Christian Scientist scenario

[mycrofft]

I'm gonna ask a question.

How many people here have actually worked a pediatric arrest? I have. Multiple times.

You can talk about what you'd do until you're blue in the face. When you really have to make decisions is when there's a dead kid in front of you.

I'm not fighting the parents. I'm not catching a charge. I will do everything in my power for that child but it's not my kid, I'm not sacrificing my livelihood by collecting a violent charge while on duty and potentially jeopardizing my livelihood.

Just another angle to consider.

What would your wife and kids day if you came home and told them you lost your job?

And the patient is still dead and you are waiting trial? I hear you.

There is an answer we don't often utilize here, which we were not taught, and that is to BE PERSUASIVE. Sweet talk the parents. Lie. In their presence actually call 911 and tell the operator who you are and that you need law enforcement because there is either a fresh or impending death about to occur. Beg. Whatever. But don't get into the macho armchair "I'd hit 'em with my E cylinder" routine.

 

[DrParasite]

I'm gonna ask a question.

How many people here have actually worked a pediatric arrest? I have. Multiple times.

I have.... they suck. usually they are drownings, or an expected death (kid had a medical condition, etc). Never had a parent say don't help, usually it's hurry up and help my kid.

I'm not fighting the parents. I'm not catching a charge. I will do everything in my power for that child but it's not my kid, I'm not sacrificing my livelihood by collecting a violent charge while on duty and potentially jeopardizing my livelihood.

I will. I'll fight the parents. I'll take the charge. and I'll take that risk in a heartbeat, and you said why below

What would your wife and kids day if you came home and told them you lost your job?

"Wife: what happened? me: I got fired/suspended/arrested today. wife: omg why???? me: saw a kid who was dead/dying, thought of my own kids, how much I love them, and want them to succeed and have a nice long life, and couldn't live with myself if I just stood by and watch this kid die because the parents refused to let me help him. So i did what I needed to in order to ensure this kid had as much of a chance as my own kids. "

I don't have any kids, but i could live with myself much easier doing that than standing around and letting the kid die.

And as much as I usually say people have the right do make thier own stupid medcial decisions, and have them sign the RMA form, this would be the exception. Get LEO involved (I don't care if the desk Sgt himself needs to get in a car, or a white shirt police supervisor needs to come to the scene), a supervisor, in this case it's much easier to beg for forgiveness than wait for permission to be granted.

 

[Brevi]

in this case it's much easier to beg for forgiveness than wait for permission to be granted.

Lol, Rob has the easier to ask forgiveness than get permission quote in his signature.

Guess he doesn't find it applicable here.

 

[Brevi]

I apologize if I come across as crass, but it seems that several of you are voicing that you would make patient care decisions based on avoiding punishment instead of what you believe is right or wrong.

It's a pre-conventional level of reasoning, which I find to be a terrifying imperative in a healthcare provider.

 

[bbmtnbb]

The basic underlying importance of this thread is to prep us for the inevitable that we will all encounter. We NEED to know our limits and responsibilities legally as we know them in lur hearts ethically. FIND OUT what you can and can't do in your county and do it. Again morally -which is not legally--I could NOT walk away easily-will I endanger myself in a fight with dad-probably not but will I leave NO. Use your words widely with EMS and POP and see where you get. I am confident I could sway someone to make this work. Get it worked out in your head and discuss this BEFORE it happens!!

 

[Rialaigh]

I apologize if I come across as crass, but it seems that several of you are voicing that you would make patient care decisions based on avoiding punishment instead of what you believe is right or wrong.

It's a pre-conventional level of reasoning, which I find to be a terrifying imperative in a healthcare provider.

erm...this is most of protocol based EMS. I put people in spinal all the time even though I think it is the "wrong" thing to do. We do tons of things in EMS that are widely thought among street level providers to be "Wrong" but we do it because it is the lesser of two evils...the worse one being losing your job or getting sued....

In area's that are not very up on evidence based medicine and treatment providers are required to treat people with outdated techniques that are frequently touted as "Wrong"

 

[Household6]

I apologize if I come across as crass, but it seems that several of you are voicing that you would make patient care decisions based on avoiding punishment instead of what you believe is right or wrong.

It's a pre-conventional level of reasoning, which I find to be a terrifying imperative in a healthcare provider.

My opinion of right and wrong are negated by my protocols. Rules I follow are in place to keep me out of jail, not appease my bleeding heart.

 

[vcuemt]

Protocols exist for a reason - to protect you, your agency, your patients, your community, and so on. Parents have the right to make healthcare decisions for their children, just as they have the right to hold religious beliefs you and I might characterize as insane, stupid, etc etc. You don't get to take those rights away, and not only because people who were elected have passed laws and people who were appointed have written SOPs that say so, but also for larger, ethical reasons. Who are you to say what they are doing is incorrect? You approach the situation as a healthcare provider and you want to provide care, but your priorities are only one facet of the situation. The parents (in this made-up scenario) have priorities stemming from their religious beliefs. You are going to decide that your beliefs trump theirs when it pertains to their child? That's arrogant.

We aren't out practicing vigilante medicine. Laws govern the police for a reason, even though criminals do go free after committing crimes. I'm sure there are many cops who'd rather shoot someone they "know" is a bad guy than face the possibility that he go free after a trial for any number of reasons, but they don't get to make those decisions. And that's a good thing, because we are a society of laws.

Of course that's easy for me to say sitting at a desk and typing this onto an online forum. If this was actually me in this scenario I'd respect the parents' wishes right up until the cops showed up and told me to go to work. I'd just hope it wasn't too late.

"Person, personnel, patient" doesn't only apply when talking about scene safety. Your first allegiance on the back of the truck has to be to #1 - legally, too.

 

[mycrofft]

" 'Wife: what happened? me: I got fired/suspended/arrested today. wife: omg why???? me: saw a kid who was dead/dying, thought of my own kids, how much I love them, and want them to succeed and have a nice long life, and couldn't live with myself if I just stood by and watch this kid die because the parents refused to let me help him. So i did what I needed to in order to ensure this kid had as much of a chance as my own kids. '

I don't have any kids, but i could live with myself much easier doing that than standing around and letting the kid die."

ALTERNATE ENDING IN REAL WORLD:

EMT: "Wife, I pushed a grieving mother onto her butt and threatened her husband with my clipboard. I'm at County Jail, please tell the kids I'm sorry and get hold of a lawyer for me, and $10,000 for bail. PS the kid was dead already".

or

EMT: "Wife, I'm at Memorial. We just brought in a kid who drowned, had a hard time getting his parents to let us in but they did. Just calling to give you and little JoJo and Akeesha a hug, I gotta go, be home the usual time".

 

[jrm818]

Protocols exist for a reason - to protect you, your agency, your patients, your community, and so on. Parents have the right to make healthcare decisions for their children, just as they have the right to hold religious beliefs you and I might characterize as insane, stupid, etc etc. You don't get to take those rights away, and not only because people who were elected have passed laws and people who were appointed have written SOPs that say so, but also for larger, ethical reasons. Who are you to say what they are doing is incorrect? You approach the situation as a healthcare provider and you want to provide care, but your priorities are only one facet of the situation. The parents (in this made-up scenario) have priorities stemming from their religious beliefs. You are going to decide that your beliefs trump theirs when it pertains to their child? That's arrogant.

Who am I (and who are you, too)? I'm an educated medical professional, acting in place of a physician, and I'm rendering my educated medical opinion that the child in front of me is likely to die or be disabled if they fail to receive immediate care. Our society says that children dying is "incorrect," and in this case we are the voice of society. Its not an arrogant personal decision, its a societal decision that is necessary because children are generally unable to protect themselves from insane/stupid/abusive/foolish parents.

I don't really understand the basis of your opinion either. I doubt it came from your training. Nor does it seem to be based in the law. Did you read the rest of the thread? If not, read it, and read some of these too:

http://pediatrics.aappublications.org/content/128/2/427.full.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528596/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726617/pdf/v022p00869.pdf
http://www.ncmedicaljournal.com/wp-content/uploads/NCMJ/sep-oct-07/brezina.pdf

I'll admit that there have been minimal test cases so the issue is a little complicated. Additionally rules may change a bit state to state, but in general it seems pretty clear that the courts have held that the state has a substantial interest in protecting the lives of children, and that the state's interest outweighs the parental interests in exercising control over their children. Parents have rights, but so do children. In this case, the child has the right to grow to adulthood and make their own stupid decisions. TLDR: parents are non-omnipotent; they do not have the right to decide if their child lives or dies.

I don't' really see how this is very hard - what would you do if you saw a parent beating their children with a whip and claim its was religious practice? In the process of sacrificing them at an alter? If you say "walk away" or "watch until PD arrives" I think I would question either your honesty or your integrity. This is little different - a parent attempting to cause the death or injury of their child, the reason is irrelevant.


Obviously making contact with medical control ASAP, trying persuasion first (but quickly) and getting PD and supervisors to back you up absolutely ASAP is critical. This scenario will likely never play out the way it is described. But if it did, I have trouble respecting any person who would truly watch a child die, knowing they could help, due to fear of legal repercussions (which are doubtful anyways).


This reminds me of all the times people spout nonsense about how EMS is "just another job." If you feel better by refusing to take accept the importance of the decisions you are paid to make every day, great, but that doesn't make you a Toyota technician. Practicing medicine (even via protocols)sometimes requires tough decisions and can have a profound impact on people's lives. That requires some moral fortitude (and, of course, a working knowledge of your states laws and policies etc.) - you can't always just punt responsibility.

 

[jrm818]

Thirty-eight states and the District of Columbia have religious exemptions in their civil codes on child abuse or neglect including decisions about healthcare.
Seventeen states have religious defenses to felony crimes against children including results from decisions about healthcare.

Hospitals and ethics boards frequently label people "mature minors" and allow them to refuse medical care on the grounds of religion. Some as young as 12-14 can refuse life saving treatment for themselves.

Take a look here and read through some cases and some of the legislation that is currently active

http://childrenshealthcare.org/

No clue where you wanted us to look on that website, but as to the top of the post: my understanding is that the laws you reference protect parents from criminal charges for failing to obtain medical care for their children. Those laws do not prohibit medical personnel from overruling paretns to provide life saving care in an emergency

 

[mycrofft]

" I'm an educated medical professional, acting in place of a physician ".

Paramedics are technicians operation under protocols written by MD's, and supervised by their medical controller. They are not in lieu of a physician. Even PA's and FNP's are not in lieu of physicians.

Be that as it may, everyone including paramedics is responsible for reporting and preventing child abuse and endangerment. Point taken.

 

[mycrofft]

Just because I can't let it alone….

Would a responder be justified in using lethal force against a parent whose obstruction will cause a child's death? How about another adult's?

 

[VFlutter]

TLDR: parents are non-omnipotent; they do not have the right to decide if their child lives or dies.

But you do?

 

[Av8or007]

Yes. Withholding medical care for a child on the basis of religion when the child is unable to consent to withhold the care themselves is no different then child abuse.

What happens if your religion involved starvation or beatings? Is that ok too?

Of course not.

 

[TheLocalMedic]

Would a responder be justified in using lethal force against a parent whose obstruction will cause a child's death? How about another adult's?

No. Lethal force is not acceptable. But it is absolutely legal to use the "necessary" amount of force required to prevent them from killing or injuring another person. "Necessary" is a pretty broad term, so interpret that as you may, but I envision that as restraining them rather than bashing them over the head with an O2 tank.

 

[TheLocalMedic]

But you do?

Yes. Preventing a child from receiving immediate, life-saving care is illegal, and I am ethically and legally obligated to act to save that child, even if it is against the parents wishes.

 

[Carlos Danger]

No. Lethal force is not acceptable. But it is absolutely legal to use the "necessary" amount of force required to prevent them from killing or injuring another person. "Necessary" is a pretty broad term, so interpret that as you may, but I envision that as restraining them rather than bashing them over the head with an O2 tank.

I'm curious how you propose physically restraining 1 or both parents and simultaneously providing care to the child?

 

[jrm818]

But you do?

x2 to localmedic's reply

I don't make any decision - society made the decision that ending a child's life because of parental beliefs is unacceptable. And its not much of a complicated decision - kid gets every chance to live, period. Seems pretty reasonable....freedom in this country is not without qualification.

EMS providers may be the enforcers of that decision. It is not a decision that I/we just made on our own, however. That said, I make no apologies for being culturally normative when a child's life is on the line

Did you read any of the information that was posted? This isn't a novel idea I cooked up....it's been established by common law, written law, and the courts. This is also a concept that a healthcare professional should have some familiarity with.....

 

[TheLocalMedic]

I'm curious how you propose physically restraining 1 or both parents and simultaneously providing care to the child?

Restraining was just an example of the kind of force that may be considered. In this case it may be that you wouldn't have to use much force, perhaps just initiating care and ignoring the parent's protests, or removing the child to the ambulance. But if it gets physical I'm not adverse to protecting myself and the patient. This is a more drastic scenario, but letting a potentially dying child just lay there isn't an option.

1. Call for code 3 law enforcement (and possibly an extra ambulance and a fire crew if there isn't one present)
2. Quickly try to reason with the parents (probably less than a minute)
3. Get access to the patient - if that means getting them out of there, great, and if the parents try to block you, then get them out of the way. Stop only if there's a serious risk to yourself.