Education And Debate Ethical debate

Too drunk to care?Ethanol, emergencies, and ethical dilemmasCommentary: Guidelines could never be developedCommentary: Balance the risk as best you canCommentary: Doctors can never have a moral holiday

BMJ 1998; 316 doi: (Published 16 May 1998) Cite this as: BMJ 1998;316:1515

Too drunk to care?

What should doctors do if they are faced with a medical emergency after they have had a few alcoholic drinks? Dr David Cressey describes how, although not entirely sober, he felt compelled to help an unconscious person at a sports event, and two medical ethicists, a psychologist, and another doctor give their views.

Ethanol, emergencies, and ethical dilemmas

  1. David M Cressey, registrar (
  1. Anaesthetic DepartmentRoyal Hallamshire Hospital, Sheffield S10 2JF
  2. aTrimbos Institute, PO Box 725, 3500 AS Utrecht, Netherlands
  3. bDepartment of Medical Ethics, Erasmus University Rotterdam, Netherlands
  4. cBristol Oncology Centre, Bristol BS2 8ED
  5. Bristol Oncology Centre, Bristol BS2 8ED
  6. Centre of Medical Law and Ethics, King's College, London WC2R 2LS

    While attending a recent sports event as a spectator, I was faced with a dilemma. I saw an incident in which a spectator was left unconscious and could have injured his neck. The injured man had been placed in the recovery position but was not moving. As the official crowd doctor was not immediately on hand, I felt I should at least offer my services. However, I had had an alcoholic drink. I told the attending ground steward that I was an anaesthetist, and warned him of the risks of a possible neck injury. The steward then asked for my help. I quickly assessed the patient; he had a clear airway, was breathing adequately, had a strong pulse, was pink and well perfused. None the less he had a coma score of 3, and I had seen him drinking and eating moments before the accident.

    When the paramedics and official crowd doctor arrived, the patient was fitted with a hard collar and was placed on a scoop stretcher. Having introduced myself to the crowd doctor and briefed him on the patient's state, I told him that I had had a drink. I then had to decide whether I should participate further in the patient's care. Here was a young man with a possible neck injury and in a hard collar. He had a full stomach, a coma score of 3, and although currently maintaining his own airway, the protective reflexes were obtunded.

    Immediate intubation had been considered …

    Correspondence to: Professor Rigter

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