Legal vs. Ethical. Scope of Practice. Standard of Care 11/18/2010. Can something Illegal be ethical? Do ethics vary?
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1 Legal vs. Ethical Can something legal be unethical? Can something Illegal be ethical? Do ethics vary? Legal duties: Provide for the well being of the patient by rendering necessary care interventions outlined in the scope of practice. defined by state legislature Provided by medical directions through protocols Referenced to the National Standard Curricula adopted by the state Legal right to function as EMT is contingent upon medical direction, and licensure Ethical responsibilities Pt advocacy Practice maintain skills to point of mastery Continuing i ed Critically review performance Honesty What is the Uniform Discipline Act? RCW , or the UDA, consists of laws governing the licensure and discipline procedures for health and health related professionals and businesses. These rules and regulations strengthen and consolidate disciplinary procedures for licensed and certified health and health care related professions and agencies. Standard of Care The fictional Reasonable Man Standards imposed by custom Standards imposed by law Standards imposed by Institutions Standards imposed by textbooks 1
2 Advanced Directives WA No CPR Guidelines Read on website for state test. Bracelet Obvious death Palliative care The transition from life to death How to talk with family/friends Compelling Reasons Allows EMS to withhold resuscitation efforts if BOTH criteria are met: Verbal indication of family members/caretakers of patients desire not to be resuscitated The patient has a terminal condition In Snohomish County medical control must be contacted for confirmation What would you do? 90 y/o male unresponsive in nursing home Skin warm/pale Hx of CHF Staff states upon arrival this pt has a POLST on file Remain seated if you withhold CPR Stand if begin CPR What would you do? 76 y/o female unresponsive at home Skin cool/pale Hx of lung cancer Neighbor on scene states We were just talking yesterday, and she told me she was ready to die and wouldn t want CPR Remain seated if you with hold CPR Stand if begin CPR The bottom line Issues of death and dying are difficult, and information is often vague. In addition, decisions need to be made quickly and possibly under a high degree of stress. To help you make good decisions become familiar with: State guidelines and; Sno Co Protocols 12 2 & 12 3 Document completely and clearly Consent Informed Legal age Pt must understand potential consequences of actions Must be obtained from every conscious, competent adult prior to rendering care Pt may agree to partial care 2
3 Consent Implied Based on assumption that unconscious pt would desire assistant Can be applied when patient is incable of rations decisions when in doubt use med. Control. Minors or Mentally incompetent Consent must be obtained from parent/guardian Emancipation Minors in WA = 18 When life threat exists implied consent applies Sno Co. Protocol Assault/Battery Can be applied if consent to touch/treat not obtained Restraint and implied threat Is retreat an option? Establish/maintain Primary Management Respect dignity Least restrictive method Never prone Handcuffs Monitor vitals constantly and CMS Document EVERYTHING SNO Co. Protocol 8 1 and 8 3 Refusals Patients have the right to refuse treatment/transport Can change their minds Potential legal landmine Comparative degrees of liability: EMT and Pt agree to Tx: Low EMT and Pt agree to NO Tx: Med EMT wants Tx, Pt doesn t: Med (w/proper doc.) EMT doesn t want Tx, Pt does: High (always use med control) Use Med control if any doubt exists Document thoroughly, and have refusal signed Techniques for Refusal Assess as thoroughly as possible Advise Pt of potential risks Contact med control Use Jedi Mind Tricks Be persistent, involve family if appropriate If unsuccessful explain options Get refusal signed by pt or witness and document Abandonment Pt must be transferred to equal or higher trained appropriate provider At hospital pt must be transferred to care provider 3
4 Duty to Act Legal On duty Responding as On Call provider Self created by making contact at scene of emergency Moral/Ethical Passing scene of emergency When in aid rig in another juristiction Confidentiality HIPAA class to come Defamation Slander/Libel Pictures Special Situations Organ Donors Requires written permission EMS Treatment does not change Contact med control for assistance Check for Medical Jewelry Crime Scene (EMS Online) Pt is #1 priority When crime suspected take care to disturb as little as possible, and inform PD of disturbances Cut around penetrations in clothing Observe and document anything unusual Special Reporting Situations Reporting child abuse or neglect RCW Reporting vulnerable adult abuse/neglect RCW Indicators of abuse: Hx of events vs. C/C Conflicting stories Injuries at various healing stages Obvious fear Reluctance to answer questions Not allowed to be alone Shape of injury Potential abuser answering for pt Neglect Emotional abuse Reasons alleged victims lie about being assaulted Anger at person/authority Inability to separate fact/fiction Mental illness Crime RCW Sexual Assault Violent Crime Domestic Violence DUI Some RCWs Abuse or Neglect of Nursing Home or State Hospital Patient: Abuse of Child & Adult Dependent Persons (26.44): ; Abuse of Vulnerable Adults: Admission of Minor Over 13 Years Old for Mental Health Treatment without Parental Consent: ; ; ; Offense against a child (penalties): Physician Misconduct: ; Exceptions:
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