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Chapter 3

Medical, Legal, and Ethical Issues

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Objectives (1 of 4)

• 1.1.5 Describe the differences between ethical behavior and legal requirements.

• 1.1.6 State specific activities that are most appropriate to ethical behavior.

• 1.1.7 Identify whether a particular activity is unethical and/or illegal, given certain patient care situations.

• 1.1.8 Identify whether a particular activity is ethical or unethical given certain patient care situations.

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Objectives (2 of 4)

• 1.2.22 Describe the ability of physician run critique based on documentation.

• 1.3.1 Discuss the significance and scope of the following in relationship to EMT practice: State Medical Practice Act, Good Samaritan Act/Civil Immunity, state EMS statutes, state motor vehicle codes, and state and local guidelines for "Do Not Resuscitate."

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Objectives (3 of 4)

• 1.3.2 Define the following: negligence, medical liability, tort, duty to act, battery, slander, informed consent, expressed consent, implied consent, abandonment, libel, assault, and false imprisonment.

• 1.3.3 Describe the significance of accurate documentation and record keeping in substantiating incident.

• 1.3.4 Identify those situations that require the EMT-I to report those incidents to appropriate authorities.

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Objectives (4 of 4)

• 1.3.5 Describe the four elements to prove medical liability.

• 1.3.6 Describe the significance of obtaining expressed consent.

• 1.3.7 Describe the extent to which force and restraint may be used to protect the EMT, the patient, and the third party.

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Medical, Legal, and Ethical Issues

• Scope of practice– Defined by state law– Outlines care you can provide– Further defined in protocols and standing orders– Authorized through online and off-line medical

direction

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Standards of Care (1 of 2)

• Standard imposed by local custom– Often based on locally accepted protocols

• Standard imposed by the law– May be imposed by statutes, ordinances,

administrative guidelines, or case law

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Standards of Care (2 of 2)

• Professional or institutional standards– Recommendations published by organizations and

societies– Specific rules and procedures of your service or

organization

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Standards Imposed by States

– Medical Practices Act• Exempts EMT-Is from licensure requirements

– Certification and licensure• Process of evaluating and recognizing that EMT-Is have met

certain predetermined standards

– State EMS legislation• Regulations regarding medical control, protocols, and

communication

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Laws

• Legislative, administrative, and common– Enacted at the federal, state, and local levels by

legislative branches of government• Criminal law

– Federal, state, or local government prosecutes individuals on behalf of society

• Civil (tort) law– Deals with private complaints brought by a plaintiff

against a defendant for illegal act/wrongdoing

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Duty to Act

• Individual’s responsibility to provide patient care.• Responsibility to provide care comes from either statute

or function. • Legal duty to act begins once an ambulance responds

to a call or treatment is initiated.

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Negligence

• The failure to provide the same care that a person with similar training would provide.

• Negligence is determined by the following factors:– Duty to act– Breach of duty– Damages– Proximate cause

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Abandonment

• Termination of care without patient’s consent.• Termination of care without provisions for continued

care.• Care cannot stop unless someone of equal or higher

training takes over.

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Consent

• Expressed consent• Implied consent• Minors and consent• Mentally incompetent adults• Forcible restraint

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Assault and Battery

• Assault– Unlawfully placing a person in fear of immediate

bodily harm without consent• Battery

– Unlawfully touching a person

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The Right to Refuse Treatment

• Mentally competent adults have the right to refuse care.• Patients must be informed of risks, benefits, treatments,

and alternatives.• The patient must be fully alert and oriented to refuse.• EMT-I should obtain a signature and have a witness

present, if possible.

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Good Samaritan Laws and Immunity

• Good Samaritan– Based on the principle that you should not be liable

when assisting another in good faith• Immunity

– Usually reserved for governments

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Advance Directives

• Written documents that specify medical treatment for a competent patient, should he or she become unable to make decisions.

• DNR orders must meet the following general requirements:– Clearly state the patient’s medical problem(s)– Be signed by the patient or legal guardian– Be signed by one or more physicians– Be dated in the preceding 12 months

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Ethical Responsibilities

• Make the physical/emotional needs of the patient a priority.

• Practice/maintain skills to the point of mastery. • Critically review performances.• Attend continuing education/refresher programs. • Be honest in reporting.

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Confidentiality

• Information received from or about a patient is considered confidential.

• Disclosing information without permission is considered a breach of confidentiality.

• Generally, information can be disclosed only if the patient signs a written release.

• Terms: Libel, slander, invasion of privacy, and defamation

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HIPAA

• Acronym for the Health Insurance Portability and Accountability Act of 1996.

• The section that most affects EMS relates to patient privacy.

• It provides guidance on what types of information is protected, the responsibility of health care providers regarding that protection, and penalties for breaching that protection.

• Dramatically limits the ability to obtain follow-up information.

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Records and Reports

• Complete documentation is a safeguard against legal complications.

• If an action or procedure is not recorded, courts assume it was not performed.

• An incomplete or untidy report is considered evidence of incomplete or inexpert care.

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Special Reporting Requirements

• Abuse of children, elderly people, and others• Injury during the commission of a felony• Drug-related injuries• Childbirth• Suicides• Animal bites• Certain communicable diseases• Assault and rape

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Scene of a Crime

• If an emergency scene is also a crime scene, you must notify law enforcement immediately.

• Do not disturb the scene.

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The Deceased

• In most states EMT-Is cannot pronounce a patient dead.• Obvious death includes:

– Rigor mortis– Mortal injury– Dependent lividity– Decomposition

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Special Situations

• Organ donors• Medical identification insignia