Chapter 3 Medical, Legal, and Ethical Issues
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A basic principle of emergency care is:
to do no further harm.
A health care provider usually avoids legal exposure if he or she acts (two things):
- 1. In good faith
- 2. According to an appropriate standard of care
Permission to render care.
The patient’s right to make decisions about his or her health.
The patient acknowledges he or she wants you to provide care or transport is ____ consent.
In order for expressed consent to be valid, the patient must provide ____ consent, which means you have explained the treatment being offered, along with the potential risks, benefits, and alternatives, as well as the potential consequences of refusing treatment.
The principle of implied consent is known as the ____ ____.
____ consent applies to patients who are:
a. Mentally ill
b. In a behavioral (psychological) crisis
c. Developmentally delayed
A person who is under the legal age in a given state but, because of other circumstances, is legally considered an adult.
Many states consider minors to be emancipated if they are (three things):
- 1. married
- 2. if they are members of the armed services
- 3. if they are parents
Teachers and school officials may act in place of parents (____ ____ ____) and provide consent for treatment to injuries that occur in a school or camp setting.
in loco parentis
Necessary with a patient who is in need of medical treatment and transportation but is combative and presents a significant risk of danger to himself, herself, or others.
The disclosure of information without proper authorization.
breach of confidentiality
HIPAA is the acronym for the:
Health Insurance Portability and Accountability Act of 1996.
A ____ order (also known as a “do not attempt resuscitation” order) gives permission not to resuscitate.
An advance directive is also referred to as (two things):
- 1. Living will
- 2. Health care directive
Some patients may have named surrogates to make decisions for them when they can no longer make their own (two things):
- 1. Durable powers of attorney for health care
- 2. Also known as health care proxies
In the absence of physician orders, the general rule is, if the body is still ____ and ____, initiate emergency medical care. Cold temperature (hypothermia) emergencies are an exception to this rule.
Eight presumptive signs of death (don't memorize):
- 1. Unresponsiveness to painful stimuli
- 2. Lack of a carotid pulse or heartbeat
- 3. Absence of breath sounds
- 4. No deep tendon or corneal reflexes
- 5. Absence of eye movement
- 6. No systolic blood pressure
- 7. Profound cyanosis
- 8. Lowered or decreased body temperature
Four definitive signs of death:
- 1. A body in parts (decapitation)
- 2. Dependent lividity
- 3. Rigor mortis
- 4. Putrefaction
After death, when blood settles to the lowest point of the body, causing discoloration of the skin.
The stiffening of body muscles caused by chemical changes within muscle tissue after death.
When does rigor mortis occur?
Occurs between 2 and 12 hours after death
When does putrefaction occur?
Putrefaction (or decomposition) of body tissues, which (depending on temperature conditions) occurs between 40 and 96 hours after death
In most states, the medical examiner, or the coroner in some states, must be notified in the following seven cases (don't memorize):
- 1. The patient is dead on arrival (DOA) (sometimes called dead on scene [DOS])
- 2. Death without previous medical care, or when the physician is unable to state the cause of death.
- 3. Suicide (self-destruction)
- 4. Violent death
- 5. Poisoning, known or suspected
- 6. Death from accidents
- 7. Suspicion of a criminal act
Outlines the care you are able to provide and is usually defined by state law.
Scope of Practice
The medical director further defines the scope-of-practice by developing (two things):
- 1. Protocols
- 2. Standing orders
Authorization to provide care is given by medical director and is either one of two things:
Authorization to provide care that is given by the medical director via telephone or radio is:
Authorization to provide care that is given by the medical director through standing orders or protocols is:
What a reasonable EMT in a similar situation would do is:
standards of care
The manner in which you must act or behave is called a:
standard of care.
Standard of care is established in many ways, including (five things):
- 1. Local custom
- 2. Statutes
- 3. Professional or institutional standards
- 4. Standards imposed by textbooks
- 5. Standards imposed by states
Standard of care is established in many ways, including ____ ____. How a reasonably prudent person with similar training and experience would act under similar circumstances, with similar equipment, and in the same or similar place.
Standard of care is established in many ways, including ____. In many states, this may take the form of treatment protocols.
Standard of care is established in many ways, including professional or institutional ____.
a. Recommendations published by organizations and societies that are involved in emergency medical care.
b. Specific rules and procedures of the EMS service, ambulance service, or organization to which you are attached
c. An example of a professional standard is the American Heart Association’s standard for BLS and CPR.
Standard of care is established in many ways, including standards imposed by ____ such as the Medical Practices Act and certification and licensure.
The practice of ____ is defined as the diagnosis and treatment of an illness or disease.
The process by which an individual, institution, or program is evaluated and recognized as meeting predetermined standards to ensure safe and ethical care.
The process by which a competent authority, usually the state, grants permission to practice a job, trade, or profession.
An individual’s responsibility to provide patient care.
Duty to act
Once your ambulance responds to a call or treatment is begun, you have a legal:
The failure to provide the same care that a person with similar training would provide in the same or similar situation.
All four of the following factors must be present for the legal doctrine of negligence to apply and for a plaintiff to prevail in a lawsuit against an EMS service or provider:
- 1. Duty
- 2. Breach of duty
- 3. Damages
- 4. Causation
The obligation to provide care.
The EMT does not act within an expected and reasonable standard of care.
Breach of duty
A patient is physically or psychologically harmed in some noticeable way.
A cause-and-effect relationship between a breach of duty and the damages suffered by the patient.
Negligence falls under the general category known as ____. ____ are civil wrongs. Other ____ actions are suits for defamation of character and invasion of privacy.
The unilateral termination of care by the EMT without the patient’s consent and without making any provisions for care to be continued by a medical professional who is competent to provide care for the patient.
Unlawfully placing a person in fear of immediate bodily harm. Includes threatening to restrain a patient who does not want to be transported.
Unlawfully touching a person. Includes providing emergency care without consent.
Seizing, confining, abducting, or carrying away by force. Could include a situation where a patient is transported against his or her will.
The unauthorized confinement of a person.
The communication of false information that damages a person’s reputation.
Type of defamation that is written.
Type of defamation that is spoken.
____ ____ laws are based on the common law principle that when you reasonably help another person, you should not be held liable for errors or omissions that are made in giving care.
To be protected by provisions of Good Samaritan law, several conditions must generally be met (four things):
- 1. You acted in good faith in rendering care.
- 2. You rendered care without expectation of compensation.
- 3. You acted within the scope of your training.
- 4. You did not act in a grossly negligent manner.
Conduct that constitutes a willful or reckless disregard for a duty or standard of care.
The philosophy of right and wrong, moral duties, and of ideal professional behavior.
The code of conduct affecting character, conduct, and conscience.
____ specifically addresses ethical issues that arise in the practice of health care.
The time within which a case must be commenced.
Statute of limitations
A legal defense that may be raised when the defendant feels that the conduct of the plaintiff somehow contributed to injuries or damages sustained by the plaintiff.
Three typical types of defense for an EMT in court:
- 1. Statute of limitations
- 2. Governmental immunity
- 3. Contributory negligence
An opportunity for both sides to obtain more information to reach a better understanding of the case.
Discovery includes (two things):
- Interrogatories (written requests or questions)
- Depositions (oral requests or questions)
Written requests or questions during the discovery phase of a legal case.
Oral requests or questions during the discovery phase of a legal case.
Most cases are settled following the discovery phase during a ____ phase and do not go to trial.
For those that go to trial, two types of damages may be awarded, including:
- Compensatory damages
- Punitive damages
____ damages are intended to restore the plaintiff to the same condition he or she was in prior to the incident.
____ damages are intended to deter the defendant from repeating the behavior and are reserved for cases where the defendant has acted intentionally or with a reckless disregard for the safety of the public. These damages are not commonly awarded in negligence cases.
Able to make rational decisions about personal well-being.
A term relating to medical jurisprudence (law) or forensic medicine.
The manner in which principles of ethics are incorporated into professional conduct.
Ability to understand and process information and make a choice regarding appropriate medical care.
Written, accepted levels of emergency care expected by reason of training and profession; written by legal or professional organizations so that patients are not exposed to unreasonable risk or harm.
Standard of care
Most commonly defined by state law; outlines the care you are able to provide to the patient.
Scope of practice
When the EMT or EMS service is held liable even when the plaintiff is unable to clearly demonstrate how an injury occurred.
res ipsa loquitor
When a person who has a duty abuses it, and causes harm to another individual; the EMT, the agency, and/or the medical director may be sued for negligence.
A written document that specifies medical treatment for a competent patient, should he or she become unable to make decisions. Also know as an advance directive or living will.
health care directive
The legal doctrine whereby an act is considered negligent because it violates a statute (or regulation).
Negligence per se
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