Virtual Mentor. June 2010, Volume 12, Number 6: 435-516. Full Issue PDF

June 2010 Contents

Time and Resource Constraints in the Emergency Room

Ethics Poll

Without exception, practicing physicians who are in good health have a professional obligation to serve in cases of local disaster or epidemic if they are needed.
Agree.
Disagree.
Don't know.

Many people complain that hospital emergency departments (EDs) are overcrowded, that it takes hours to be seen for treatment, and that the quality of care suffers as a consequence. It is often alleged that use of EDs for nonemergency and nonurgent care is the reason for the overcrowding. Which of the following best describes how you think the problem of emergency room crowding should be handled?
People with nonemergency and nonurgent problems should not be accepted in the ED, and the government (i.e., taxpayers) should repay hospitals for uncompensated emergency and urgent care.
The EDs are working as well as possible; people with emergent and urgent needs are seen first, and the others just have to wait.
Conveniently located retail clinics with extended hours will soon alleviate ED overcrowding.
By providing 32 million more people with health insurance, the new Patient Protection and Affordable Care Act will alleviate ED overcrowding.

When an otherwise healthy person comes to the ED with life-threatening injuries (e.g., from an injury, accident, or fire) and refuses life-sustaining treatment, his or her decision-making capacity (DMC) is evaluated. Had the same person consented to the treatment, chances are good that he or she would not be evaluated for DMC. Is the special evaluation of DMC for those who refuse treatment fair?
No. DMC should be evaluated for those who consent also.
No. Refusal of treatment should not trigger an evaluation of DMC if consent to treatment doesn’t trigger it.
Yes. It's prudent to demand that DMC be demonstrated when someone refuses life-sustaining treatment.

View

From the Editor

Keeping Ethics Alive in the ED
Thomas Robey
Full Text | PDF
Virtual Mentor. 2010; 12:437-439.

Educating for Professionalism

Clinical Cases

Make It OK That This Life Is Ending
Commentary by Caroline Pace
Full Text | PDF
Virtual Mentor. 2010; 12:440-443.

Taking No for an Answer—Refusal of Life-Sustaining Treatment
Commentary by Stephanie Cooper
Full Text | PDF
Virtual Mentor. 2010; 12:444-449.

Resource Allocation Shake-Up
Commentary by Damon Allen Darsey and Robert Galli
Full Text | PDF
Virtual Mentor. 2010; 12:450-454.

Medical Education

Preparing for the Unexpected—Teaching ER Ethics
Kelly A. Edwards and Thomas Robey
Full Text | PDF
Virtual Mentor. 2010; 12:455-458.

The Code Says

AMA Code of Medical Ethics’ Opinion on Physician Duty to Treat
Full Text | PDF
Virtual Mentor. 2010; 12:459.

Journal Discussion

Rethinking the Physician’s Duty in Disaster Care
Douglas Bernstein
Full Text | PDF
Virtual Mentor. 2010; 12:460-465.

Clinical Pearl

Disaster and Mass Casualty Triage
Christopher H. Lee
Full Text | PDF
Virtual Mentor. 2010; 12:466-470.

Law, Policy, and Society

Health Law

Is EMTALA That Bad?
Edward Monico
Full Text | PDF
Virtual Mentor. 2010; 12:471-475.

Policy Forum

Nonurgent Care in the Emergency Department—Bane or Boon?
John C. Moskop
Full Text | PDF
Virtual Mentor. 2010; 12:476-482.

Ending Ambulance Diversion in Massachusetts
Laura Burke
Full Text | PDF
Virtual Mentor. 2010; 12:483-486.

Medicine and Society

Gaps in the Safety Net Metaphor
Jay Baruch
Full Text | PDF
Virtual Mentor. 2010; 12:487-491.

History, Art, and Narrative

History of Medicine

Social Justice, Egalitarianism, and the History of Emergency Medicine
Brian J. Zink
Full Text | PDF
Virtual Mentor. 2010; 12:492-494.

Op-Ed and Correspondence

Op-Ed

Unwitting Partners in Death—The Ethics of Teamwork in Disaster Management
Gregory Luke Larkin
Full Text | PDF
Virtual Mentor. 2010; 12:495-501.

Resources

Suggested Readings and Resources
PDF
Virtual Mentor. 2010; 12:502-513.

About the Contributors
Full Text | PDF
Virtual Mentor. 2010; 12:514-516.