Autism Care Ethics in the Emergency Department: From Triage to Disposition Open Access

Abstract

With the increasing prevalence of autism spectrum disorder (ASD), healthcare providers in the pediatric emergency department (PED) must reflect on delivering patient-centered and ethically-informed care. Patients with autism are more likely than their neurotypical peers to utilize the pediatric emergency department for a range of chief complaints, including behavioral health emergencies. Current practice utilizes standard behavioral health protocols to care for patients with autism presenting with aggression and other behavioral health complaints. As a result, the ethics of behavioral healthcare in the PED through department protocols such as venipuncture for medical screening or the use of chemical or physical restraint must be considered. 

This work proposes a paradigm shift from current practice to a practice informed by the proposed Autism Care Ethics (ACE). ACE utilizes aspects of care ethics and the growing field of autism ethics to present a lens for ethically informed care of the ASD patient in the PED. ACE attempts to integrate considerations of empathy into practice. Previously proposed elements of an ethics of care such as “context-dependence” and “relationship orientation” are utilized to form a theory of care that is both patient-centered and trauma-informed.

Table of Contents

Introduction: Triage – Michael's Narrative 1

Chapter 1: History & Physical: Autism Spectrum Disorder & the Emergency Department 6

Chapter 2: The Work-Up: What We Do 23

Chapter 3: The Differential Diagnosis: Altering the Paradigm, An Invitation 36

Chapter 4: Medical Decision Making: Ethical Implications of Current Practice 53

Chapter 5: Disposition & Visit Summary: A New Lens and Future Directions 61

References 64

Acknowledgements 71

About this Master's Thesis

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School	Laney Graduate School
Department	Bioethics
Degree	M.A.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medical Ethics Health Sciences, Mental Health Ethics
Keyword	autism spectrum disorder behavioral health pediatric emergency medicine empathy care ethics ethics of care autism ethics
Committee Chair / Thesis Advisor	Kathleen Kinlaw, Emory University
Committee Members	Claudia R. Morris , Emory University April R. Dworetz, Emory University

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