Chapter 3: Medical Legal and Ethical Issues

Overview

• Focuses on ethical responsibilities, medical legal directives, and guidelines for Emergency Medical Technicians (EMTs).
• Covers patient care aspects such as confidentiality, consent, refusal of care, and advance directives.
• Discusses organ donation, evidence preservation, and end-of-life issues.

Principles of Emergency Care

• Do no harm: Primary principle to avoid legal exposure.
• Consent: Permission needed to render care.
  • Informed Consent: Patient aware of treatment risks, benefits, alternatives.
  • Implied Consent: Assumed in life-threatening situations for patients unable to consent.
  • Involuntary Consent: For mentally ill or developmentally delayed patients.
  • Minors: Generally requires parental consent unless emancipated.

Refusal of Care

• Patients with decision-making capacity can refuse care, even if it results in harm.
• Document refusals carefully.
• Ensure patient understands risks of refusal.

Confidentiality

• Patient information is confidential.
• Breach of confidentiality can lead to legal consequences.
• HIPAA: Protects patient information.

Social Media

• Maintain professionalism online and offline.
• Respect patient privacy.

Advance Directives

• Do Not Resuscitate (DNR): Allows withholding of resuscitation efforts.
• Living Wills and Healthcare Proxies: Specify treatment preferences when patients cannot decide.

Death and Medical Examiner

• Presumptive Signs of Death: Lack of pulse, absence of reflexes, etc.
• Definitive Signs of Death: Decapitation, rigor mortis, etc.
• Medical examiner involvement required in specific cases like violent deaths.

Organ Donation

• Treat organ donors as any other patient.
• Organs require oxygen to remain viable.

Scope of Practice

• Defined by state law and medical director.
• Standards of Care:
  • Local customs
  • Legal statutes
  • Professional standards

Legal Concepts

• Negligence: Failure to provide a standard of care.
  • Requires duty, breach, damages, causation.
• Abandonment: Unilateral termination of care without proper transfer.
• Assault and Battery: Providing care without consent.
• Defamation: False information damaging reputation.

Good Samaritan Laws

• Protects individuals providing emergency care in good faith without compensation.

Record Keeping

• Accurate record-keeping is crucial.
• Part of legal documentation in patient care.

Mandatory Reporting

• Includes child abuse, elder abuse, and certain injuries or diseases.

Ethical Responsibilities

• Uphold ethics in professional conduct.
• Legal duties may intersect with ethical responsibilities.

EMT in Court

• EMTs may appear as witnesses or defendants in civil or criminal cases.
• Legal defenses include statutes of limitations and governmental immunity.

Review Questions

• Covered key scenarios and legal/ethical solutions regarding patient care, consent, and reporting.

This chapter emphasizes legal and ethical guidelines for EMTs to ensure safe, responsible, and lawful patient care.