Legal and Ethical Issues Legal and Ethical Issues Chapter 4

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  • Legal and Ethical Issues Legal and Ethical Issues Chapter 4
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  • Topic Overview Standard of care / Scope of practice Standard of care / Scope of practice Consent Consent Informed (Expressed) Informed (Expressed) Implied Implied Children and mentally Incompetent Adults Children and mentally Incompetent Adults Refusal of Care Refusal of Care Advanced Directives Advanced Directives Do Not Resuscitate (DNR) orders Do Not Resuscitate (DNR) orders Living wills. Living wills.
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  • Objectives Negligence Negligence Duty Duty Legal vs. moral Legal vs. moral Breach of Duty Breach of Duty Abandonment Abandonment Battery Battery Causation Causation Damages Damages Good Samaritan Laws Good Samaritan Laws Confidentiality Confidentiality Crime scene preservation Crime scene preservation Documentation Documentation
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  • Legal and Ethical Considerations Legal Duties Legal Duties All states have established guidelines to allow emergency care to be given without worry of being sued. All states have established guidelines to allow emergency care to be given without worry of being sued. Laws require a certain Standard of Care Laws require a certain Standard of Care Standard of Care Standard of Care Care expected based on the providers training and experience, taking into account the conditions under which the care is rendered. Care expected based on the providers training and experience, taking into account the conditions under which the care is rendered.
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  • Legal and Ethical Considerations Based on laws, administrative orders and guidelines published by the EMS system, organizations and societies. Based on laws, administrative orders and guidelines published by the EMS system, organizations and societies. First Responder guidelines established by First Responder guidelines established by USDOT USDOT State State Institutional (PCC and CCE) Institutional (PCC and CCE)
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  • Legal and Ethical Considerations Ethical Responsibilities Ethical Responsibilities Primary Consideration Primary Consideration Make the physical and emotional needs of the patient a priority Make the physical and emotional needs of the patient a priority Additional Responsibilities Additional Responsibilities Maintaining skills and knowledge Maintaining skills and knowledge Includes practicing until you have obtained confidence and mastery of the skills Includes practicing until you have obtained confidence and mastery of the skills Continuing education and refresher programs Continuing education and refresher programs Review your performance and assess the techniques you use Review your performance and assess the techniques you use Evaluate yourself Evaluate yourself Be honest in reporting care provided Be honest in reporting care provided
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  • Legal and Ethical Considerations Consent Consent Patient says or acknowledges that you can treat them Patient says or acknowledges that you can treat them Expressed Consent Expressed Consent Consent given by a rational adult after being informed of the providers training and what care procedures are to be done. Risks and options to care. Consent given by a rational adult after being informed of the providers training and what care procedures are to be done. Risks and options to care.
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  • Legal and Ethical Considerations Implied Consent Implied Consent An unconscious patient is assumed to want help. An unconscious patient is assumed to want help. A legal position that assumes an unconscious or badly injured adult patient would consent to receiving emergency care. A legal position that assumes an unconscious or badly injured adult patient would consent to receiving emergency care. May apply to other type of patients as well May apply to other type of patients as well Mentally ill Mentally ill Children and Mentally Incompetent Adults Children and Mentally Incompetent Adults Parental Consent Parental Consent Serious Injury/Illness in the absence of a parent Serious Injury/Illness in the absence of a parent A form of implied consent A form of implied consent
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  • Legal and Ethical Considerations Competence Competence The patients ability to understand your questions. The patients ability to understand your questions. The patients ability to understand the implications of decisions made. The patients ability to understand the implications of decisions made. Not competent when: Not competent when: intoxicated intoxicated drug ingestion drug ingestion serious injury serious injury mental incompetence mental incompetence
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  • Legal and Ethical Issues To determine competence To determine competence Ask Questions Ask Questions PPTE PPTE WWWWH WWWWH Remember answering questions does not always establish competence - Suicidal Remember answering questions does not always establish competence - Suicidal
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  • Legal and Ethical Considerations Refusal of Care Refusal of Care When conscious and competent patients can refuse your care When conscious and competent patients can refuse your care Reasons may be based on Reasons may be based on religious grounds religious grounds lack of trust lack of trust personal reasons personal reasons You CAN NOT force care on these patients You CAN NOT force care on these patients You CAN NOT legally restrain them until EMS arrives You CAN NOT legally restrain them until EMS arrives
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  • Legal and Ethical Considerations Only Course of Action Only Course of Action Try to gain their confidence through conversation Try to gain their confidence through conversation When your services are refused: When your services are refused: Do Not argue Do Not argue Do Not question their reasons (if based on religious views) Do Not question their reasons (if based on religious views) Do Not touch Do Not touch Stay Calm and Professional Stay Calm and Professional Make sure EMS has been activated Make sure EMS has been activated Talk to the patient Talk to the patient If possible have a neutral witness to your offer to help If possible have a neutral witness to your offer to help
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  • Legal and Ethical Considerations If a patient is not competent they cannot refuse medical care or give consent If a patient is not competent they cannot refuse medical care or give consent Often times this is where law enforcement becomes involved i.e...mental warrant Often times this is where law enforcement becomes involved i.e...mental warrant A parent or guardian can refuse to let you care for a child A parent or guardian can refuse to let you care for a child Follow the previously discussed steps. Follow the previously discussed steps. IF an adult takes a child from the scene before EMS arrives, you must report the incident to EMS or the police IF an adult takes a child from the scene before EMS arrives, you must report the incident to EMS or the police Conscious patient refuses care then becomes unconscious, implied consent usually takes over and care begins Conscious patient refuses care then becomes unconscious, implied consent usually takes over and care begins
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  • Legal and Ethical Considerations Advance Directives Advance Directives DNR (Do Not Resuscitate) Orders DNR (Do Not Resuscitate) Orders Legal document Legal document Signed by physician and patient Signed by physician and patient Terminal illness & does not wish to prolong life through resuscitative efforts Terminal illness & does not wish to prolong life through resuscitative efforts Texas has a state wide form that must be used Texas has a state wide form that must be used The Original DNR form or a copy of the form are to be accepted (NEW) The Original DNR form or a copy of the form are to be accepted (NEW) Approved ID bracelet with patient information engraved Approved ID bracelet with patient information engraved
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  • Legal and Ethical Considerations Living Wills Living Wills Document signed by patient regarding use of long- term life support and comfort measures such as respirators, intravenous feedings, pain medications. Document signed by patient regarding use of long- term life support and comfort measures such as respirators, intravenous feedings, pain medications.
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  • Legal and Ethical Considerations Negligence Negligence Basis for most lawsuits involving prehospital care is negligence Basis for most lawsuits involving prehospital care is negligence You could be sued IF: You could be sued IF: You had a Duty to Provide care or you assume the responsibility to provide care You had a Duty to Provide care or you assume the responsibility to provide care Care for the patient was not provided to the standard of care Care for the patient was not provided to the standard of care Patient was injured in some way as a result of this improper care Patient was injured in some way as a result of this improper care
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  • Legal and Ethical Considerations Duty to Act Duty to Act While on duty a first responder has a obligation to respond to an emergency and provide care at the scene While on duty a first responder has a obligation to respond to an emergency and provide care at the scene Your duty to act may involve your office Your duty to act may involve your office If you volunteer for an organization, you have a duty to act within the respond area of that organization If you volunteer for an organization, you have a duty to act within the respond area of that organization As a Doctor of Chiropractic????? As a Doctor of Chir