Primum non nocere. First, do no harm.
The Hippocratic oath is an oath of ethics historically taken by physicians and is one of the most widely known of Greek medical texts. “I will abstain from all intentional wrong-doing and harm.”
In its original form, it requires a new physician to swear, by a number of healing gods, to uphold specific ethical standards. The oath is the earliest expression of medical ethics in the Western world, establishing several principles of medical ethics which remain of paramount significance today.
These include the principles of medical confidentiality and non-maleficence. As the seminal articulation of certain principles that continue to guide and inform medical practice, the ancient text is of more than historic and symbolic value. It is enshrined in the legal statutes of various jurisdictions, such that violations of the oath may carry criminal or other liability beyond the oath’s symbolic nature. [i]
Over time and through the eons, the oath has changed in its recitation by the various medical societies who adopt a similar oath, with changed language, but certainly with the same intent of “first do no harm.”
As EMTs and paramedic first responders, we are made aware of the Hippocratic Oath early in our training and that oath is reinforced periodically through refresher training or by examples of others violating the oath in their care of their patients.
The NAEMT has a Code of Ethics of eleven (11) statements of service to your patient and the community that begins with:
- Professional status as an Emergency Medical Services (EMS) Practitioner is maintained and enriched by the willingness of the individual practitioner to accept and fulfill obligations to society, other medical professionals, and the EMS profession. As an EMS practitioner, I solemnly pledge myself to the following code of professional ethics and proceeds to list several additional standards of care or ethical standards that illustrate our responsibility to our patients and community. [ii]
Enshrining this oath in State Law is not easily found in an Internet search and even in my state of Washington. Many of the court cases are related to “ex parte” communications between a defense attorney and the plaintiff’s physician over a medical malpractice case and the conversation was condemned by the court. (See Loudon v. Mhyre, 110 Wn.2d.675, 756 P.2d (1988).
Many cases involving a violation of the oath are found in medical malpractice cases where the essential tenant of “doing no harm” was violated and many of those cases are based on the poor medical outcome and violation of an established Standard of Care.
There are numerous examples of EMTs and paramedics violating this oath and their agencies’ ethical codes and code of conduct. Some examples are:
- A pair of New Jersey EMTs have been suspended after allegedly physically assaulting a handcuffed patient at an Atlantic City casino.
- A New York City EMT was arrested and charged with sexually abusing a patient.
- A former Mississippi Coast paramedic pleaded guilty Monday to sexually assaulting patients in the back of ambulances while enroute to Mississippi hospitals for medical care.
- Paramedics and police officers have been charged with manslaughter, criminally negligent homicide and other charges in the death of Elijah McClain by using carotid holds and administration of ketamine to subdue Mr. McClain.
A search of the Internet will reveal many more cases of EMT first responders abusing patients—not a great example of care performed by thousands of EMT, paramedics, and first responders around the nation.
Now, our profession is faced with a horrible example of patient abuse: two first responder EMTs from Springfield, Illinois, have been charged with first-degree murder of a patient after he was strapped to a gurney face-down and died. A police body camera has recorded the abuse suffered by this patient and this case is scheduled for trial for the criminal element of murder. The family has also retained the services of a high profile civil rights attorney to pursue civil litigation.
In the United States, everyone is innocent until proven guilty in a court of law and the video evidence is horrifying to any observer. Certainly by members of the EMS profession who are putting their health and safety on the line providing daily service to their community, this act makes their job much more difficult. This recorded example of abuse and ultimate death of the patient sets back years of goodwill created by the professionals providing service to their community.
There is no direct punishment for breaking the Hippocratic Oath, although an arguable equivalent in modern times is medical malpractice, which carries a wide range of punishments, from legal action to civil and criminal penalties. [iii]
Under Illinois law, a first-degree murder charge can be filed when a defendant “knows that such acts create a strong probability of death or great bodily harm.”
Noted EMS attorney and colleague Douglas Wolfberg, a founding partner of Page, Wolfberg & Wirth, a law firm that concentrates on representing emergency medical services, said it’s immensely rare for a provider to face a murder or homicide charge in connection with patient care and it’s difficult for prosecutors to make a criminal case beyond a reasonable doubt. Wolfberg said he was extremely troubled by the video and believes the pair at least provided “wholly deficient care” from when Finley first interacted with Moore to when the paramedics strapped their patient in the prone position. [iv] Listen to Doug and Steve Wirth discuss this issue on a podcast entitled “How Does This Happen?” sponsored by Lexipol. [v]
Regardless of the legal outcome of this and other abuse cases, our job is to provide the very best care for the sick and injured members of our communities. Remember your oath to “first, do no harm.”
ENDNOTES
[i] https://en.wikipedia.org/wiki/Hippocratic_Oath
[ii] https://www.naemt.org/about-ems/code-of-ethics
[iii] Groner M.D., Johnathan (2008). “The Hippocratic Paradox: The Role of The Medical Profession In Capital Punishment In The United States”. Fordham Urban Law.
[iv] https://www.jems.com/news/ems-attorney-prosecutors-will-have-hard-time-proving-murder-charges-against-il-medics/
[v] https://www.ems1.com/legal/articles/how-does-this-happen-wolfberg-and-wirth-weigh-in-on-emt-murder-charges-y9grZUmoaqdquxLq/
JOHN K. MURPHY, J.D. M.S, PA-C, EFO, began his fire service career as a firefighter/paramedic and retired as a deputy chief after 32 years of service. He is an attorney licensed in Washington whose focus is on firefighter health and safety, firefighter risk management, employment practices liability, employment policy, internal investigations, and expert witness and litigation support. He was a Navy corpsman with the Marine Corps. He is a lecturer, an educator, an author, a legal columnist, a blogger, and a member of Fire Engineering’s Fire Service Court Blog Talk Radio Show. He is also a lecturer at the IAFC Fire Rescue International and I-Women conferences. He is a National Fire Academy instructor. He is a distance learning instructor for the University of Florida Fire and Emergency Services programs.
This commentary reflects the views of the author and not necessarily the views of Fire Engineering. It has not undergone the standard peer-review process, and should not be construed as legal advice or counsel.
