Exploring moral quandaries: An interpretative phenomenological inquiry into the ethical dilemmas faced by Emergency Medical Technicians (EMTs) in the Southern Philippines

Abstract

Background: Emergency Medical Technicians (EMTs) in Lanao del Sur, Philippines, face ethical dilemmas shaped by the Meranao cultural value of ‘Maratabat,’ which emphasizes family honor and dignity. Understanding these cultural nuances is crucial for improving emergency medical care and addressing the ethical challenges encountered by EMTs in this region.

Objective: This study aimed to explore the ethical dilemmas experienced by EMTs in disaster management settings, particularly how cultural values shape their decision-making processes.

Methods: A phenomenological design was utilized. Eight EMTs working at the Provincial Disaster Risk Reduction and Management Office (PDRRMO) of Lanao del Sur, Philippines, were purposefully selected to participate. Data were collected from 31 January 2024 to 1 February 2024 through in-depth interviews, and thematic analysis was employed for data analysis.

Results: Key themes emerged, including navigating complex dilemmas, adhering to organizational protocols, influential factors impacting EMTs’ capacity to handle ethical dilemmas in emergency services, and coping strategies for EMTs in addressing the psychological burden from ethical dilemmas in emergency care. The concept of ‘Maratabat’ greatly affects EMTs’ ethical decision-making processes, guiding their actions in the field.

Conclusion: The study highlights the importance of cultural values, organizational backing, and coping mechanisms in effectively enabling EMTs to address moral quandaries in their professional roles. Institutional support, a positive organizational culture, and continuous education are essential in assisting EMTs in making informed decisions amid ethical dilemmas. These findings have implications for interventions and strategies to support EMTs as frontline providers of emergency medical services, enhancing patient care quality during crises.

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Declaration of Conflicting Interest

The authors declared no conflict of interest in this study.

Acknowledgment

The authors gratefully acknowledge the invaluable contributions of the participants and the support extended by the local government authorities of PDDRMO of Lanao del Sur, Marawi City. Their cooperation and involvement were essential for the successful completion of this study.

Authors’ Contributions

Raifa M. Guro, as the main researcher, played a pivotal role in conceptualizing the research topic and data collection. Asnorah P. Hadji Ali, also the main researcher, significantly contributed to the research by providing expertise in healthcare management, facilitating data collection, and offering valuable insights into the research topic. Ashley A. Bangcola contributed to the research by providing expertise in data analysis and being involved in applying methods to analyze the gathered data. Additionally, she assisted in interpreting the findings and drawing meaningful conclusions from the data analysis. Monalinda M. Macawadib played a significant role in the research by assisting in the analysis of the gathered data and contributed to ensuring the accuracy and reliability of the data analysis process. Norhanie A. Ali contributed to the research by providing valuable support in analyzing the gathered data and being involved in conducting data analysis, qualitative coding, or other data processing methods. Alibasher D. Macalnas played an integral role in the research by assisting in the analysis of the gathered data and contributed to ensuring the robustness and reliability of the data analysis process. All authors were accountable in each step of the study and approved the final version of the article to be published.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declaration of the Use of AI in Scientific Writing

We, the authors, disclose the utilization of ChatGPT (https://chat.openai.com/) to enhance the tone and style of our manuscript. In March 2024, we employed ChatGPT to proofread our work comprehensively. Specifically, we instructed the AI to identify typos, grammatical errors, passive voice constructions, repeated phrases, and unnecessary adverbs within our manuscript. The resulting output was subsequently refined to align more closely with our intended writing style.

References

Read more

Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological. (pp. 57-71). American Psychological Association. https://doi.org/10.1037/13620-004

Bruun, H., Milling, L., Mikkelsen, S., & Huniche, L. (2022). Ethical challenges experienced by prehospital emergency personnel: A practice-based model of analysis. BMC Medical Ethics, 23(1), 80. https://doi.org/10.1186/s12910-022-00821-9

Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Los Angeles: Sage Publications.

Fatovich, D. M., Finn, J., Webb, S., & Macdonald, S. P. J. (2020). The challenges of obtaining consent in emergency care research. Tasman Medical Journal, 2(1), 11-14.

Foster, K., Evans, A., & Alexander, L. (2023). Grace under pressure: Mental health nurses' stories of resilience in practice. International Journal of Mental Health Nursing, 32(3), 866-874. https://doi.org/10.1111/inm.13130

Ha, K.-M. (2024). Emergency preparedness for older adults via culture. Working with Older People, 28(1), 61-73. https://doi.org/10.1108/WWOP-01-2023-0001

Ibragimov, D. S., Soboleva, M. V., Dementyeva, Y. D., Roshchupkina, S. V., Bakhtiiarov, R. M., & Petrenko, E. G. (2023). Ethical aspects in medical practice: Investigation of ethical dilemmas and principles related to medical practice. Journal of Complementary Medicine Research, 14(3), 111-115. https://doi.org/10.5455/jcmr.2023.14.03.20

King, I. M. (1992). King's theory of goal attainment. Nursing Science Quarterly, 5(1), 19-26. https://doi.org/10.1177/089431849200500107

Kumar, N., Fatima, M., Ghaffar, S., Subhani, F., & Waheed, S. (2023). To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department. Clinical and Experimental Emergency Medicine, 10(2), 138-146. https://doi.org/10.15441%2Fceem.23.027

Primc, N., Schwabe, S., Poeck, J., Günther, A., Hasseler, M., & Rubeis, G. (2023). A typology of nurses' interaction with relatives in emergency situations. Nursing Ethics, 30(2), 232-244. https://doi.org/10.1177/09697330221128902

Puspitasari, R. A., Isharyanto, I., & Purwadi, H. (2019). Juridical review of presumed consent as the right of patients in emergency conditions. Journal of Health Policy and Management, 4(2), 96-104. https://doi.org/10.26911/thejhpm.2019.04.02.04

Roberts, M. (2021). Embodied ethical decision-making: A clinical case study of respect for culturally based meaning making in mental healthcare. American Journal of Dance Therapy, 43(1), 36-63. https://doi.org/10.1007/s10465-020-09338-3

Roy, C., & Andrews, H. A. (1999). The Roy adaptation model (2nd ed.). Stamford, CT: Appleton & Lange.

Shearer, K., Thomas, M., Signal, T., & Townsend, R. (2023). Factors influencing the lived experience of paramedics facing ethical dilemmas: A case comparison. International Journal of Ethics Education, 8(2), 321-333. https://doi.org/10.1007/s40889-023-00164-y

Tindall, L. (2009). J.A. Smith, P. Flower and M. Larkin (2009), Interpretative phenomenological analysis: Theory, method and research. Qualitative Research in Psychology, 6(4), 346-347. https://doi.org/10.1080/14780880903340091

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042

Torabi, M., Borhani, F., Abbaszadeh, A., & Atashzadeh-Shoorideh, F. (2018). Experiences of pre-hospital emergency medical personnel in ethical decision-making: A qualitative study. BMC Medical Ethics, 19, 1-9. https://doi.org/10.1186/s12910-018-0334-x

Valdez, L., Beran, F. E., Azman, C. J., Pimentel, A., & Baldovino, R. (2022, 16-18 Dec. 2022). Design and development of an IoT-based smart ambulance system with patient monitoring 2022 IEEE International Power and Renewable Energy Conference (IPRECON), Kollam, India. https://doi.org/10.1109/IPRECON55716.2022.10059568

Vranada, A., Rong, J.-R., & Pranata, S. (2022). Shared decision-making in emergency room setting: A concept analysis. Jurnal Aisyah: Jurnal Ilmu Kesehatan, 7(S2), 23-30. http://dx.doi.org/10.30604/jika.v7iS2.1393

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