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{
    "pk": 38060,
    "title": "Physician-Assisted Dying Witnessed by Emergency Medical Services: A Case Report ",
    "subtitle": null,
    "abstract": "<p><strong>Introduction:</strong> Physician-assisted dying (PAD) is a practice that allows terminally ill patients to self-administer prescribed lethal medication.  In the 11 U.S. states where PAD is legal, the incidence of PAD cases is rapidly increasing.  Despite the majority of these cases occurring in the out-of-hospital setting, states lack specific emergency medical services (EMS) protocols to guide prehospital clinicians who may encounter PAD in the field.  Here, we describe a case in which a patient called 9-1-1 for a medical emergency and requested to ingest their prescribed lethal medication while in EMS care.</p>\n<p><strong>Case Report:</strong> EMS was dispatched for a 56-year-old female who was bleeding from her tracheostomy stoma.  Despite the clinicians’ recommendation for transport to the emergency department, the patient refused transport and instead requested to ingest her PAD medication.  The crew, unfamiliar with PAD laws, were unsure if they could legally honor the patient’s refusal.  Clinicians consulted with on-line medical control, who were also unaware of PAD.  After extensive deliberation, the crew eventually decided to honor the patient's refusal and thoroughly document the situation.  The patient self-administered her medication as EMS cleared the scene.</p>\n<p><strong>Conclusion</strong>: This case highlights the logistical challenges and ethical dilemmas faced by the responders, and underscores the complexity of balancing patient autonomy with legal and medical responsibilities in prehospital PAD situations.  As PAD becomes increasingly prevalent, equipping EMS clinicians with clear protocols and ongoing education about prehospital PAD cases is vital to preserving patient rights while protecting clinicians from legal and ethical uncertainty.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Physician-assisted Dying"
        },
        {
            "word": "emergency medical services"
        },
        {
            "word": "Refusal of Care"
        },
        {
            "word": "Protocols"
        },
        {
            "word": "case report"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/8hj2s279",
    "frozenauthors": [
        {
            "first_name": "Saahith",
            "middle_name": "",
            "last_name": "Potluri",
            "name_suffix": "",
            "institution": "Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland; Montgomery Emergency Medical Services, Belle Mead, New Jersey",
            "department": ""
        },
        {
            "first_name": "Tharun",
            "middle_name": "",
            "last_name": "Potluri",
            "name_suffix": "",
            "institution": "Montgomery Emergency Medical Services, Belle Mead, New Jersey; Georgetown University, Department of Human Science, School of Health, Washington, DC; Georgetown University, Georgetown Emergency Response Medical Service, Washington, DC",
            "department": ""
        },
        {
            "first_name": "Jose",
            "middle_name": "V",
            "last_name": "Nable",
            "name_suffix": "",
            "institution": "Georgetown University, Georgetown Emergency Response Medical Service, Washington, DC; Georgetown University School of Medicine, Department of Emergency Medicine, Washington, DC",
            "department": ""
        },
        {
            "first_name": "Paul",
            "middle_name": "",
            "last_name": "Peng",
            "name_suffix": "",
            "institution": "Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey",
            "department": ""
        },
        {
            "first_name": "Kusum",
            "middle_name": "",
            "last_name": "Punjabi",
            "name_suffix": "",
            "institution": "Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey",
            "department": ""
        }
    ],
    "date_submitted": "2024-10-24T14:59:01.218000-07:00",
    "date_accepted": "2025-01-14T11:33:21.282000-07:00",
    "date_published": "2025-03-20T23:10:00-07:00",
    "render_galley": null,
    "galleys": [
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            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/38060/galley/35732/download/"
        }
    ]
}