care in a public setting in the face of these disorders. The question of stepping forward becomes more difficult when the emergencies involve injuries, disorders, or illnesses that fall outside of the general scope of clinical practice for most otolaryngologist-head and neck surgeons. Therein lies the ethical challenge: “Is it better for me to help, with my limited capabilities, or to let others step forward who might actually have more or less capability than I have? Do I have a moral responsibility to volunteer, no matter what the circumstance?”

Hesitation about responding to a call for a physician can certainly be based on capability and scope of practice, but it could also be based on other issues, including fear of possible litigation, potential personal and/or professional embarrassment, concerns about how responding might impact travel plans, and lack of information regarding availability of therapeutic or resuscitation equipment. Most calls for physician assistance are unexpected and urgent, reducing the time for consideration before the need to respond is required.

Another debate that may be involved in a physician’s consideration of whether or not to respond is whether there is another healthcare provider in the immediate area who may be better qualified to assist the victim than the otolaryngologist. Additionally, is there enough time before things get critical for nearby first responders to arrive and resolve the critical issue? In some circumstances, it may be immediately obvious that you are the only provider capable of assisting. Conversely, given the wide range of healthcare providers available these days, it may be impossible to know who is best qualified to respond until the capabilities of those responding begin to sort themselves out. In fact, perhaps the best possible scenario in an urgent call for a “doctor” would be for multiple providers to respond and, after a brief assessment of the victim’s condition and needs, identify the most appropriate and capable individual to direct the medical care. Such a decision need not be based on academic degree, but rather on who has the appropriate knowledge and experience in dealing with the situation at hand—for instance, an EMT or critical care nurse might be better suited to care for a patient with a suspected MI than the responding otolaryngologist. An alternative, and certainly salutary, approach would be to quickly work out a team effort, in which each professional handles an aspect of care that is most appropriate to his/her training, giving the victim the benefit of professionals working together for the best outcome.