Abstract
Ethical challenges are integral to health care and are associated with moral distress among health professionals. Moral distress can turn into burnout with a range of negative effects for professionals, patients, relatives, collaborators, and the organisation. Based on action research a focus group study was conducted inclucing prehospital personnel from the emergency services in the Region of Southern Denmark. Results showed that ethical challenges arise in contexts of 1) caring for patients, 2) managing organizational demands, 3) collaborating. Ethical challenges are addressed informally by personnel in emergency vehicles, at ambulance stations, outside working hours, and ocationally involve family or friends with a background in health care. Further, prehospital physicians address ethically sensitive issues during monthly meetings. Voicing ethical challenges presupposes confidence, trust, and safety in relation to colleagues, management, and the organisation. Existing forms of clinical ethics support are ill suited to the prehospital emergency services. Targeted clinical ethics support initiatives are needed to address moral distress, prevent burnout, and build a supportive working environment. Initiatives must be developed collaboratively with personnel and tested bottom-up to identify and eliminate barriers for implementation.