Chapter 3: Medical Legal and Ethical Issues

Overview

• Focus on ethical responsibilities and medical legal directives for EMTs.
• Discusses confidentiality, consent, refusal of care, and advance directives.
• Covers organ donor policies, evidence preservation, and end-of-life issues.

Basic Principles

• Do No Harm: Emergency care should prioritize not causing additional harm.
• Good Faith: Acting in good faith and following the standard of care reduces legal exposure.

Consent

Types of Consent

• Express Consent: Patient acknowledges and agrees to care and transport.
  • Must be informed consent.
• Implied Consent: Assumes consent when patient is unconscious or incapable of informed decision.
  • Only applicable in life-threatening situations.
• Involuntary Consent: Applies to mentally ill, behavioral crises, or developmentally delayed.
  • Often involves guardians or law enforcement.
• Minors: Usually requires parental consent, but can be bypassed in emergencies or if the minor is emancipated.

Refusal of Care

• Patients with decision-making capacity can refuse treatment.
• Documentation of refusal and understanding of consequences is essential.
• Ethical consideration to encourage reconsideration and provide information.

Confidentiality

• Patient information is confidential and protected under HIPAA.
• Release of information requires patient consent, subpoena, or billing needs.

Legal Directives and Documentation

Advance Directives

• DNR (Do Not Resuscitate): Instructions to withhold resuscitation.
• Living Wills/Healthcare Proxy: Specify treatment preferences if incapacitated.

Signs of Death

• Presumptive Signs: Unresponsiveness, no pulse, lack of breath, and more.
• Definitive Signs: Decapitation, dependent lividity, rigor mortis, etc.

Medical Examiner Cases

• Involves cases such as DOA, unknown cause, suicides, violent deaths.

Organ Donors

• Treated like any other patient; priority is life-saving.
• Donor status often indicated on IDs or donor cards.

Scope of Practice and Standards

• Defined by state law; further refined by medical director.
• Standards of care involve acting as a similarly trained person would under similar circumstances.

Legal Terms

• Negligence: Failure to provide standard care; requires duty, breach, damages, and causation.
• Abandonment: Stopping care without ensuring continued professional medical care.
• Assault and Battery: Legal issues involving threats or unlawful touching.
• Good Samaritan Laws: Protect those offering aid in good faith from liability.

Documentation and Reporting

• Thorough documentation is crucial for protection against legal issues.
• Special reporting requirements for abuse, injury during felony, communicable diseases, etc.

Ethical Responsibilities

• EMTs must uphold ethical standards and incorporate them into practice.
• Bioethics deals with ethical dilemmas in healthcare practice.

Legal Proceedings

• EMTs can be involved in court as witnesses or defendants in civil or criminal cases.
• Proper legal representation is advised.

Review Questions Highlights

• Questions covered express consent, abandonment, false imprisonment, negligence, implied consent, advanced directives, and more.

Conclusion

• Understanding legal and ethical responsibilities is critical for EMTs to provide effective and lawful care.