1. Medico Legal Ethics
Ms. Lalith Sivanathan

2. 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

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

4. 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.

5. 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.

6. 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.

7. 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.

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

9. 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.

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

11. 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.

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

13. 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)

14. Scope of Practice
Range of duties and skills care providers are allowed and expected to perform.

15. Medical/Legal and Ethics
Consent/refusal of care
Confidentiality
Advanced directives
Tort and criminal actions
Evidence preservation
Statutory responsibilities

16. Medical/Legal and Ethics (cont’d):
Mandatory reporting
Ethical principles/moral obligations
End-of-life issues

17. 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.

18. 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.

19. 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.

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

21. 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

22. 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.

23. 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.

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

25. 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.

26. 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

27. 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.

28. 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

29. 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)

30. Advance Directives (1 of 3)
Advance directive specifies treatment should the patient become unconscious or unable to make decisions.
A do not resuscitate (DNR) order is an advance directive that gives permission not to resuscitate.
“Do not resuscitate” does not mean “do not treat.”

31. Advance Directives (2 of 3)
Advance directive is also called:
Living will
Health care directive

32. Advance Directives (3 of 3)
Some patients may have named surrogates to make decisions for them.
Durable powers of attorney for health care
Also known as health care proxies

33. Special Situations (1 of 4)
Organ Donors
Expressed a wish to donate organs
Evidenced by information on:
Organ donor card and/or
Driver’s license
Your priority is to save patient’s life.
Remember that organs need oxygen.

34. Special Situations (2 of 4)
Organ Donor card

35. Special Situations (3 of 4)
Medical identification insignia
Bracelet, necklace, or card indicating:
DNR order
Allergies
Diabetes, epilepsy, or other serious condition
Helpful in patient assessment and treatment

36. Special Situations (4 of 4)
Medical identification insignia
Source: Courtesy of the MedicAlert Foundation®. © 2006, All Rights Reserved. MedicAlert® is a federally registered trademark and service mark.

37. Scope of Practice (1 of 3) Outlines the care you are able to provide
Usually defined by state law

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

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

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

41. 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

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

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

44. 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.”

45. 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

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

47. 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.

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

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

50. 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

51. 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).

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

53. 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.

54. 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

55. 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.

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

57. 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

58. 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

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

60. 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

61. 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

62. 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.

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

64. Questions?