Seattlest: Know Your Rights! (Oh wait, you ain't got none)

Anon

Mon, 18 Jun 2007 23:44:26 -0800

So who cares whether it is a 'doctor' who is making the call, paramedics and EMTs are actually the experts in out-of-hospital emergency medical treatment therefore they should be the ones 'making the call'. Also as an academic in the ambulance field I feel that it would be unethical of me not to perform research on patients who are suffering cardiac arrest considering they only have a 3% long-term chance of surving neurologically intact! I need to improve that. However the fact the the patient is unconscious and needs immediate treatment means that researchers cannot ask their consent and don't have time to ask a legal representative. But everybody needs to know that all studys are required to be approved by an ethics committee who would not let the study take place without ensuring that: the benefits to the patient outweigh the risks, community consultation has taken place, the patients or their families are informed asap, information about the study is publically available and their is no known or likely reason why patients would refuse the treatment. Research is important (how do you think that defibrillation became common practice?)and researchers and medical personnel have an ethical obligation to improve their treatments.

Jeremy M. Barker

Thu, 07 Jun 2007 15:01:05 -0800

Fair enough, though most of the guidelines I saw, including the one I cited from the AMA, stress that a physician be the one to communicate the treatment to a patient. In this case, EMT or paramedic--and I apologize for the error--it is not a doctor who appears to be making the call. It seems to me that the crucial issue is that regardless of whether it's an EMT or a more trained paramedic, it is not a doctor making the call, except from a long distance of via some method of communication. A doctor's responsibilities are far in excess of temporary emergency medical personnel. Regardless of training, it doesn't seem like it should be their job.

Megan

Thu, 07 Jun 2007 14:19:35 -0800

I think you are confusing EMT's with Paramedics. While there are EMT's on many ambulances in King County, it is the much more extensively trained paramedics that are administering these treatments. No offense meant to EMT's, but it's important to make the distinction, since paramedics are trained to administer medications, perform advanced cardiac life support, intubate, etc.. and all in a moving ambulance!

Jeremy M. Barker

Thu, 07 Jun 2007 13:10:14 -0800

Good question: when confronted by the need for medical experimentation and the perceived lack of other alternatives, what are we supposed to do? The law authorizing this exists for precisely this reason. In some European countries, I understand, with an integrated medical system, it's perfectly easy to keep track of who agrees to what study. That would one way of doing it (and achieving that level of integration would, of course, mean that everyone in the US had health insurance). But of course the group in charge of these studies can't make that happen for the US, so in a sense it's completely stupid to discuss. Or is it? I think it fair to point out that if someone else has the capacity to do it in a more ethical fashion, maybe it should be done there. Who suffers? Med students? American medical manufacturers? I don't know. I see the point in favor of these sorts of studies from beginning to end, and it makes a certain sense. Unfortunately, as with any real issue, there's not a clear-cut solution. The question to my mind is, do people want to be guinea pigs and lab rats? If no, why should we have to? That's also a very simple and rather straight-forward sounding proposition, I think. So it's a tough issue. Fundamentally, I think it needs at this point to turn on a couple factors: One, what has ROC done to inform the public? Was is enough, or was it--like so many things involving public information--a close hewing to the rules and otherwise really going through the motions. Two, do we the public, as we find out more about the study, have real representation to ensure our safety? In other words, I'm no doctor, but to my mind a stopped heart needs to be restarted. There's a very low survival rate for people defibrillated outside of hospitals, which is why they're testing to see whether two methods of increasing oxygenation could have better outcomes. I don't if that makes sense, or if the normal method of immediately defibrillating makes sense. So who does? Obviously, I doubt that the doctors here intend to do anyone harm, but why should we trust them out of hand, with no real consultation besides some posters and a post on Craigslist? Who's looking out for us? Universal healthcare and an integrated healthcare computer system may be out of reach, but public representatives out to ensure our well-being are not, and insofar as I understand, we have no public health representatives directly engaged with ROC/UW, no one we can go to besides the study's progenitors themselves, who are able to do it following the letter or the law and standard scientific practice. In short, we have no more rights than do lab rats, save that occasionally PETA or SETA will go apeshit on their behalf.

RJL20

Thu, 07 Jun 2007 12:46:10 -0800

So, say you've developed a new technique that's only applicable in situations where a patient's heart has stopped and/or they've been subjected to extreme trauma. How do you go about getting opt-in volunteers for a study on that? I'm not saying that there isn't an ethical concern here, but what's the alternative? Never developing any new techniques to deal with trauma, because there isn't a way to study them that doesn't either involve lack of consent or further endangering the patient by waiting for an authorized representative to consent on their behalf?