OBJECTIVE: Precision medicine is a rapidly progressing avenue to providing the right care to the right patient at the right time and spans all medical fields and specialties. However, given its reliance on computation and timely, accurate information, actualizing precision medicine within the emergency department and its 'anyone, anywhere, anytime' approach presents unique challenges which could exacerbate disparities rather than improve care. METHODS: We performed a qualitative, nominal group technique study of emergency physicians with prior knowledge of precision medicine concepts to identify high priority ethical concerns facing the implementation of precision medicine in the emergency department. RESULTS: Twelve emergency physicians identified 91 ethical concerns which were organized into a framework with three major themes: values, privacy, and justice. The framework identified the need to address these themes across three time points of the precision medicine process: acquisition of data, actualization in the care setting, and after effects of its use. CONCLUSIONS: Precision medicine may help to improve the quality of care provided in the emergency department, but significant hurdles exist. Our framework helps to identify high-yield ethical concerns that could serve as focus areas for future research and policy in order to guide the effective implementation of precision medicine in the emergency department.

The authors have declared no competing interest.

Research made possible thanks in part to a generous seed grant from Stanford University McCoy Family Center for Ethics in Society - Ethics, Society, and Technology Hub Seed Grant.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics committee/IRB of Stanford University gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

All data produced in the present work are contained in the manuscript.