The ethical dilemma of emergency department patients with low-risk chest pain

Emerg Med J. 2021 Nov;38(11):851-854. doi: 10.1136/emermed-2020-209900. Epub 2021 Mar 9.


Millions of patients present to US EDs each year with symptoms concerning for acute coronary syndrome (ACS), but fewer than 10% are ultimately diagnosed with ACS. Well-tested and externally validated accelerated diagnostic protocols were developed to aid providers in risk stratifying patients with possible ACS and have become central components of current ED practice guidelines. Nevertheless, the fear of missing ACS continues to be a strong motivator for ED providers to pursue further testing for their patients. An ethical dilemma arises when the provider must balance the risk of ACS if the patient is discharged compared with the potential harms caused by a cardiac workup. Providers should be familiar with the ethical principles relevant to this dilemma in order to determine what is in the best interests of the patient.

Keywords: acute coronary syndrome; chest - non trauma; clinical assessment; ethics.

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / diagnosis*
  • Chest Pain / etiology
  • Chest Pain / therapy
  • Electrocardiography / methods
  • Emergency Service, Hospital / ethics*
  • Emergency Service, Hospital / organization & administration
  • Humans
  • Personal Autonomy
  • Risk Factors
  • Social Justice