Chapter 3: Medical, Legal, and Ethical Issues
Basic Principle of Emergency Care
- Do No Further Harm: Healthcare providers avoid legal exposure when acting in good faith and according to appropriate care standards.
Consent
- Definition: Permission to render care.
- Types of Consent:
- Express Consent: Patient acknowledges they want care.
- Informed Consent: Patient is informed about treatment, risks, benefits, and alternatives.
- Implied Consent: Applied to patients who are unconscious or incapable of informed decision-making.
- Involuntary Consent: For mentally ill, behavioral crisis, or developmentally delayed patients.
- Decision-Making Capacity:
- Considerations include mental capacity, legal age, influence of substances, pain, injuries, sensory impairments, language barriers, and understanding of information.
- Minors and Consent:
- Typically requires parental consent, but exceptions exist (e.g., emancipated minors, emergencies).
Forcible Restraint
- Necessary for patients posing a danger to themselves or others.
- Legal consultation and law enforcement involvement are recommended.
Right to Refuse Treatment
- Adults with Decision-Making Capacity: Can refuse treatment, even with risks.
- Documentation: Thorough documentation and involvement of medical control are crucial.
Confidentiality
- Definition: Patient information is confidential and protected under HIPAA.
- HIPAA: Governs privacy of patient information and imposes penalties for breaches.
Advanced Directives
- Do Not Resuscitate (DNR): Specifies no resuscitation, but supportive measures are allowed.
- Other Forms: POLST and MOLST explicitly outline acceptable interventions.
Signs of Death
- Presumptive Signs: Lack of responsiveness, pulse, breathing, reflexes, and more.
- Definitive Signs: Mortal damage, dependent lividity, rigor mortis, and decomposition.
Medical Examiner Cases
- Involvement Required: For deaths under suspicious or certain circumstances.
Special Situations
- Organ Donors: Identify through donor cards or licenses.
- Medical Identification: Includes DNR orders and serious medical conditions.
Scope of Practice
- Defined by state law and medical director protocols.
- Standards of Care: Based on local, state, professional, and institutional guidelines.
Negligence
- Definition: Failure to provide care similar to peers under similar circumstances.
- Legal Doctrine of Negligence: Duty, breach, damages, causation.
Torts
- Civil wrongs like defamation or invasion of privacy.
Abandonment
- Definition: Unilateral termination of care without patient's consent.
Assault, Battery, and Kidnapping
- Assault: Threatening harm.
- Battery: Unlawful touching.
- Kidnapping: Transport against will.
Good Samaritan Laws
- Protect those rendering aid if done in good faith and within training scope.
Records and Reports
- Importance: Accuracy protects from legal complications.
- National EMS Information System: Standardizes EMS data.
Mandatory Reporting
- Obligations to report child abuse, violence, infectious diseases, etc.
Ethical Responsibilities
- Ethics Vs. Morality: Ethics is professional conduct; morality is personal values.
In Court
- Witness or Defendant: Maintain neutrality as a witness; seek legal representation as a defendant.
Review Questions
- Express Consent: Holding out an arm for blood pressure indicates express consent.
- Abandonment Example: Terminating care without consent.
- False Imprisonment: Unauthorized confinement.
- Negligence: Failure to provide similar care.
- Implied Consent for Minors: Used when parents can't be contacted.
- Advance Directive: Specifies care if a patient loses decision-making capacity.
- Competent Refusal: Legal age, conscious, alert individuals.
- Assault Example: Threatening restraint for consent.
- Duty to Act: Exists for on-duty EMS personnel.
- False Statement: Patient care report becomes part of hospital records.
Note: Always consult local protocols and legal requirements for precise application of these concepts.