Chapter 3: Medical, Legal, and Ethical Issues

Overview

• This chapter covers the ethical responsibilities and medical-legal directives for EMTs.
• Topics include patient confidentiality, consent, refusal of care, advance directives, organ donation, evidence preservation, and end-of-life issues.

Basic Principle

• Do No Harm: Health care providers avoid legal exposure by acting in good faith and adhering to appropriate standards of care.
• Even with proper care, legal actions from patients are possible.

Consent

1. Definition: Permission to render care.
2. Types of Consent:
   • Express Consent: Patient acknowledges the desire for care and transport; must provide informed consent.
   • Implied Consent: Assumed in life-threatening situations when patients are unconscious or unable to give consent.
   • Involuntary Consent: Applies to mentally ill, behavioral crisis, or developmentally delayed patients; obtain consent from guardians where possible.
   • Minors: Parent/legal guardian typically gives consent. Exceptions include emancipated minors.

Right to Refuse Treatment

• Conscious adults with decision-making capacity can refuse treatment.
• Refusal decisions should be well-documented and involve online medical control.

Confidentiality

• Includes all patient interactions, history, and treatment.
• HIPAA: Protects patient information; includes penalties for breaches.

Advanced Directives

• DNR Orders: Do not resuscitate orders permit withholding resuscitation; must still provide supportive care.
• Living Wills/Healthcare Directives: Specify medical treatment for incapacitated patients.

Determination of Death

• Presumptive Signs: Include lack of pulse, unresponsiveness, no chest rise.
• Definitive Signs: Include decapitation, rigor mortis, dependent lividity.

Medical Examiner Cases

• Required in cases like DOA, suicide, violent deaths, or child deaths.

Organ Donation

• Treat potential donors as any other patient to preserve organ viability.

Scope of Practice

• Defined by state law and medical director protocols.
• Standing Orders and Protocols: Authorize EMT actions either online or offline.

Standards of Care

• Dictated by local customs, laws, institutional standards, and professional organizations.

Legal Concerns

1. Negligence: Failure to provide expected care with proof of duty, breach, damage, and causation.
2. Abandonment: Unilateral termination of care without patient consent or proper transfer.
3. Assault, Battery, and Kidnapping: Involve unlawful threats and physical actions without consent.
4. Defamation: Communication damaging a person's reputation (libel and slander).

Good Samaritan Laws

• Provide legal protection to those assisting in emergencies if specific conditions are met.

Records and Reporting

• Comprehensive record-keeping is crucial; incomplete reports may suggest poor care.

Mandatory Reporting

• Include child/elder abuse, felony-related injuries, certain diseases, and more.

Ethical Responsibilities

• Ethics guide the conduct of EMTs; involve right and wrong, professional behavior.
• Bioethics: Deals with ethical issues in healthcare practice.

EMT in Court

• EMTs may be involved as witnesses or defendants in legal cases.
• In civil suits, defenses can include statutes of limitations and governmental immunity.

Key Review Points

• Express consent can be non-verbal (e.g., patient holding out arm for BP measurement).
• Abandonment occurs when care is handed to someone less trained.
• Legal definitions and distinctions between assault, battery, and false imprisonment are important.