Chapter 2 Medical, Legal, and Ethical Issues © Steve Hamblin/Alamy Images

National EMS Education Standard Preparatory Applies fundamental knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical technician (EMT), medical/legal, and ethical issues to the provision of emergency care.

Introduction A basic principle of emergency care is to do no further harm. Provide competent emergency medical care that conforms with the standard of care taught to you. EMTs must understand not only the various legal aspects of emergency medical care, but the ethical issues as well.

Consent (1 of 2) Consent is permission to render care. A person must give consent for treatment. If the patient is conscious and rational, he or she has a legal right to refuse care.

Consent (2 of 2) Foundation of consent is decision-making capacity. –Can understand information provided –Can make informed choice regarding medical care Patient autonomy is right of patient to make decisions about his or her health.

Types of Consent Expressed Implied Consent of a minor Involuntary consent

Minors and Consent (1 of 2) Parent or legal guardian gives consent. In some states, a minor can give consent. –Emancipated minors –Some states consider minors to be emancipated if they are married, members of the armed services, or if they are parents. Teachers and school officials may act in place of parents.

Minors and Consent (2 of 2) If true emergency exists, and no consent is available: –Consent is implied. –Treat the patient.

The Right to Refuse Treatment Conscious, alert adults with decision- making capacity: –Have the right to refuse treatment –Can withdraw from treatment at any time Even if the result is death or serious injury

Refusal of Care for a Minor (1 of 2) Consider the emotional impact of the emergency on the parents’ judgment. Use patience and calm persuasion. Enlist the help of your supervisor, medical control, or law enforcement. When in doubt, contact medical control.

Refusal of Care for a Minor (2 of 2) Before you leave a scene where a patient, parent, or caregiver has refused care: –Ask them to sign a refusal of care form. –Document all findings and treatments rendered. –A witness is valuable in these situations. –If the responsible party refuses to sign the form, contact medical control and document the situation on the PCR.

Confidentiality (1 of 4) Information should remain confidential. Information generally cannot be disclosed except: –If legal subpoena is presented –If patient signs a release

Confidentiality (2 of 4) Health Insurance Portability and Accountability Act (HIPAA ) of 1996 –Contains a section on patient privacy –Strengthens privacy laws –Safeguards patient confidentiality –Provides guidance on: What types of information are protected The responsibility of healthcare providers Penalties for breaching protection

Confidentiality (3 of 4) HIPAA (cont’d) –Protection health information (PHI) Includes information that can be used to identify the patient. May be disclosed for purposes of treatment, payment, or operations. You may be legally mandated to report your findings in certain situations.

Confidentiality (4 of 4) HIPAA (cont’d) –Except for treatment purposes, only the minimum amount of information necessary should be released. –Failure to abide can result in civil and/or criminal action. –Each EMS system is required to have a policy and procedure manual and to designate a privacy officer.

Advance Directives (1 of 5) Advance directives specify treatment should the patient be unable to make decisions on his or her own. A “do not resuscitate” (DNR) order gives permission not to resuscitate.

Advance Directives (2 of 5)

Advance Directives (3 of 5) Without a valid, written advance directive or DNR order, if a patient or family member calls for your services, you are required by law to provide such services. –Unless the patient refuses

Advance Directives (4 of 5) Some patients may have named surrogates to make decisions for them. –Durable power of attorney –Health care proxy

Advance Directives (5 of 5) General guidelines: –Patients have the right to refuse treatment if they are able to communicate their wishes. –A written order from a physician is required for DNR orders to be valid in a health care facility. –Periodically review state and local protocols. –When you are in doubt or the written orders are not present, you have an obligation to resuscitate.

Torts Civil tort is a wrongful act that gives rise to a civil suit. –Not within the jurisdiction of US criminal courts –The goal is to provide compensation to victims for wrongdoings against them.

Negligence (1 of 3) Failure to provide same care that a person with similar training would provide in same or similar situation All of the following must be present: –Duty –Breach of duty –Damages –Causation

Negligence (2 of 3) Res ipsa loquitor – the theory used to hold an EMT or an EMS system liable even when the plaintiff is unable to clearly demonstrate how an injury occurred Negligence per se – a theory that may be used when the conduct of the person being sued is alleged to have occurred in clear violation of a statute

Negligence (3 of 3) Contributory negligence – a legal defense that may be raised when the defendant believes that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff

Abandonment Unilateral termination of care by EMT without: –Patient’s consent –Making provisions for continuing care Once care is started, you must not stop until an EMS provider assumes responsibility. –Failure to do so can result in civil action.

Defamation (1 of 2) Communication of false information that damages reputation of a person –Libel if written –Slander if spoken

Defamation (2 of 2) Defamation could arise out of: –False statement on a run report –Inappropriate comments made during conversation Only communicate information about your patients to authorized persons. Document information should be accurate, relevant, and factual.

Intentional Torts Involve actual crimes Assault: unlawfully placing person in fear of immediate bodily harm Battery: unlawfully touching a person Kidnapping: seizing, confining, abducting, or carrying away by force

Ethical Responsibilities (1 of 3) Ethics: philosophy of right and wrong, moral duties, ideal professional behavior Morality: code of conduct affecting character, conduct, and conscience Applied ethics: the manner in which principles of ethics are incorporated into professional conduct

Ethical Responsibilities (2 of 3) Requires you to evaluate and apply ethical standards Meet your legal and ethical responsibilities while caring for your patients’ physical and emotional needs. Let your decision making and actions be guided by applicable rules, laws and policies.

Ethical Responsibilities (3 of 3)

Credits Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the author(s). Background slide image (ambulance): © Galina Barskaya/ShutterStock, Inc.