Medico Legal Ethics Ms. Lalith Sivanathan

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

Best Protection Your best protection from liability is to perform systematic assessments, provide appropriate medical care, and maintain accurate and complete documentation.

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.

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.

Medical Law and Ethics Law Ethics 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. Ethics is a standard of behavior. Moral values serve as the basis for ethical conduct. Family, culture, and society help form an individual’s moral values.

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 individual’s 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.

Sources of Law (1 of 2) Constitutional—based on the Constitution. Common—derived from society’s acceptance of customs and norms.

Sources of Law (2 of 2) Legislative—created by law- making bodies such as state assemblies. Administrative—enacted by governmental agencies at either federal or state levels.

Categories of Law (1 of 3) Criminal—division of the legal system that deals with wrongs committed against society or its members.

Categories of Law (2 of 3) Civil—division of the legal system that deals with non- criminal issues and conflicts between two or more parties.

Categories of Law (3 of 3) Tort—a civil wrong committed by one individual against another.

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)

Scope of Practice (2 of 3) Medical director further defines by developing: Protocols Standing orders

Scope of Practice (3 of 3) Carrying out procedures outside scope of practice may be considered: Negligence Criminal offense

Standards of Care (1 of 3) Manner in which you must act or behave You must be concerned about safety and welfare of others.

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

Standards of Care (3 of 3) Standards of care established by (cont’d): Standards imposed by states Medical Practices Act Certification Licensure

Duty to Act Individual’s responsibility to provide patient care Duty to act applies: Once your ambulance responds to a call Treatment is begun

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

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.

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.

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.

Implied Consent (1 of 2) Applies to patients who are Unconscious Otherwise incapable of making informed decision Source: © Dan Myers

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

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.

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.

Minors and Consent (2 of 2) If true emergency exists, and no consent is available: Treat the patient. Consent is implied.

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.

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

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.

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

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)

Malpractice Res ipsa loquitur Malpractice claims are lawsuits by a patient for errors in diagnosis or treatment Negligence cases are those in which a person believes a medical professional’s actions, or lack thereof, caused harm to the patient Res ipsa loquitur Latin term which means “The thing speaks for itself.”

Malpractice (cont.) 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 one’s required duty or that is required by law

Negligence Failure to provide same care that person with similar training would provide in same or similar situation.

D The 4 Ds of Negligence amages erelict uty irect Cause Patients must prove that they suffered injury. erelict failed to comply with the standards of the profession. uty Patients must show that a physician-patient relationship existed. irect Cause Patients must show that any damages were a direct cause of a physician’s breach of duty. Patients must be able to prove all 4 Ds in order to move forward with a malpractice suit.

Negligence (2 of 2) All four of the following elements must be present for negligence to apply: Duty Breach of duty Damages Causation

Abandonment Unilateral termination of care by caregiver without: Patient’s consent Making provisions for continuing care

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

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).

Defamation (1 of 2) Communication of false information that damages reputation of a person Libel if written Slander if spoken

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.

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

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.

Records and Reports (1 of 3) Compile record for all incidents involving sick or injured patients Important safeguard against legal complications

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

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

Special Mandatory Reporting Requirements (2 of 3) Most states have a reporting obligation (cont’d): Attempted suicides Dog bites Communicable diseases Assaults Domestic violence

Special Mandatory Reporting Requirements (3 of 3) Most states have a reporting obligation (cont’d): Sexual assault Exposures to infectious disease Transport of patients in restraints Scene of a crime The deceased

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

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.

Summary You must meet legal and ethical responsibilities while caring for the patient’s physical and emotional needs.

Questions?