Exploring New Zealand paramedic attitudes towards placebos versus adrenaline trials in pre-hospital cardiac arrest: An ethical inquiry. Presentation to the Paramedics Australasia 2015 Conference, Adelaide, Australia.

The use of placebos is ethically controversial; they usually involve a degree of deception and at least, a withholding of information. However, in some instances their use can be justified. In New Zealand and elsewhere, the use of adrenaline by paramedics in the treatment of cardiac arrest is standard and recommended practice. However a systematic review and meta-analysis of adrenaline in the treatment of out of hospital cardiac arrest has been inconclusive, providing the impetus for a number of research projects into adrenaline’s efficacy. The implementation of clinical trials to assess such efficacy has been accompanied by a sense of unease for both the public and some participating health professionals. Better understanding the ethical complexity of placebo use in such clinical trials may help contribute to the planning, design and implementation of future research in this area. This qualitative, interpretative study explores the attitudes of seventeen New Zealand practising independent / intensive care paramedics towards a hypothetical clinical trial scenario involving the use of placebo or adrenaline in an out of hospital primary adult cardiac arrest. The Values Exchange, a web-based educational technology, provided an ethical decision-making framework for participants to consider the scenario. A thematic analysis of their responses suggest that the need to maintain public trust through openness and honesty is a key driver for paramedic decision-making during this type of clinical trial. Identified areas of ethical tension included balancing the benefits and risks for patients and balancing the needs of trial patients with those of future patients.