Transcript Document

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 decisionmaking 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.