# Medical Ethics - Emergency Medical Care and Personal Choice **URL:** \ **Category:** Great Debates\ **Created:** [September 8, 2023, 11:04pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805 "2023-09-08T23:04:02Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![ParallelLines](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/parallellines/32/3575_2.png) [@ParallelLines](https://boards.straightdope.com/u/ParallelLines)\ **Post date:** [September 8, 2023, 11:04pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/1 "2023-09-08T23:04:02Z")
Continuing the discussion from [Discussion thread for the "Polls only" thread](https://boards.straightdope.com/t/discussion-thread-for-the-polls-only-thread/972380/6664): An ongoing discussion in the above thread caused me to create a new spin off. I’ll quote the sections of my first post on the subject that includes the text of the Poll from the Polls Only thread that prompted the discussion. > [@Discussion thread for the "Polls only" thread (Part 1)](https://boards.straightdope.com/t/discussion-thread-for-the-polls-only-thread-part-1/972380/6664): > > I voted to take the patient to the closest ER, but my reasoning is a bit more complex. First, quoting the poll - > > > [@Polls only: No discussion](https://boards.straightdope.com/t/polls-only-no-discussion/953642/3841): > > > > You are an ambulance driver. You are transporting a woman who’s suffered serious injury. The risk to her life is low _if you can get her to an ER quickly._ However, she is imploring the paramedics/EMTs to make sure she is taken to a hospital that is in her insurance network, which would cost her little or nothing. If she is taken to an out-of-network hospital, she could be on the hook for a massive medical bill. > > Ok, first, note that while perhaps not intentionally so, you, the driver, are not explicitly an EMT or Paramedic. Most drivers are, some are not according to a quick google search. So, right off the bat, you may be utterly unqualified to make the evaluation stated in the first line. And if they’re in the back being treated by the _other_ EMTs, who have more firsthand knowledge, why are YOU making the decision? And even if you -are- all paramedics/EMT, you just don’t know enough to be SURE. If things are bad enough for an ambulance to have been called and assuming the original analysis is correct that it requires _urgent_ care, then get more info for the patients safety ASAP, which means the closest option, with none of the unknowns about traffic or other issues, which brings us to this: > > > [@Polls only: No discussion](https://boards.straightdope.com/t/polls-only-no-discussion/953642/3841): > > > > The out-of-network emergency rooms are all nearby. The in-network emergency rooms are all further away. You do not know how much things like traffic or other variables may slow your arrival. Assume that you yourself will face no legal liability and the only considerations are patient $ vs. patient odds of survival. > > Again, huge number of unknowns in terms of taking them to their preferred location. The whole question is stated to be based on a real case, but we’re supposed to (in that final line) assume there are no consequences, legal or otherwise. But at that point, it makes the poll largely pointless, because the final clause says there ARE consequences, just not legal ones. The patient survival vs costs. At which point, survival \> saving money. > > Plus, speaking from some experience, if the PPO is going to nitpick about an emergency room visit despite most boilerplate agreements, they’re going to ding you for everything else, including the damn ambulance ride. My wife was once billed $5 grand for an ambulance ride because it was out of area / network, after she was thrown in one by an EMT against her will for what was serious but not critical dehydration issues. > > Our system is fucked up, the whole network thing is only going to add one minor, probably negligible layer of suckitude and not worth the risk. Because even if I’m somehow not liable for any legal issues, if my patient dies because they were trying to save money, and I agreed, I’m going to be far more damaged by the event than by my worries about her budget. @puzzlegal has had numerous, well reasoned responses that put a priority on the customer’s right to choose, as many of us would prefer. Yes, there may be additional risk, but considering the crippling cost of USA’s emergency medical care, it may well be life changing in an entirely different way. I’m opening up the discussion where we’re no longer subject to interpreting the poll’s scenario, because I think it’s much more important to talk about the situation as a whole. At which point is the individual’s right to choose more important than their own safety? In the original scenario, only the one individual’s life is at risk - so I _outside_ the limitations of the scenario generally support their choice. But side notes that haven’t been discussed include how do we determine (and IF -we- should determine) if they’re in their right mind? What if it’s a non-physical emergency - such as a mental health crisis. If they don’t want to be treated, should we absent their direct consent? And that leaves out a related recent medical crisis. COVID. In that case, we’re not just putting ourselves at risk by refusing treatment, or demanding alternate treatment options - we’re putting everyone else around us at risk. So I’ll reiterate my main opinion: if the only person I put at risk (leaving out possible emotional harm as too intangible to evaluate) is myself, I feel that a person should be made aware of all reasonable and likely risks, and then allowed to make their choice of care, assuming they are of reasonably sound mind. Yes, that leaves a freaking elephant in the room especially in terms of moral obligations to do no harm for medical professionals, but that’s going to be the subject of endless lawsuits no matter what. I can’t fix that, although the scenario that sparked all this would be made much easier if we could untangle the clusterf\*\*\* of the American medical complex. But when the scenario evolves beyond risk to a single person, whether it be COVID, Typhoid Mary or other historical examples, I find that there is a degree of greater good that is compelling. But I’m not a medical expert, a politician or otherwise equipped to decide where to draw the exact line, other than I know I will eventually do so. Final note: this is in no way an attack on @puzzlegal, I agree far more than I disagree with them on the subject IMHO, but felt that we were speaking past each other based on my desire to not move beyond the guidelines of the original poll. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [September 8, 2023, 11:13pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/2 "2023-09-08T23:13:40Z")
> [@ParallelLines](#): > > At which point is the individual’s right to choose more important than their own safety? The question raises the issue of do you have the right to go to a hospital further away if it’s covered by your insurance, even if it endangers your life. I’d say yes, in the abstract. You _should_ have that right. The problem is that an ambulance is not an Uber. They have protocols. Trauma goes to St. Mary’s. Heart attacks to Mercy General. The patient’s choice is to take the ride where it’s going or ask to be dropped off at the next corner. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [September 8, 2023, 11:28pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/3 "2023-09-08T23:28:16Z")
> [@ParallelLines](#): > > but felt that we were speaking past each other based on my desire to not move beyond the guidelines of the original poll. Yeah, we clearly read the original poll differently. ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [September 9, 2023, 12:32am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/4 "2023-09-09T00:32:58Z")
Where I live, ambulance service is a municipal function run by the fire dept. And their rules are pretty explicit - they take you to the nearest ER that will accept you, period. Full stop. If you want to go to a different ER, you can transport yourself there or hire the private ambulance company that serves this area. ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [September 9, 2023, 12:50am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/5 "2023-09-09T00:50:21Z")
So my question is this even a matter of _medical_ ethics at all, as you point out, you are not a medical professional, you are a driver. It seems more analogous to getting in a taxi (or a bus) that is meant (as far you are concerned, at least) to go to place A but actually takes you to place B, despite you saying “I want to go to place A”. It’s not completely OK (I guess there are extreme cases where the driver might even get charged with kidnapping?) but its not the same, ethically, as giving a patient medical care against their express wishes. ---
**Author:** ![ParallelLines](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/parallellines/32/3575_2.png) [@ParallelLines](https://boards.straightdope.com/u/ParallelLines)\ **Post date:** [September 9, 2023, 2:10am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/6 "2023-09-09T02:10:07Z")
A quick review of the websites indicate that most, but again not ALL drivers in ambulance services are also EMT/Paramedics. So yes, you may or may not depending upon the individual driver have the qualifications to make at least a semi-informed judgement. Part of the problem though is touched on by @Kent_Clark - in some areas, the ambulances are run by the public / city, and in some they’re entirely a for-profit enterprise, so of course, we don’t have a unified series of expected / legal behaviors and rules. I don’t mean the thread to be limited to just ambulance services and choice as well, thus my comments on medical care that is the patients choice that contravenes medical advice. I mean I find it hard to believe you can demand unsafe medical for yourself (and often your child) or reject it outright, but it’s part and parcel of the whole personal choice thing. ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [September 9, 2023, 2:31am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/7 "2023-09-09T02:31:59Z")
> [@ParallelLines](#): > > A quick review of the websites indicate that most, but again not ALL drivers in ambulance services are also EMT/Paramedics. So yes, you may or may not depending upon the individual driver have the qualifications to make at least a semi-informed judgement. Though that doesn’t change the ethics of it, any more than your bus or taxi driver being a doctor makes it a matter of medical ethics. It seems to me that it doesn’t become a matter of medical ethics until the patient is delivered at the nearest hospital and then the doctors have to decide whether to treat them, despite saying they wanted to be treated at a different hospital. ---
**Author:** ![thorny\_locust](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thorny_locust/32/431_2.png) [@thorny\_locust](https://boards.straightdope.com/u/thorny_locust)\ **Post date:** [September 9, 2023, 2:35am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/8 "2023-09-09T02:35:14Z")
People are allowed to do all sorts of things that aren’t safe. You can ride horses; you can climb mountains; you can play football; you can ride motorcycles. Reducing risk to life is a reasonable goal; but it’s not an absolute, in all sorts of things other than ambulance rides. Why should it be an absolute because an ambulance is involved? The fact that we have such a screwed up health care system that people routinely risk their lives for fear of their medical bills is a major problem. But that strikes me as a separate issue. The person who wants the ambulance to take them to hospital A instead of hospital B might have a variety of reasons. Maybe their usual doctor’s only available at A. Maybe they think (possibly accurately) that hospital B has a terrible record of dealing with the kind of problem that’s causing them to need an ambulance. ---
**Author:** ![Redcanoe](https://avatars.discourse-cdn.com/v4/letter/r/b487fb/32.png) [@Redcanoe](https://boards.straightdope.com/u/Redcanoe)\ **Post date:** [September 9, 2023, 2:54am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/9 "2023-09-09T02:54:33Z")
Around here ambulance service is a private company who works together with the paramedics on the city fire truck. They have a dispatch system that works with the hospitals in the whole metro area. Last year my wife was talking with Kaiser and they wanted her to go to the hospital ( long story). The ambulance guy told us, and Kaiser over the phone, that once my wife agreed to transport she was going to the hospital dispatch sent them to. The choice depended on bed space, staffing, specialty and so on. He could not guarantee going to the Kaiser hospital about 5 miles from our house. I ended up taking her there myself. With the paramedics blessing, it wasn’t really an emergency, just the Kaiser Dr. over the phone being overly cautious. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [September 9, 2023, 3:18am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/10 "2023-09-09T03:18:45Z")
> [@thorny\_locust](#): > > Maybe they think (possibly accurately) that hospital B has a terrible record of dealing with the kind of problem that’s causing them to need an ambulance. For almost 10 years I lived right adjacent to the county line. The county hospital serving my area sucked pond scum. Just over the border in the other county was an excellent private hospital. It was actually closer to my residence and usual haunts than was the hospital in my county. Not a huge difference; call it 4 vs 8 miles across generic suburbia & freeways. Shortly after moving there I stopped by the local firehouse to ask the paramedic crew, who also did patient transport if necessary, if they could take me over the border to the “good” hospital if I was intact enough to be able to make that request. “No.” That’s when I decided that if I was ever _in extremis_ I was calling a friend or an Uber, not 911. The paramedics were a highly professional and well-regarded force. But their mandatory destination was unacceptable. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 9, 2023, 4:03am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/11 "2023-09-09T04:03:41Z")
> [@LSLGuy](#): > > But their mandatory destination was unacceptable. Though IMHO that is the most ethical response. A paramedic should not be placed in the position of making those choices. Guidelines should be clear. Once inside an ambulance the default must be to assume that the circumstance is an emergent one. It may look minor. It may seem like a situation that did not need an ambulance and could have just been seen in a doctor’s office the next day, but an ambulance team must assume emergent. They are not a taxi service or an Uber to take you where you want to go. They are an emergency medical service able to stabilize and maintain while getting to the hospital dispatch has directed them to. Of course the context is a broken system for payment and ambulances it infrequently used as CYA or as taxis. But dealing with those issues is not the ethical purview or job of the EMT. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [September 9, 2023, 10:42am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/12 "2023-09-09T10:42:08Z")
> [@LSLGuy](#): > > That’s when I decided that if I was ever _in extremis_ I was calling a friend or an Uber, not 911. Two other things to consider (maybe not for you, but in general) 1. the ambulance crew can stabilize or treat many issues 2. when you arrive, the emergency department prioritizes patients who arrived by ambulance over those who came in other methods. If you are having a heart attack or bleeding out, your odds are better with the ambulance. ---
**Author:** ![Stratocaster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/stratocaster/32/16393_2.png) [@Stratocaster](https://boards.straightdope.com/u/Stratocaster)\ **Post date:** [September 9, 2023, 11:53am UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/13 "2023-09-09T11:53:25Z")
> [@puzzlegal](#): > > If you are having a heart attack or bleeding out, your odds are better with the ambulance. Can that be true? If my wife and I burst through the door, I fall to the floor clutching my chest as my wife shrieks, “Help! My husband is having a heart attack!”—the response would be, “Get in line”? ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [September 9, 2023, 12:16pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/14 "2023-09-09T12:16:34Z")
I injured my sternum (luxation of manubrium) and it was intermittently uncomfortable. If I sneezed it would “pop” apart and I’d use pressure to get things back as they should be. It was an annoyance, but I assumed it would eventually heal. I happened to sneeze as I walked by Presbyterian University Hospital in Pittsburgh, so I walked into the ER, thinking if there wasn’t a long wait I might as well see what a doctor thought. Approaching the desk, I almost did an about face, as there was a very full waiting area with obviously sick/injured people. The triage nurse asked why I was there and the minute I pressed on my sternum and told her I had pain when I **BOOM**. She never let me finish explaining, I was in a wheelchair and she was racing me to an exam space. I kept arguing that my pain was musculoskeletal, but she wouldn’t stop. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [September 9, 2023, 12:30pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/15 "2023-09-09T12:30:46Z")
No, of course they triage heart attacks ahead of the kid with a runny nose. But the ambulance drivers talk to the triage nurse before they unload, and you don’t have to get to the triage nurse and explain that you are having a heart attack after you arrive. That can make a difference. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [September 9, 2023, 12:32pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/16 "2023-09-09T12:32:09Z")
> [@puzzlegal](#): > > when you arrive, the emergency department prioritizes patients who arrived by ambulance over those who came in other methods. Not really, in my experience. The ambulance may get you taken straight to the back rather than to the waiting room, but that’s really it. A sprained ankle that arrived by ambulance isn’t treated before chest pain brough in by a spouse. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [September 9, 2023, 12:35pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/17 "2023-09-09T12:35:00Z")
I didn’t mean to imply that every person who arrives by ambulance cuts in front of every person who walks through the door. Just that if it actually is a “seconds count” kind of emergency, the ambulance patient will be seen faster. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [September 9, 2023, 12:54pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/18 "2023-09-09T12:54:13Z")
Anyway, I’ve been advised by people who ought to know that if you think you are having a heart attack, you should call an ambulance, even if your spouse might get you to the emergency department just as fast. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [September 9, 2023, 1:04pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/19 "2023-09-09T13:04:30Z")
Absolutely - but that’s less because you’ll be seen slightly faster at the ER and more because the EMT/paramedics on the ambulance will start treating you immediately. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [September 9, 2023, 1:16pm UTC](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805/20 "2023-09-09T13:16:25Z")
The idea of ambulances having trained paramedics on board who could provide real care en route is actually relatively recent, from the ‘60s in Pittsburgh. A very interesting story … > **[How Pittsburgh's Freedom House Pioneered Paramedic Treatment](https://www.npr.org/sections/codeswitch/2015/03/01/389798498/how-pittsburghs-freedom-house-pioneered-paramedic-treatment)** > > The groundbreaking ambulance service was created in the 1960s as the city struggled with racial tensions and poor medical transport. It trained African-American men to provide crucial emergency care. [Next page](https://boards.straightdope.com/t/medical-ethics-emergency-medical-care-and-personal-choice/989805.md?page=2)