SLIDES_CH03 Medical, Ethical, and Legal Issues

100 question-and-answer flashcards covering consent, confidentiality, advance directives, signs of death, scope of practice, negligence, Good Samaritan laws, mandatory reporting, ethical responsibilities, and court considerations for EMTs.

What is the basic principle of emergency care that providers should follow?

To do no further harm.

Acting in good faith and according to an appropriate standard of care helps health-care providers avoid what?

Legal exposure.

Define consent in the medical context.

Permission from a patient to render care.

What legal right does a conscious and rational patient have regarding care?

The right to refuse care.

What is the foundation of consent that determines if a patient can make medical decisions?

Decision-making capacity.

What term describes the patient’s right to make decisions about their own health?

Patient autonomy.

What type of consent is given when a patient verbally agrees to treatment after risks and benefits are explained?

Expressed (informed) consent.

When does implied consent apply?

When a patient is unconscious or incapable of decision-making and a threat to life or limb exists.

By what doctrine is implied consent also known?

The emergency doctrine.

For patients with mental illness, developmental delay, or behavioral crisis, what type of consent is required?

Involuntary consent obtained from a guardian or conservator.

Who usually provides consent for treatment of minors?

A parent or legal guardian.

Give two examples of emancipated minors who may be able to give their own consent.

Married minors and those in the armed services (also teen parents).

In a true emergency with an unaccompanied minor, what type of consent applies?

Implied consent.

What is forcible restraint and when may it be used?

Physically restraining a combative patient when legally permissible to prevent harm.

Once restraints are applied, under what condition should they be removed en route?

Only if they pose a risk to the patient.

Why are calls involving refusal of treatment frequently litigated?

Improper handling can lead to allegations of negligence or abandonment.

Name one assessment step to determine if a patient can make an informed refusal.

Ask and repeat questions to assess comprehension (also evaluate answers and observe behavior).

What is a more defensible legal position: treating or failing to treat a patient?

Providing treatment.

What document should a patient sign when refusing care?

A refusal of care form.

What three categories of patient information are considered confidential?

Patient history, assessment findings, and treatment provided.

Which 1996 federal law contains provisions on patient privacy?

HIPAA (Health Insurance Portability and Accountability Act).

Under HIPAA, what is protected health information (PHI)?

Any patient-identifying medical information that must be kept confidential.

Failure to comply with HIPAA can result in what?

Civil and/or criminal action.

Name one social media guideline for EMS providers regarding patient information.

Avoid posting agency logos, uniforms, or patient information online.

What does DNR stand for?

Do Not Resuscitate.

Does a DNR order mean “do not treat”?

No; it only directs withholding resuscitation, not all care.

List four requirements for a valid DNR order.

Statement of medical problem, patient or guardian signature, physician signature, and not expired.

What do POLST and MOLST forms specify?

Physician/Medical orders for life-sustaining treatment outlining acceptable interventions.

What is a durable power of attorney for health care?

A document naming a surrogate (health-care proxy) to make medical decisions.

Give three presumptive signs of death.

Unresponsiveness to pain, absence of carotid pulse, absence of breath sounds (others include no reflexes, eye movement, systolic pressure, cyanosis, low temperature).

Name two definitive signs of death.

Dependent lividity and rigor mortis (others include decapitation, putrefaction).

Between what time frame does rigor mortis typically occur?

2–12 hours after death.

Between what time frame does putrefaction generally occur?

40–96 hours after death.

List three situations that require notifying the medical examiner.

Suicide, violent death, and death without previous medical care (also DOA, poisoning, accidents, suspected criminal acts, child deaths).

What is the EMS provider’s top priority when treating an identified organ donor?

Saving the patient’s life and maintaining organ oxygenation.

Name three possible locations for medical identification insignia on a patient.

Bracelet, necklace, or keychain (also cards or USB flash drives).

What is the scope of practice?

The care an EMS provider is legally allowed to perform as defined by state law and medical-director protocols.

Performing procedures outside your scope of practice may be considered what?

Negligence or a criminal offense.

Define standards of care.

The manner in which an EMS provider must act or behave toward patients.

Give two sources that establish standards of care.

Local customs and professional guidelines such as AHA CPR standards (also laws, textbooks, institutional protocols).

What is duty to act?

An individual’s legal responsibility to provide patient care once responding or beginning treatment.

Negligence is defined as what?

Failure to provide the same care a similarly trained person would provide in similar circumstances.

What four elements must be present to prove negligence?

Duty, breach of duty, damages, and causation.

What does the legal doctrine res ipsa loquitur mean?

"The thing speaks for itself," implying negligence when injury would not occur without it and was under EMS control.

Define negligence per se.

Conduct that is negligent because it violates a statute.

What is a tort?

A civil wrong.

What is abandonment in EMS?

Unilateral termination of patient care without patient consent and without transferring to an equal or higher provider.

Give an example of assault in the EMS context.

Threatening to restrain a patient who refuses care.

Give an example of battery in EMS.

Providing treatment without patient consent.

What constitutes kidnapping in EMS?

Transporting a patient against their will.

What is false imprisonment?

Unauthorized confinement of a person.

What is defamation?

Communication of false information that damages someone’s reputation.

Differentiate libel and slander.

Libel is written defamation; slander is spoken.

State one condition that must be met under Good Samaritan laws for immunity.

Acting in good faith (others include no expectation of compensation, within training scope, not grossly negligent).

Define gross negligence.

Willful or reckless disregard for the standard of care.

What is sovereign immunity?

Legal protection limiting liability for governmental EMS systems.

Complete the legal maxim: “If it wasn’t documented, .”

It wasn’t performed.

Why are complete patient care reports important?

They safeguard against legal complications and reflect quality of care.

What is NEMSIS?

National EMS Information System, a standardized database for EMS data.

List four types of incidents that most states require EMS providers to report.

Child abuse, dog bites, communicable diseases, and attempted suicides (others include elder abuse, felony injuries, domestic violence, sexual assault, deaths).

Define ethics in the healthcare context.

Philosophy of right and wrong, moral duties, and ideal professional behavior.

What is bioethics?

Ethics dealing specifically with issues in healthcare practice.

When summoned to court, what two people should an EMT notify?

Service director and legal counsel.

As a witness in court, what is an EMT’s role?

Remain neutral and review the run report before testifying.

Name two defenses that may be used if an EMT is a defendant in a civil case.

Statute of limitations and contributory negligence (also governmental immunity).

What is discovery in legal proceedings?

The process where both sides obtain more information through interrogatories and depositions.

Distinguish compensatory and punitive damages.

Compensatory cover actual loss; punitive punish egregious conduct.

What is the purpose of the emergency doctrine?

To allow treatment under implied consent in life-threatening emergencies.

What principle states that a patient can withdraw consent at any time?

Right to refuse treatment.

What key competency area includes consent, confidentiality, and advance directives in the National EMS Education Standards?

Medical/Legal and Ethics.

What federal act strengthens patient privacy laws and defines PHI?

HIPAA.

What is patient decision-making capacity?

Ability to understand information and make an informed medical choice.

How should an EMT handle a social media post involving patient info?

Do not post any identifiable patient information; maintain professionalism.

What document allows EMS to follow specific end-of-life wishes signed by a physician?

POLST/MOLST.

During what timeframe does algor mortis occur?

It is the gradual cooling of the body until it matches ambient temperature after death.

What is dependent lividity?

Pooling of blood in dependent body parts causing discoloration after death.

Who determines the cause of death?

A physician (or medical examiner).

What should an EMT do when encountering a patient wearing a MedicAlert bracelet?

Access the bracelet information or contact MedicAlert for patient history.

Why should EMS providers preserve evidence at a scene?

To comply with legal responsibilities and avoid compromising investigations.

Define confidential information in EMS.

Any patient-related data including history, assessment, or treatment that cannot be disclosed without authorization.

What is the minimum age for medical decision autonomy in most states?

18 years (legal adulthood), unless emancipated.

What should EMS providers do before restraining a patient?

Consult medical control and involve law enforcement if needed.

What legal concept protects a provider who assists during an off-duty emergency without compensation?

Good Samaritan immunity.

Give one example of statutory responsibility for EMTs.

Mandatory reporting of abuse or certain injuries.

What term describes failure to act when there is a duty to do so?

Breach of duty.

Why is preserving the chain of custody of evidence important?

To ensure evidence is admissible in court.

Who may act in loco parentis for a minor at school?

Teachers or school officials.

What are standing orders in EMS?

Written protocols authorizing specific care without contacting medical control.

What is credentialing in EMS?

Process of determining and maintaining competence through licensure, certification, etc.

Define “standard of care” as it pertains to textbooks.

Guidelines and practices described in authoritative EMS textbooks (e.g., NHTSA curriculum).

How does contributory negligence affect a lawsuit?

It may reduce or bar recovery if the patient's own actions contributed to injury.

What is an interrogatory?

A written question submitted during discovery requiring a written answer under oath.

What is a deposition?

An oral sworn testimony taken during discovery.

Why should an EMT review the run report before court testimony?

To ensure accuracy and refresh memory.

Name two ethical obligations of an EMT off duty regarding social media.

Maintain patient confidentiality and professional conduct.

What is the Medical Practices Act related to EMS?

State laws that impose standards for medical practice and EMS provider certification/licensure.

How does a professional standard differ from a local custom?

Professional standards are set by authoritative bodies; local customs are practices common in a region.

What is the role of the medical director in defining scope of practice?

Developing protocols and standing orders.

What type of damages may punish the defendant for reckless conduct?

Punitive damages.

What should an EMT do if charged with a criminal offense?

Secure an experienced criminal attorney immediately.