Medical, Legal, & Ethical Issues Flashcards
A basic medical, legal, and ethical principle of emergency care is to first ___
Do no further harm
EMTs are better positioned to avoid professional legal problems when they ___
Act in good faith, follow an appropriate standard of care, and provide compassionate care
Immediate care or treatment
Emergency medical care
Typically, ___ is required from every conscious adult before care can be started
Consent
An adult who is ___ has the legal right to refuse care
Conscious, rational, and capable of making informed decisions
Consent can be expressed or ___
Implied
The foundation of consent is ___
Decision-making capacity
The ability of a patient to understand the information you are providing, coupled with the ability to process that information and make an informed choice regarding medical care
Decision-making capacity
The right of a patient to make decisions concerning their health
Patient autonomy
Generally regarded as a legal term and determinations regarding it are made by a court of law
Competence
The term more commonly used in health care to determine whether or not a patient is capable of making health care decisions
Decision-making competence
Factors to be considered when determining a patient’s decision-making competence
- Mental limitation/dementia
- Are they of legal age?
- Impaired by alcohol, drugs, or serious injury/illness
- Experiencing significant pain
- Have a significant injury that could distract from a more serious injury
- Hearing or visual problems
- Language barrier
- Do they understand you/ask rational questions?
The type of consent given when the patient specifically acknowledges that they want you to provide care or transport
Expressed consent
Expressed consent is also called ___
Actual consent
Expressed consent may be ___
Verbal or nonverbal
To be valid, the consent the patient provides must be ___
Informed consent
You explained the nature of the treatment being offered, along with the potential risks, benefits, and alternatives to treatment, as well as potential consequences of refusing treatment
Informed consent
Always document consent in your ___
Run report
A patient may agree to certain types of emergency medical care but ___
Not to others
When a person is unconscious or otherwise incapable of making a rational, informed decision about care and unable to give consent, the law assumes that the patient would consent to care and transport to a medical facility if they were able to do so
Implied consent
Implied consent applies only when ___
A serious medical condition exists and should never be used unless there is a threat to life or limb
The principle of implied consent is known at the ___
Emergency doctrine
Relating to medical jurisprudence or forensic medicine
Medicolegal
In most instances, the law allows a ___ to give consent for an injured person who is unable to do so
Spouse, a close relative, or next of kin
If a patient is being treated based on implied consent and regains consciousness and appear capable of making an informed decision, the doctrine of implied consent ___
Would no longer apply
Under certain circumstances ___ are legally permitted to give consent for any individual who is incarcerated or has been placed under arrest
LE and prison officials
A prisoner who is conscious and capable of making decisions may ___
Refuse care
Involuntary consent is similar to ___ and consent should be obtained from ___
- Those involving minors
- Someone legally responsible for the patient, such as a guardian or conservator
Minors require a ___ to give consent for treatment and transport
Parent or legal guardian
In every state, when a parent cannot be reached to provide consent, health care providers are allowed to ___
Give emergency care to a child
In some states, a minor can consent to receive medical care, depending on ___
The minor’s age and maturity
People who, despite being under the legal age in a given state, can be legally treated as adults based on certain circumstances
Emancipated minors
Many states consider minors to be emancipated if they are ___
Married, members of the armed forces, or if they are parents
Also if they are living away from and no longer relying on their parents for support
A minor who is a parent may also give consent for ___
Their own child
If a minor is injured and requires medical treatment in a school or camp setting, teachers and school officials may act ___
In loco parentis
In the position or place of a parent, and can legally give consent for treatment of the minor if the parent or guardian is not available
In loco parentis
Even if acting in loco parentis, you should still attempt to ___
Obtain consent from a parent or legal guardian whenever possible
If a parent or legal guardian is not present and a true emergency exists, the consent to treat the minor is ___
Implied
___ is sometimes necessary when you are confronted with a patient who is in need of medical treatment and transportation but is combative and presents a significant physical risk of danger to themselves or others
Forcible restraint
Typically you should consult ___ for authorization to restrain or ___
- Medical control
- Contact LE personnel who have the authority to restrain people
___ should always be attempted prior to considering physical restraints
Verbal de-escalation
After restraints are applied, they should not be removed en route unless ___
They pose a risk to the patient, even if the patient promises to behave
While restrained, it is essential that you ___
Protect the patient’s airway and monitor the patient’s respiratory and circulatory status to avoid asphyxia, aspiration, and other complications
Consider calling for ALS backup to provide ___, as this may be safer than physical restraint, depending upon the situation
Pharmacologic restraint
Adults who are ___ have the right to refuse treatment or withdraw from treatment at any time
Conscious, alert, and appear to have decision-making capacity
Calls involving refusal of treatment pose a risk of ___
Litigation
In all such cases of refusal of treatment, you should involve ___
Online medical control and document this consultation
What information should be given to the patient to guide their decision to accept or refuse care?
- What might be wrong with the patient
- Description of the treatment believed necessary
- Possible risks of treatment
- Availability of alternative treatments
- Possible consequences of refusing treatment
PCR
Patient Care Report
When treatment is refused, you must assess the patient’s ability to make an ___
Informed decision
Patients who have attempted or conveyed ___ intent should not be regarded as having normal mental capacity
Suicidal
When in doubt, providing treatment is usually a much more ___ than failing to treat a patient
Defensible position
Before leaving the scene where a patient has refused care, you should again encourage the patient up to ___ times if the situation allows, to permit treatment
3
Do what before leaving a patient who has refused care?
- Encourage them to change their mind
- Remind them to call 911 if it changes or gets worse
- Advise them to see their personal physician ASAP
- Have them sign a refusal of treatment form (signature should be witnessed by a family member or police officer)
- Notify medical control
Who must sign the refusal of care for for a child?
The individual who is refusing treatment
Communication between you and the patient is considered ___
Confidential
Disclosure of confidential information to anyone other than those providers directly involved in the care of the patient without proper authorization may result in liability for ___
Breach of confidentiality
Patient information may also be shared with ___
Third-party billing personnel
HIPAA considers all patient information that you obtain in the course of providing medical treatment to a patient to be ___
Protected health information
PHI
Protected health information
PHI includes not only medical information, but also any information that can ___
Be used to identify the patient
As an EMT, you have an obligation to guard all PHI from ___
Unlawful disclosure, either written or verbal
Safeguards to protect PHI include departmental ___
Security measures
When an EMT’s role provides access to PHI of patients other than those for whom the EMT provided care, those records may be accessed only if there is a ___
Legitimate business reason to do so
What PHI records may the EMT not access without appropriate permission granted by the department privacy and security officer?
- Celebrities
- The EMTs own
- The records of family members
PHI may be disclosed for purposes of ___
- Treatment
- Payment
- Operations
A DNR is a type of ___
Advance directive
A ___ patient is able to make rational decisions about their well-being
Competent
A written document that specifies medical treatment for a competent patient, should they become unable to make decisions
Advance directive
An advance directive is often referred to as a ___ but may also be referred to as a ___
- Living will
- Health care directive
DNR orders give you permission not to ___
Attempt resuscitation
DNR requirements
- Clear statement of the patient’s medical problems
- Signature of the patient or legal guardian
- Signature of one or more physicians or other licensed health care providers
- In some states it might have an expiration date. If they do they must be dated in the preceding 12 months to be valid
POLST
Physician Orders for Life-Sustaining Treatment
MOLST
Medical Orders for Life-Sustaining Treatment
You may encounter POLST and MOLST forms when caring for patients with ___
Terminal illnesses
A POLST or MOLST form will ___
Explicitly describe acceptable interventions for the patient and must be signed by a physician, physician assistant, or nurse practitioner
Some patients may have named surrogates to make decisions for them regarding their health care in the event that they are unable to make such decisions for themselves
Durable power of attorney for health care
or
health care proxy
When presented with a power of attorney at the scene of a medical emergency, you must ___
Read it carefully to ascertain its meaning and validity
If there is any question regarding a medical power of attorney, you should ___
Contact online medical control
___ emergency care while efforts to interpret the power of attorney are made
Do not delay
The person named in the power of attorney or health care proxy is only authorized to make decisions when ___
The patient is no longer capable of doing so
Even in the presence of a DNR order, you are still obligated to ___
Provide supportive measures (oxygen, pain relief, and comfort) to a patient who is not in cardiac arrest
When you are in doubt or the written orders are not present for a DNR order, you have an obligation to ___
Resuscitate
Determination of the cause of death is the medical responsibility of a ___
Physician
There are both ___ and ___ signs of death
- Definitive
- Presumptive
In many states death is defined as ___. Many states have also adopted ___ provisions
- The absence of circulatory and respiratory function
- Brain death
Brain death provisions refer to is as ___
Irreversible cessation of all functions of the brain and brainstem
In questions of whether to begin BLS, the general rule is ___
If the body is still intact, and there are no definitive signs of death, initiate emergency medical care
More evidence of death will be needed in cases of ___
Sudden death due to hypothermia, acute poisoning, or cardiac arrest
Conclusive signs of death that are obvious and clear to even nonmedical people
Definitive signs of death
Most medicolegal authorities will consider the presumptive signs of death, particularly when they follow a ___
Severe trauma or occur at the end stages of a long-term illness
Presumptive signs of death
- Unresponsiveness to painful stimuli
- Lack of a carotid pulse or heartbeat
- Absence of chest rise and fall
- No deep tendon or corneal reflexes
- Absence of pupillary reactivity
- No systolic blood pressure
- Profound cyanosis
- Lowered or decreased body temperature
Definitive signs of death
- Obvious mortal damage, such as decapitation
- Dependent lividity
- Rigor mortis
- Algor mortis
- Putrefaction
Blood settling to the lowest point of the body, causing discoloration of the skin
Dependent lividity
The stiffening of body muscles caused by chemical changes within the muscle tissure
Rigor mortis
Rigor mortis progression
Develops first in the face and jaw, gradually extending downward until the body is in full rigor
The rate of rigor mortis onset is affected by ___
The body’s ability to lose heat to its surroundings
Rigor mortis occurs sometime between ___ after death
2 to 12 hours
Refers to the cooling of the body until it matches the ambient temperature
Algor mortis
Decomposition of body tissues
Putrefaction
How long for putrefaction to take place?
Depending upon temperature conditions, sometime between 40 and 96 hours after death
Once you have adequately determined death based on local protocols, ___
Remove yourself from the scene
Outlines the care you are legally able to provide for the patient
Scope of practice
Your medical director further defines the scope of practice by developing ___
Protocols and standing orders
The manner in which you must act or behave as an EMT
Standard of care
Your conduct must be judged in the light of the emergency situation, taking into account ___
- Scene safety
- General confusion at the scene of the emergency
- The needs of other patients
- The type of equipment available
A serious situation, such as an injury or illness that arises suddenly, threatens the life or welfare of a person or group of people, and requires immediate intervention
Emergency
In addition to standards imposed by law, professional or institutional standards may be admitted as evidence in determining the adequacy of an ___
EMTs conduct
State health department regulations usually govern the ___
Scope and level of training
Court decisions have resulted in case law defining standards of ___
Care
An individual’s responsibility to provide patient care
Duty to act
Responsibility comes from either ___
Statute or function
The failure to provide the same care that a person with similar training would provide in the same or a similar situation
Negligence
Deviation from the accepted standard of care that may result in further injury to the patient
Negligence
Negligence is based on ___
- Duty
- Breach of duty
- Damages
- Causation
It is possible to be held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred
Theory of res ipsa loquitur
Theory of res ipsa loquitur can apply if ___
It can be shown that an injury occurred, that the cause of the injury was in the control of the EMT, and that such injuries generally do not occur unless there is negligence
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 per se
Civil wrongs
Torts
All forms of negligence come under the general category known as ___
Torts
The unilateral termination of care by the EMT without the patient’s consent and without making any provisions for continuing care by a medical professional who is competent to provide care for the patient
Abandonment
Once care is started, you have assumed a duty that must not stop until ___
An equally competent medical provider assumes responsibility
Unlawfully placing a person in fear of immediate bodily harm
Assault
Threatening to restrain a patient who does not want to be transported could be considered ___
Assault
Unlawfully touching a person
Battery
___ lawsuits for battery are common in health care
Civil
To sustain a criminal case of assault or battery, it is generally necessary to prove ___
The intent to cause harm
Seizing, confining, abducting, or carrying away of a person by force
Kidnapping
It is more likely for an EMT to be the target of a civil lawsuit for ___ rather than kidnapping since they are acting in good-faith to provide care for the patient
False imprisonment
The unauthorized confinement of a person that lasts for an appreciable period of time
False imprisonment
Communication of false information that damages the reputation of a person
Defamation
Defamation in writing
Libel
Defamation that is spoken
Slander
Based on the common law principle that when you reasonably help another person, you should not be liable for errors and omissions that are made in giving good-faith emergency care
Good Samaritan Laws
Good Samaritan laws are not intended to apply to ___
People who are at work being compensated for doing a job
Good Samaritan laws apply when you are ___
Off-duty
Conditions for the Good Samaritan law
- You acted in good faith rendering care
- You rendered care without expectation of compensation
- You acted within the scope of your training
- You did not act in a grossly negligent manner
Conduct that constitutes a willful or reckless disregard for a duty or standard of care
Gross negligence
Immunity statutes apply to EMS systems that are considered governmental agencies
Sovereign immunity
___ could provide early warning of a disease outbreak
NEMSIS
The philosophy of right and wrong, of moral principles, and of ideal professional behavior
Ethics
The study of morality
Ethics
A code of conduct that cen be defined by society, religion, or a person, affecting character and conscience and the definition of right versus wrong
Morality
Field of ethics that addresses issues that arise in the practice of health care
Bioethics
The manner in which principles of ethics are incorporated into professional conduct
Applied ethics
A civil lawsuit begins with the service of a ___ and ___
Summons
Complaint
Sets forth the details of the plaintiff’s case and provides the theory on which the plaintiff is relying to recover a judgement against you and your service
Complaint
The response to the complaint is called an ___
Answer
Time within which a claim must be initiated
Statute of limitations
Generally applies only to EMS systems that are operated by municipalities or other governmental agencies
Governmental immunity
Legal defense that may be raised when the defendant thinks that the conduct of the plaintiff somehow contributed to any injuries or damages that were sustained by the plaintiff
Contributory negligence
The next phase of a trial after the answer to the summons
Discovery
An opportunity for both sides to obtain information that will enable the attorneys to have a better understanding of the case and assist in negotiating a possible settlement or in preparing for a trial
Discovery
Written questions that each side sends to the other
Interrogatories
Oral questions asked of parties and witnesses under oath
Depositions
These damages are intended to compensate the plaintiff for the injuries they sustained
Compensatory damages
Not commonly awarded in negligence cases and are reserved for those cases where the defendant has acted intentionally or with a reckless disregard for the safety of the public
Punitive damages
