Chapter 4 - Medical, Legal, and Ethical Issues

Question 1

Key Terms

leaving a patient after care has been initiated and before the patient has been transferred to someone with equal or greater medical training

Answer 1

Abandonment

Question 2

Key Terms

a DNR order; instructions written in advance of an event

Answer 2

Advance Directive

Question 3

Key Terms

placing a person in fear of bodily harm

Answer 3

Assault

Question 4

Key Terms

causing bodily harm to or restraining a person

Answer 4

Battery

Question 5

Key Terms

the obligation not to reveal information obtained about a patient except to other health care professionals involved in the patient’s care or under subpoena or in a court of law or when the patient has signed a release confidentiality

Answer 5

Confidentiality

Question 6

Key Terms

permission from the patient for care or other action by the EMT

Answer 6

Consent

Question 7

Key Terms

the location where a crime has been committed or any place that evidence relating to a crime may be found

Answer 7

Crime Scene

Question 8

Key Terms

a legal document, usually signed by the patient and his physician, which states that the patient has terminal illness and does not wish to prolong life through resuscitative efforts

Answer 8

Do Not Resuscitate (DNR) order

Question 9

Key Terms

an obligation to provide care to a patient

Answer 9

Duty to act

Question 10

Key Terms

regarding a social system or social or professional expectations for applying principles of right and wrong

Answer 10

Ethical

Question 11

Key Terms

consent given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being

Answer 11

Expressed consent

Question 12

Key Terms

a series of laws, varying in each state, designed to provide limited legal protection for citizens and some health care personnel when they are administered emergency care

Answer 12

Good Samaritan Laws

Question 13

Key Terms

The Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed

Answer 13

HIPAA

Question 14

Key Terms

the consent it is presumed a patient or patient’s parent or guardian would give if they could, such as for an unconscious patient or a parent who cannot be contacted when care is needed

Answer 14

Implied Consent

Question 15

Key Terms

in place of a parent, indicating a person who may give consent for care of a child when the parents are not present or able to give consent

Answer 15

In Loco Parentis

Question 16

Key Terms

being held legally responsible

Answer 16

Liability

Question 17

Key Terms

false injurious information in written form

Answer 17

Libel

Question 18

Key Terms

regarding personal standards or principles of right and wrong

Answer 18

Moral

Question 19

Key Terms

a finding of failure to act properly in a situation in which there was a duty to act, that needed care as would reasonably be expected of the EMT was not provided, and that harm was caused to the patient as a result

Answer 19

Negligence

Question 20

Key Terms

a person who has completed a legal document that allows for donation of organs and tissues in the event of death

Answer 20

Organ Donor

Question 21

Key Terms

physician orders that state not only the patient’s wishes regarding resuscitation attempts but also the patient’s wishes of artificial feeding, antibiotics, and other life-sustaining care if the person is unable to state his desires later

Answer 21

Physician Order for Life-Sustaining Treatment (POLST)

Question 22

Key Terms

a Latin term meaning “the thing speaks for itself.”

Answer 22

Res Ipsa Loquitur

Question 23

Key Terms

a law that permits a person to drop off an infant or child at a police, fire, or EMS station or to deliver the infant or child to any available public safety personnel. The intent of the law is to protect children who may otherwise be abandoned or harmed

Answer 23

Safe Haven Law

Question 24

Key Terms

a set of regulations and ethical considerations that define the scope, or extent and limits, of the EMT’s job

Answer 24

Scope of practice

Question 25

Key Terms

false injurious information stated verbally

Answer 25

Slander

Question 26

Key Terms

for an EMT providing care for a specific patient in a specific situation, the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation

Answer 26

Standard of Care

Question 27

Key Terms

a civil, not a criminal, offense; an action or injury caused by negligence from which a lawsuit may arise

Answer 27

Tort

Question 28

Short Answer

Explain the difference between expressed and implied consent.

Answer 28

The difference between expressed and implied consent is significant because a patient offering expressed consent is an adult who is mentally competent to make decisions, is informed of the risks associated with the care he is about to receive, and is conveying a conscious decision to receive the care. In implied consent, patients are typically unconscious or incapacitated in some way such that you must assume they would agree to be treated if they were conscious.

Question 29

Short Answer

What are the components required to prove negligence?

Answer 29

A finding of negligence requires that all of the following circumstances be proved: the EMT had a duty to they patient (duty to act), the EMT did not provide the standard of care (committed a breach of duty), and by not providing the standard of care, the EMT caused harm to the patient (proximate causation) (the harm can be physical or psychological).

Question 30

Short Answer

What is your first priority at a crime scene: preserving evidence or patient care? Why?

Answer 30

Your first priority is always patient care, but it is still possible to preserve evidence and minimize your impact on the scene during the course of your actions. Work closely with law enforcement.

Question 31

Short Answer

You bring a patient to the hospital and the nurse tells you, “Put the patient in bed 5; I’ll be right there.” The nurse doesn’t come over and you leave. Is this abandonment? Why or why not?

Answer 31

If an EMT has initiated care then leaves a patient without ensuring the patient has been turned over to someone with equal or greater training, it constitutes abandonment. The fact that this patient was left in a hospital bed doesn’t matter; there must still be a transfer of care.

Question 32

Short Answer

You have a patient who weighs 400 pounds. You want other EMTs at your squad to know this so they can be prepared. Can you leave a copy of your run report on the bulletin board at the station to notify the others?

Answer 32

Leaving a copy of the run report on the bulletin board at the station for everyone to review is a violation of the law (HIPAA). Any information you obtain about a patient’s history, condition, or treatment is considered confidential and must not be shared with anyone else. Sharing the information with another caregiver involved with the continuing care of the patient (such as the nurse receiving the patient at the hospital) is allowed, but tracking a run report up on a bulletin board for all crews (and potentially the cable guy) to see is illegal.

Question 33

Critical Thinking

You and your partner are in your ambulance on the way back from a call when you come upon a motor-vehicle crash. It is in an adjoining ambulance district. Do you have a duty to act? Do you have a moral or ethical obligation?

Answer 33

This may not fit the strict definition of “duty to act” because you were not officially dispatched to this call, but you still have a moral and ethical obligation to render aid since you are on duty and you are trained providers. In general, if you follow your conscience and provide care, you will incur less liability than if you do not act. Always follow your local protocols and laws.

Question 34

Critical Thinking

You are transporting a patient who was seriously injured when he was ejected from his vehicle in a high-speed collision. You talk to another member of your crew who tells you the patient died the next day. That crew member is worried about getting sued over the death. Do you think that a lawsuit against you is likely? Why or why not?

Answer 34

Think back about your care of the patient and your actions on the call. Were the actions of your crew so obviously responsible for the patient’ death that a lawsuit is in order? Does res ipsa loquitur apply? If not, evaluate your care and actions on the call against the three tests of negligence: (1) Did you have a duty to act? (2) Did you provide the standard of care or commit a breach of duty? (3) If you failed to provide the standard of care, did your actions cause harm to the patient (also known as proximate causation)? In order for negligence to be proven, all three must apply. Remember that proximate causation cannot be applied to patients who are so seriously injured that they cannot be saved.

Question 35

Critical Thinking

You respond to a motor-vehicle crash and find a seriously injured patient. You find he has no pulse and are about to begin CPR when someone tells you, “He’s got cancer and a DNR. Don’t do that, man!” No one has the DNR order at the scene. Do you do CPR and transport the patient?

Answer 35

A critical decision such as withholding CPR should not be made based on hearsay; it should be made based on a legal document. Without the actual DNR present, you should continue CPR and consider making contact with medical direction for further guidance.