CHAPTER 3: MEDICAL, LEGAL &

ETHICAL ISSUES
CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING
ACADEMY
 ETHICS
Ethics- the science of right and
wrong of moral duties and of
ideal behavior
Medical Ethics – part of ethics
that deals with the health care of
human beings
 SCOPE OF PRACTICE
 Outlines care you can
provide
 Further defined in
protocols and standing
orders
 Authorized through
online and off-line
medical direction

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 STANDARD OF CARE

 Standard imposed by
local custom
 Often based on locally
accepted protocols

 Standard imposed by the

law
 May be imposed by
ordinances, administrative
guidelines, or case law

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 LEGAL DUTIES
Duty to act : the legal obligation to
the patient
 On-duty – you are legally obligated to assist
within your formal scope of practice
 Off-duty
 You may stop and help
 You may pass the scene and make no attempt to call for help.
 You may pass the scene and call for help
 PATIENT BILL OF RIGHTS
 The patient has right to considerate and respectful care
 The patient has the right to refuse treatment to the extent
permitted by law and to be informed of the medical
consequences of his actions
 The patient has the right to expect that all communications
and records pertaining to his care should be treated as
confidential
 The patient has the right to expect continuity of care
ETHICAL RESPONSIBILITIES

 Provide needs of the patient with respect for human

dignity, w/o regard to nationality, race, gender or
status
 Practice/maintain skills to the point of mastery.
 Critically review performances.
 Attend continuing education/refresher programs.
 Be honest in reporting.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 CONSENT

 Before treating a patient, responders must obtain

consent from patient, parent, or guardian
 Principle of autonomy, self-determination
 Right to be self-directing

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 TYPE OF CONSENT
 FORMAL CONSENT
 Expressed Consent
- Comes from the patient or family member.
 Informed Consent
- Comes from the EMR/EMT and the patient.
 The patient must be of legal age.
 Must be obtained from every conscious, competent adult
 Document when patient withholds consent

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 TYPE OF CONSENT

 IMPLIED CONSENT
 Verbal/written consent
not possible
 Reasonable person
would want emergency
treatment

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 TYPE OF CONSENT

 LAW OF EMANCIPATED MINOR

- a minor patient (below 18 y/o) can give consent if
he/she is living away with parents, economically stable
and pregnant.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 CONSENT

 Other types of consent

 Children, mentally incompetent individuals not legally able
to give expressed consent
 Must obtain consent from parent/guardian
 Unless implied consent more appropriate

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

CONSENT FORM
 REFUSAL OF TREATMENT &
TRANSPORT

 Person has right to refuse care

 Must be competent, able to make clear judgment

 Patient has right to withdraw from treatment

 “False imprisonment” if transferred against will

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 REFUSAL OF TREATMENT &
TRANSPORT
 Protecting Yourself
Do the following before you leave the scene:
 Try again to persuade the patient to accept treatment or
transport to a hospital
 Make sure that the patient is able to make a rational
informed decision
 If the patient still refuses, have him sign a refusal form
 Encourage the patient to seek help if certain symptoms
develop

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

REFUSAL OF TREATMENT &
TRANSPORT

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 ABANDONMENT

 Termination of care without

patient’s consent
 Termination of care without
provisions for continued care
 Care cannot stop unless someone
of equal or higher training takes
over

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 NEGLIGENCE

 The care of one provider

deviates from the accepted
standard of care and results
in further injury of the
patient

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 NEGLIGENCE DETERMINATION
• To prove negligence, must show:
 The EMS Practitioner had the
duty to act
 The patient was injured, either
physically or psychologically.
 The EMS Practitioner violated
the standard of care expected.
 The EMS Practitioner action
or lack of action caused or
contributed to the patient’s
injury
CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY
 INTOXICATED, IRRATIONAL, AND
EMOTIONALLY DISTURBED PATIENTS
 High legal risk
 Held against wishes, charges can result
 “Protective custody”
 Violent/suicidal patients
 Forcible removal
 “Soft” restraints
 Precise documentation

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 ASSAULT AND BATTERY

Assault - Unlawfully placing a person in fear

of immediate bodily harm without consent

Battery – Unlawfully or intentional touching

of another’s body without the others consent

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 GOOD SAMARITAN LAWS AND
IMMUNITY

 Good Samaritan
 Based on the principle that you should not be liable when
assisting another in good faith
 Immunity
 Usually reserved for governments

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 ADVANCE DIRECTIVES
 Specifies medical treatments desired if patient is unable to make
decisions
 Instructions written in advance documenting the wish of the chronically
or terminally ill patient not to be resuscitated and legally allows the
responder to withhold resuscitation. Usually accompanied by doctor’s
written instruction

 Do not resuscitate (DNR) orders

 Patients have the right to refuse resuscitative efforts.
 Require a written order from one or more physicians
 When in doubt, begin resuscitation.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 CONFIDENTIALITY

 Information received from or about a patient is considered

confidential.
 Disclosing information without permission is considered a
breach of confidentiality.
 Generally, information can only be disclosed if the patient
signs a written release.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 CONFIDENTIALITY

INSTANCES WHERE AN EMR/EMT IS ALLOWED TO

RELEASECONFIDENTIAL INFORMATION:
 Another health care provider needs to know the information
to continue medical care.
 As requested by the police as a part of a potential criminal
investigation.
 As required by legal subpoena.
 As requested by third party for billing purposes.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 HEALTH INSURANCE PORTABILITY &
ACCOUNTABILITY ACT (HIPAA)

 Safeguards patient confidentiality.

 Limits EMS providers from obtaining follow-up
information.
 Releases health information only with patient’s
permission.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 RECORDS AND REPORTS

 Complete documentation is a safeguard against legal

complications.
 If an action or procedure is not recorded, courts assume it was
not performed.
 An incomplete or untidy report is considered evidence of
incomplete or inexpert care.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 SPECIAL REPORTING
REQUIREMENTS

 Abuse of children, elderly, and spouse

 Injury during the commission of a felony

 Drug-related injury

 Childbirth

 Infectious disease exposure

 Crime scene

 Deceased

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

DYING AND DECEASED PATIENTS

 If a person is obviously dead, you may be required to

leave the body at the site if there is any possibility
that the police will have to investigate.

 In other situation, you may be required to arrange for

transport of the body so that a physician can
officially pronounce that the police will have to
investigate.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 PHYSICAL SIGNS OF DEATH

 Death is the absence of circulatory and respiratory

function.
 If the body is still warm, initiate care.

 If hypothermia is present, initiate care.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

PRESUMPTIVE SIGNS OF DEATH

 Unresponsive to painful stimuli

 Lack of pulse or heartbeat
 Absence of breath sounds
 No deep tendon or corneal reflexes
 Absence of eye movement
 No systolic blood pressure
 Profound cyanosis
 Decreased body temperature

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 DEFINITIVE SIGNS OF DEATH
 Obvious mortal injury
 Dependent lividity
 Rigor mortis
 Putrefaction (decomposition of body)

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 MEDICAL EXAMINER CASES

 DOA
 Unknown cause of death
 Suicide
 Violent death
 Poisoning
 Accidents
 Suspicion of criminal action

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 MEDICAL IDENTIFICATION
INSIGNIA

 Advance directive by medical

identification insignia
 Bracelet/Necklaces
• Also for other medical conditions

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

DONOR & ORGAN HARVESTING

 Individuals may decide in advance to donate organs

 Driver’s license/separate donor card
 Treat donor same as any other patient
 Communicate information to hospital/medical direction

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 CRIME SCENES
 Emergency care
 Ensure safety for self, fellow
responders
 Notify police through dispatch
 Try not to disturb any item at
scene
 Do not cut through holes in
clothing, if possible

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 CRIME SCENES
 Chain of evidence/custody
 Do not cut any knot in a rope
or tie.
 If the crime is rape, do not
wash or allow the patient to
wash, change clothing, use the
bathroom or take anything by
mouth.

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 RISK MANAGEMENT

 Practices by healthcare providers that reduce

possibility of lawsuit/other legal/professional actions
taken against EMT/medical director/agency

 Act according to standard of care

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

 RISK MANAGEMENT

 Document actions carefully

 Pre-hospital care record is backbone of defense

 Act in patient’s best interest

CAMARINES SUR DISASTER RISK REDUCTION AND MANAGEMENT TRAINING ACADEMY

THANK YOU!!!

CAMARINES SUR DISASTER RISK REDUCTION

AND MANAGEMENT TRAINING ACADEMY