Chapter 3 Medical, Legal, and Ethical Issues
Principle of health professions: To do NO further harm.
Avoid legal issues by acting in good faith AND up to the
standard of care.
v
Consent
§
Patient autonomy
·
Able to make informed decisions on their own.
Ø
Types of consent
§
Expressed consent
·
Verbally acknowledges permission for
care/transport
·
w/o explanation of treatment, risks, and
benefits.
§
Informed consent
·
Expressed consent + EMT explains treatment,
risks, and benefits.
·
Explanations and understanding
§
Implied consent (Aka emergency doctrine)
·
Patients who are unconscious/unable to make
informed decisions
·
Used only when there is threat to life/limb.
§
Involuntary consent
·
May apply to
¨
Mentally ill patients
¨
Patients with behavioral crisis
¨
Developmentally delayed patients
·
Usually hope to gain consent from guardian prior
¨
When NOT possible, provide care under local
provisions and utilize law enforcement when possible.
§
Minors and consent
·
Parent/legal guardian gives consent
·
Some states allow for emancipated minors to give
their own consent
¨
Married
¨
Part of the arm forces
·
In schools, teachers and school officials may
act in replacement of parents.
·
If NO consent given or lacking consent, treat as
implied consent.
v
Forcible Restraint
Ø
Sometimes necessary with combative patient
Ø
Usually best to involve law enforcement or
medical control
v
Refusal of care
Ø
requires:
§
Patient conscious
§
Rational
§
Capable of making informed decisions
Ø
Patient can withdraw from treatment at any time.
Ø
Assess the patient’s ability to make an informed
decision.
Ø
Prior to leaving a scene b/c of refusal of care
(rare) à
Usually better and more easier to provide care than NOT give care at all.
§
Encourage pt to obtain treatment again
§
Ask them to sign refusal of care
§
Obtain signature from non-EMS witness.
v
Confidentiality – Health Insurance Portability
and Accountability Act (HIPPA)
Ø
Patient information can only be disclosed if:
§
Patient signs a release
§
Legal subpoena is presented
§
Needed by billing dept
v
Advanced Directives
Ø
Do Not Resuscitate (DNR) à Physician written order to
withhold resuscitation.
Ø
Must document:
§
Statement of patient’s medical problems.
§
Signature of patient/legal guardian
§
Signature of physician/healthcare provider
§
NOT expired.
Ø
Health care directives/Health care proxies
§
Advanced directives specifies treatment when
patient unable to make decisions.
·
Physician orders for life-sustaining treatment
(POLST)
·
Medical orders for life-sustaining treatment
(MOLST)
·
Durable power of attorney for healthcare
(healthcare proxy)
v
Physical Signs of Death
Ø
Presumptive signs of death
§
Unresponsiveness to painful stimuli
§
Lack of carotid pulse
§
Absence of chest rise and fall
§
No corneal reflexes
§
No systolic BP
§
Profound cyanosis
§
Lowered/decreased body temp
Ø
Definitive signs of death
§
Obvious mortal injury (decapitation)
§
Dependent lividity (blood settles are lowest
point in the body)
§
Rigor motris (muscle stiffening for a period
after death)
§
Putrefaction (decomposition)
Ø
Medical Examiner Cases – Medical professional
trained to investigate unusual deaths
§
Dead on arrival (DOA) / dead on scene (DOS)
§
Death with without previous medical care
§
Suicide
§
Violent death
§
Poisoning
§
Death from accidents
§
Suspicion of a criminal act
§
Infant and child deaths
EMT Standards of Care
v
Scope of practice
Ø
DEF: Outlines care you can provide
Ø
Medical
director defines scope of practice by developing:
§
Protocols
§
Standing orders
v
Standards of Care – manner that a reasonable EMT
in a similar situation would do.
Ø
Established by:
§
Local custom
§
Law
§
Professional/institutional standards
§
Textbooks
§
Standards imposed by states
Possible Legal Charges
v
Negligence (Requires 4 prereqs) – Failure to provide sufficient
care.
Ø
Duty to act
§
EMT has responsibility to provide patient care
·
Once ambulance responds to a call
·
When treatment has started
§
Most cases when off duty there no responsibility
is to act
Ø Breach
of duty
§
EMT did not act within an expected reasonable
standard of care.
Ø Damages
§
Patient was physically or psychologically harmed
in a noticeable way.
Ø Causation
§
Cause & effect relationship exists between
breach of duty & damages to patient.
v
Abandonment – Termination of care by EMT w/o patient’s consent
AND w/o making provisions for care to be continued by a competent medical
professional.
Ø
Can take place:
§
At the scene
§
In the hospital emergency department.
Ø
ALWAYS obtain a signature of the person
accepting transfer of care at the hospital.
v
Assault and Battery
Ø
Assault
– Threatening to use physical force or immediate bodily harm.
§
Ex:
threatening to use restraints on the patient
Ø
Battery
– Physical touching without permission.
§
Ex:
providing care w/o consent
v
Kidnapping – Seizing, confining,
abducting, or carrying away by force.
§
Ex: transporting
patient w/o consent
v
False imprisonment
– Unauthorized confinement of a person.
§
Ex: Patient rescinds consent, but EMTs do
NOT let patient leave ambulance.
v
Defamation –
Communication of false information that damages the reputation of the person.
Ø
Libel (written) –
Ex: False statement on a run report.
Ø
Slander (spoken) –
Ex: Inappropriate comments made during conversation.
v
Good Samaritan Laws – When reasonably providing
care, NOT liable for errors or omissions in giving care.
Ø
Protected when:
§
Acted in good faith
§
NO expectation of compensation
§
Within scope of practice
§
Did NOT act in grossly negligent manner
When it comes to legal, paper and documents are EVERYTHING.
v
Action NOT recorded = NOT done.
v
Incomplete/untidy reports = Poor emergency care
in eyes of court.
v
When subpoenaed to testify in court
Ø
Notify:
§
Service director
§
Legal counsel
Ø
As witness:
§
Remain neutral
§
Review the written report BEFORE court (less
surprises)
Ø
As a defendant, an attorney is required.
§
Defenses against possible lawsuits:
·
Statue of limitations – Time limit for case to
be open about the incident (past the time limit)
·
Governmental immunity – Governmental entities
protected (Cannot be sued at all/amount of monetary judgment is limited).
·
Contributory negligence – Conduct of the
plaintiff contributed to the injuries/damages suffered by the plaintiff
(Patient’s own behavior caused their health consequences).
§
Discovery – Both sides sniff out for additional
evidence about what happened
·
Interrogatories
¨
Written requests/questions
·
Depositions
¨
Oral requests/questions
Ø
Trial
§
Most cases are settled after discovery phase.
§
IF case goes to trial:
·
Compensatory damages – plaintiff compensated for
injuries sustained.
·
Punitive damages – Defendant punished for
behavior
§
Should mostly be covered by EMS
carrier/insurance.
·
Criminal offenses – Much more serious.
Some states have mandatory reporting obligations regarding
specific situations encountered:
Some examples:
·
Child/elderly abuse
·
Injury during felony
·
Drug-related injuries
·
Childbirth
·
Attempt suicide
·
Dog bites
·
Certain communicable diseases
·
Domestic violence
·
Sexual assault/rape
·
Exposure to infectious disease
·
Restrained patients
·
Crime scenes
v
Ethics
Ø
Ethics – philosophy of right & wrong, moral
duties, ideal professional behavior.
Ø
Morality – Code of conduct affecting character,
conduct, and conscience.
Bioethics – Address issues of ethics in
healthcare.
