dc.description.abstract | Background: This case report discusses an ethical communication dilemma in prehospital patient interaction,
involving a patient who was about to board a plane at a busy airport. The article argues that the situation
raised dilemmas about communication, patient autonomy and paternalism. Paramedics should be able to find
good solutions to these dilemmas, but they have not received much attention in the literature on prehospital
ambulance work.
Case presentation: The patient had chest pains that were consistent with serious heart disease, but she
wanted to catch her plane and was unwilling to let paramedics assess her heart activity by means of an
electrocardiogram (ECG). The paramedics had to decide, there and then, whether the patient’s refusal to
submit to an ECG should be respected, or whether they should set the patient’s expressed wishes aside by
exercising verbal power and persuasive communication techniques. The paramedics chose to do the latter. It
later turned out that the patient was grateful that the paramedics had been very direct, almost brutal, in their
communication. When the patient regained her autonomy, she saw clearly that taking time to obtain and
monitor an ECG was the best option for her.
Conclusion: Looking forward in time might be a good professional strategy for deciding whether ethical
paternalism in communication is justified. If there is good reason to believe that patients who later regain
their autonomy will agree that paternalistic verbal actions were in their best interests, and if acting in
accordance with patients’ preferences can have severe negative health consequences for them, then
paramedics have good reason to believe that ethical paternalism is justified. | nb_NO |