Content Legal duties and ethical responsibilities Medical law
and ethics Definition Sources and categories of law Scope of
practice Consent Confidentiality Right to refuse treatment Advance
directives Malpractice
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Best Protection Your best protection from liability is to
perform systematic assessments, provide appropriate medical care,
and maintain accurate and complete documentation.
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Legal Duties and Ethical Responsibilities (1 of 2) Promptly
respond to the needs of every patient. Treat all patients and their
families with respect. Maintain your skills and medical knowledge.
Participate in continuing education.
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Legal Duties and Ethical Responsibilities (2 of 2) Critically
review your performance, and constantly seek improvement. Report
honestly and with respect for patient confidentiality. Work
cooperatively and with respect for other emergency
professionals.
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Medical Law and Ethics Ethics is a standard of behavior. Moral
values serve as the basis for ethical conduct. Family, culture, and
society help form an individuals moral values. A law is a rule of
conduct or action. Governments enact laws to maintain order and
public safety. Criminal and civil laws pertain to health-care
practitioners.
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Definitions Ethics The systematic study of rightness and
wrongness of human conduct and character as known by natural
reason. Morals Generally accepted customs, principles, or habits of
right living and conduct in a society and the individuals practice
in relation to these. Values Ideals & customs of a society
toward which the members of a group have an affective regard; a
value may be a quality desirable as an end in itself.
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Sources of Law (1 of 2) Constitutionalbased on the
Constitution. Commonderived from societys acceptance of customs and
norms.
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Sources of Law (2 of 2) Legislativecreated by law- making
bodies such as state assemblies. Administrativeenacted by
governmental agencies at either federal or state levels.
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Categories of Law (1 of 3) Criminaldivision of the legal system
that deals with wrongs committed against society or its
members.
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Categories of Law (2 of 3) Civildivision of the legal system
that deals with non- criminal issues and conflicts between two or
more parties.
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Categories of Law (3 of 3) Torta civil wrong committed by one
individual against another.
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Medical Law and Ethics (cont.) Criminal law Crimes against the
state Criminal acts are Felonies or Misdemeanors Examples include:
Murder Arson Sexual Assault Burglary Civil law Crimes against the
person Includes a general category of laws known as torts Torts are
either: Intentional (willful) Unintentional (accidental)
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Scope of Practice (2 of 3) Medical director further defines by
developing: Protocols Standing orders
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Scope of Practice (3 of 3) Carrying out procedures outside
scope of practice may be considered: Negligence Criminal
offense
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Standards of Care (1 of 3) Manner in which you must act or
behave You must be concerned about safety and welfare of
others.
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Standards of Care (2 of 3) Standards of care established by:
Local custom Statutes Protocols Professional or institutional
standards Example: AHA CPR guidelines Textbooks Example: NHTSA
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Standards of Care (3 of 3) Standards of care established by
(contd): Standards imposed by states Medical Practices Act
Certification Licensure
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Duty to Act Individuals responsibility to provide patient care
Duty to act applies: Once your ambulance responds to a call
Treatment is begun
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Medical/Legal and Ethics Consent/refusal of care
Confidentiality Advanced directives Tort and criminal actions
Evidence preservation Statutory responsibilities Mandatory
reporting Ethical principles/moral obligations End-of-life
issues
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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.
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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.
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Expressed Consent Patient acknowledges he or she wants you to
provide care. To be valid, patient must provide informed consent.
You have explained treatment, risks, and benefits to patient.
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Implied Consent (1 of 2) Applies to patients who are
Unconscious Otherwise incapable of making informed decision Source:
Dan Myers
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Involuntary Consent Applies to patients who are: Mentally ill
In behavioral crisis Developmentally delayed Obtain consent from
guardian Not always possible, so understand local provisions
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Minors and Consent (1 of 2) Parent or legal guardian gives
consent. In some states, a minor can give consent. Depending on age
and maturity Emancipated minors (married, armed services, parents)
Teachers and school officials may act in place of parents.
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Emancipated Minors Person under 18 years of age who is: Married
Pregnant A parent A member of the armed forces Financially
independent living away from home Emancipated minors may give
informed consent.
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Minors and Consent (2 of 2) If true emergency exists, and no
consent is available: Treat the patient. Consent is implied.
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Forcible Restraint Sometimes necessary with combative patient
Is legally permissible But generally you must consult medical
control for authorization. In some states, only a law enforcement
officer may forcibly restrain.
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The Right to Refuse Treatment (1 of 2) Conscious, alert adults
with decision-making capacity: Have the right to refuse treatment
Can withdraw from treatment at any time Even if the result is death
or serious injury clarify need for treatment
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The Right to Refuse Treatment (2 of 2) Before you leave a scene
where a patient, parent, or caregiver has refused care: Encourage
them again to allow care. Ask them to sign a refusal of care form.
Document all refusals. A witness is valuable in these
situations.
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Confidentiality (1 of 2) Information should remain
confidential. Information generally cannot be disclosed except: If
patient signs a release If legal subpoena is presented If it is
needed by billing personnel
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Confidentiality (2 of 2) HIPAA (Health Insurance Portability
and Accountability Act of 1996) Contains a section on patient
privacy Strengthens privacy laws Safeguards patient confidentiality
Considers information to be protected health information (PHI)
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Malpractice claims are lawsuits by a patient for errors in
diagnosis or treatment Negligence cases are those in which a person
believes a medical professionals actions, or lack thereof, caused
harm to the patient Malpractice Latin term which means The thing
speaks for itself.
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Examples of negligence Abandonment Delayed treatment Legal
terms used to classify negligence Malfeasance - unlawful act or
misconduct Misfeasance - lawful act done incorrectly Nonfeasance -
failure to perform an act that is ones required duty or that is
required by law Malpractice (cont.)
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Negligence Failure to provide same care that person with
similar training would provide in same or similar situation.
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uty Patients must show that a physician-patient relationship
existed. erelict failed to comply with the standards of the
profession. irect Cause Patients must show that any damages were a
direct cause of a physicians breach of duty. amages Patients must
prove that they suffered injury. Patients must be able to prove all
4 Ds in order to move forward with a malpractice suit. The 4 Ds of
Negligence
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Negligence (2 of 2) All four of the following elements must be
present for negligence to apply: Duty Breach of duty Damages
Causation
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Abandonment Unilateral termination of care by caregiver
without: Patients consent Making provisions for continuing
care
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Assault and Battery, and Kidnapping (1 of 2) Assault:
Unlawfully placing person in fear of immediate bodily harm Example:
restraint Battery: Unlawfully touching a person Example: providing
care without consent
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Assault and Battery, and Kidnapping (2 of 2) Kidnapping:
Seizing, confining, abducting, or carrying away by force Example:
transport or treatment against will A false imprisonment charge is
more likely (defined as unauthorized confinement of a person).
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Defamation (1 of 2) Communication of false information that
damages reputation of a person Libel if written Slander if
spoken
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Defamation (2 of 2) Defamation could happen with: False
statement on a run report Inappropriate comments made during
conversation Run report should be accurate, relevant, and
factual.
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Good Samaritan Laws and Immunity (1 of 2) If you reasonably
help another person, you will not be held liable for error/omission
Good Samaritan actions to be met: Good faith Without expectation of
compensation Within scope of training Did not act in grossly
negligent manner
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Good Samaritan Laws and Immunity (2 of 2) Gross negligence is
conduct that constitutes willful or reckless disregard. There is
another group of laws that grants immunity from liability to
official providers. Laws vary; always consult with the medical
director.
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Records and Reports (1 of 3) Compile record for all incidents
involving sick or injured patients Important safeguard against
legal complications
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Records and Reports (2 of 3) Courts consider: An action not
recorded was not performed Incomplete or untidy reports is evidence
of poor medical care
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Special Mandatory Reporting Requirements (1 of 3) Most states
have a reporting obligation: Abuse of children, older persons, and
others Injury during commission of a felony Drug-related injuries
Childbirth
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Special Mandatory Reporting Requirements (2 of 3) Most states
have a reporting obligation (contd): Attempted suicides Dog bites
Communicable diseases Assaults Domestic violence
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Special Mandatory Reporting Requirements (3 of 3) Most states
have a reporting obligation (contd): Sexual assault Exposures to
infectious disease Transport of patients in restraints Scene of a
crime The deceased
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Ethical Responsibilities (1 of 2) Ethics: Philosophy of right
and wrong, moral duties, ideal professional behavior Morality: Code
of conduct affecting character, conduct, and conscience. Bioethics:
Specifically addresses issues that arise in practice of health
care
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Ethical Responsibilities (2 of 2) Requires you to evaluate and
apply ethical standards Your own Those of the profession Be honest
in reporting. Keep accurate records.
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Summary You must meet legal and ethical responsibilities while
caring for the patients physical and emotional needs.