Legal and Ethical Aspects of Paramedic Practice - Article Example

Legal and Ethical Aspects of Paramedic Practice Introduction There are various legal and ethical issues that paramedics face every day. These issues range from simple to serious dilemmas that often affect the level of care that these paramedics render to their patients. This paper shall discuss one of these ethical issues. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. It shall conclude with this student’s position on the issue based on the discussions made in this paper. The facts of the ethical dilemma are narrated as follows: Paramedics were on their way to their headquarters after successfully responding and resolving a medical emergency, when they saw what appeared to be a man lying unconscious by the side of a road. When they stopped the vehicle and approached the body, they saw that it was an unconscious male with a bloodied face and head. He appeared to be a victim of a mugging because his pockets were turned inside out and he looked like he suffered a beating. They tried to wake the man but were not successful. On careful examination of the man, the paramedics saw that he had a head wound. He also had no pulse and was not breathing. The paramedics performed CPR on the patient. They were able to revive him. When he regained consciousness, the paramedics asked him what his name was and he identified himself as Dan Martin. The paramedics asked Mr. Martin how he was injured and he said he did not remember. While being treated for his injuries, he suddenly got angry and he asked the paramedics why they were treating him. He insists that he did not ask to be treated and that he had the right to refuse treatment. He later sued the paramedics for civil damages. Apparently, he acquired hairline fractures on his ribs and some bruising on his chest area due to the paramedic’s administration of CPR. He also claimed that his right to refuse treatment was violated. Legislation The Australian legislation relevant to the case above is the patient’s right to refuse treatment and the Good Samaritan Law. South Australia’s Consent to Medical Treatment and Palliative Care Act (1995) contains the relevant provisions for the incident narrated above. The Act mentions that a medical practitioner may legally render medical treatment to a person or a patient if the patient is incapable of consenting and the medical practitioner believes that the treatment is necessary in order to meet an immediate risk to life or health. Based on the above legislation, the paramedics’ actions were within the legal parameters of South Australia. The paramedics rendered medical treatment to the patient who was unconscious, and therefore, incapable of consenting. Also, the paramedics saw that he had a head wound and was bleeding, hence, there was an immediate risk to the patient’s life. The situation clearly is within the legal jurisdiction of the Act. Since, the paramedics were within their rights in rendering medical assistance to Mr. Martin, they cannot be held liable for injuries that the patient obtained. The paramedics were not negligent in their duties and they performed such duties as competent paramedics. The case above also falls under the principles behind the ‘Good Samaritan’ law. In 2002, South Australia introduced regulations to protect good Samaritans. Their earliest movies to provide immunity to good Samaritans were seen under section 74 of the Civil Liability Act 1936. The provisions of this section specified that, acts or omissions which were done or made in good faith, and without recklessness in assisting a person in apparent need of emergency assistance, are exempt from any civil liability. This protection also extends to medically-qualified good Samaritans. This would then include medical practitioners, persons with legally recognized professional health care qualifications, or a person who works or who has worked as an ambulance officer or paramedic (as cited by Dixon, 2009, p. 9). Principles in Ambulance Services The Good Samaritan law is primarily based on the basic principle of common law which says that “when you reasonably help another person, you should not be liable for errors and omissions that are made in giving good faith emergency care” (Pollak & American Academy of Orthopaedic Surgeons, 2002, p. 72). In the case above, the paramedics rendered emergency medical care to the patient in good faith. Mr. Martin was unconscious and he was in a life-threatening situation. He was also not in a position to give his consent to the medical procedure because he was unconscious. Based on common law and even basic goodness, the paramedics should be considered free from liability for rendering medical care to Mr. Martin. The four basic principles of emergency care may also be used to evaluate the case illustrated above. The four basic principles are: beneficence, non-maleficence, respect for autonomy, and justice. Beneficence According to Gullo (2004, p. 529), the principle of beneficence also includes the fundamental principles of medicine which include: the preservation of life, the restoration of health, the relief of suffering, and the restoration or maintenance of function. In the above illustrated case, the principle of beneficence justifies the paramedics’ actions. They saw an injured man by the road side and they rendered medical care to him. The fact that Mr. Martin later gained consciousness and refused medical treatment is an important consideration which can still be justified under the principle of beneficence. Various emergency procedures carried out by paramedics and by medical practitioners have shown a history of saving lives of patients during emergencies and life-threatening situations. Shelp (1982, p. 184) discusses how the moral duty associated with being a Good Samaritan is related to several factors that are concerned with the resultant harm if help is not rendered; the costs of rendering care; the imminence of harm if help is not rendered; the likeliness that options open to the agent will alleviate the situation. Therefore, if the harm to be prevented is severe, the risk minimal, the harm imminent, and the likelihood of an improved outcome are great, then being a Good Samaritan is a moral duty (Shelp, 1982, pp. 184-185). Non-maleficence The principle of non-maleficence emphasizes the avoidance of anything that has negative consequences (Gullo, 2004, p. 529). The paramedics were trying to avoid further harm from being caused upon Mr. Martin’s person; hence, they administered medical assistance to him. The patient benefitted from the paramedics; and no severe consequences upon his person were caused by the paramedic’s actions. It is prudent to judge that the principle of non-maleficence justified the paramedics’ actions, and therefore, no liability was incurred. The injuries that Mr. Martin incurred were expected injuries from life-saving measures. They consequently revived and prevented negative consequences from befalling Mr. Martin. Respect for autonomy Respect for a patient’s autonomy is an important principle in emergency services. It emphasizes that “adult patients with decision-making capacity have a right to accept or refuse recommended health care, and physicians have a concomitant duty to respect their choices” (American College of Emergency Physicians, 2009). Mr. Martin had the right to refuse treatment from the paramedics, and the paramedics had the obligation to respect his right. However, the term ‘decision-making capacity’ did not apply to Mr. Martin at the time he was unconscious. Therefore, the paramedics were within the bounds of emergency legal and ethical principles in treating him. The paramedics could not very well leave him in the middle of the road, unconscious and in obvious peril. This situation may also be likened to terminally ill or chronically ill patients who have signed NFR (Not for Resuscitation) or DNR (Do Not Resuscitate) orders. These patients usually have made arrangements with their medical providers that in case they go into cardiac arrest, resuscitation or life-saving measures shall not be carried out on their person. However, in instances where strangers (especially those with a medical background) happen to be present at the time the patient goes into cardiac arrest, life-saving measures may be unavoidably carried out on the patient. These medical practitioners or even strangers cannot be expected to know about the patient’s DNR orders. Kerridge, et.al., (2005, p. 276) emphasize that in an emergency, pre-planning may be nonexistent. Under the doctrine of necessity, as further discussed by Kerridge and colleagues (2005, p. 276), “treatment may be instituted without the consent of the patient or surrogate where there is an imminent danger to the patient’s life or health and the person is incapable of consenting”. In the case illustrated above, the patient’s life and health was in imminent danger. He had a head wound and was bleeding through such wound. He was also incapable of consenting to the medical treatment at the time he was being treated by the paramedics. All things considered, the paramedics cannot be held liable for actions which were administered in good faith. Justice The principle of justice in emergency services emphasizes a person’s right to receive the most appropriate medical care (Gullo, 2004, p. 531). This principle also points out that the delivery of medical services must be prudently assessed in order to determine their appropriateness and their effectiveness on a patient. Gullo (2004, p. 531) points out how rendering futile life-saving measures on patients can divert care from those who need it the most. In the case illustrated above, Mr. Martin appeared to be a person who was in most need of appropriate medical care. His bleeding head wound is a potential threat to his life. Such injury also implies that he may also be suffering from other injuries which may also be potentially life-threatening. To avoid further injury, immediate medical attention must be rendered. Discussions on the principle of justice can also be argued in the sense that the paramedics were acting justly and with impartiality. The American College of Emergency Physicians (2009) also emphasize that the duty of care and justice extends to all patients regardless of their race, color, creed, gender, nationality, or other irrelevant properties. The paramedics saw an unconscious and injured man lying by the road side. Their subsequent assistance to the man was made in fulfillment of the duty of care they owe to any patient, regardless of his race or his station in life. Ethical Obligations The ethical obligations in emergency services which may be applied to the above illustrated case involve consent, abandonment, and acting in good faith (Donmez, 2009, pp. 1-2). Lateef (2008, pp. 1-9) also makes mention of the previous principles on beneficence, non-maleficence, justice or fairness, and autonomy, alongside other principles like refusal of care. Consent It is considered an ethical obligation for a health care giver to ask consent from the patient before rendering medical care (Donmez, 2009, p. 1). Generally, if consent is not obtained before medical care is given, the patient may pursue assault or battery charges against the health care giver. In such case, the rescuer cannot be covered under the Good Samaritan Law. Gaining the patient’s consent enables a relationship of trust and confidence between the patient and the caregiver. It also helps ensure the patient’s cooperation during the treatment. The patient can also express his or her preferences in the treatment process. Gaining the patient’s consent helps to protect the patient’s right to refuse treatment and his right to actually control the procedures being undertaken on his person. In the case illustrated in this paper, Mr. Martin’s consent was not gained before medical attention was given to him. However, it is important to note that he was incapable of giving his consent because he was unconscious when the paramedics attended to him. He had no pulse and no breathing when he was found. In these instances, time is of the essence. And in a situation where time is crucial, “it is likely that any treatment carried out to save life would be considered to be associated with implied consent” (Greaves, et.al., 1997, p. 472). From a reasonable person’s point of view, Mr. Martin needed immediate care; and such care was crucial to his survival. The paramedics were able to revive him, albeit, expected injuries were seen on Mr. Martin after the life-saving procedures were administered. In any other instance where Mr. Martin was conscious and already refused medical attention, the paramedics may be liable for treating him amidst his expressed protests. However, seeing as Mr. Martin was unconscious, without friends or family to act as surrogates in his behalf, the paramedics could only make their decisions based on implied consent. Abandonment Another important aspect of the Good Samaritan Law is the abandonment clause. In essence, this clause points out that once emergency care is rendered to a patient, a person cannot leave the victim until more advanced medical care arrives (Donmez, 2009, p. 1). A responder who holds a lower level of certification in emergency care, has to wait until a higher level responder takes over, and so on and so forth. An initial responder who starts to administer medical assistance to a patient cannot leave the patient until and unless more advanced medical services arrive. If the initial responder starts medical care and then leaves the patient, he may be charged for abandonment. Beebe & Funk (2001, p. 43) also emphasize this abandonment principle by mentioning that a unilateral severance by the EMT of the EMT-patient relationship is considered as EMT misconduct. They further emphasize that, if it is found that the EMT purposely and “unjustifiably terminated the EMT-patient relationship, then the EMT can be held responsible for any injuries that resulted” (Beebe & Funk, 2001, p. 43). In the case of Mr. Martin, the paramedics were the first responders. They started to administer medical care to the patient and did so until they finally drove him to the emergency room. They were very much qualified to care for Mr. Martin; hence there was no need for them to call in more advanced medical services. They also appropriately endorsed Mr. Martin’s case to the emergency department of the nearest hospital. Acting in good faith Acting in good faith, under the Good Samaritan Law is about not being deliberately negligent or reckless and is also about acting within the scope of one’s training (Donmez, 2009, p. 2). Donmez (2009, p. 2) further emphasizes that when the rescuer/s tries his or their best, in accordance with their training, to assist the victim, they are protected by the law from possible mistakes or injuries incurred by the patient. The paramedics have to be aware of the existing rules and regulations in the area where they are practicing. This will help ensure that they are not violating any laws or regulations while they are fulfilling their roles as paramedics and health caregivers. Good faith can only apply in situations where the health care giver or the paramedic was functioning within legal and ethical parameters. In fact, Schwab & Gelfman (2005, p. 171), the Good Samaritan laws are in place in order to protect volunteers from criminal liability for their efforts made in good faith at the scene of an accident. However, it is important to note that this ‘immunity’ from liability does not apply to instances when the paramedic or the health care giver is “grossly negligent or engages in willful or wanton misconduct, acts beyond the scope of his or her license, or had a pre-existing relationship with the patient” (Schwab & Gelfman, 2005, p. 171). In the case being discussed in this paper, there was no gross negligence on the part of the paramedics. In fact, they were very mindful of the laws existing in their territory and they rendered medical assistance to the patient in good faith. Refusal of care This principle or concept has been previously mentioned in the previous paragraphs. It is also very much related to the concept of patient autonomy. Schottke and the American Academy of Orthopaedics (2007, p. 42) point out that “any person who is mentally in control, or competent, has a legal right to refuse treatment from emergency medical personnel at any time”. In the meantime, the medical health professional can talk to the patient and explain his circumstances and the possible remedies that may to treat his injuries. In the process, the care giver may be able to convince the patient to accept medical care and assistance. However, until and unless he does accept assistance, the paramedics and the medical health professionals have to respect the patient’s right to refuse medical care. Again, in the case of Mr. Martin, he was not competent in giving consent to the paramedics because he was unconscious. Therefore, he was not mentally competent to give his consent to the treatment. Personal moral intuition My personal moral intuition on ethical obligations that apply to the emergency services codes and practical principles relate to basic goodness and kindness. These principles are moral principles or creeds that can be applied to most aspects of our lives, especially in the way we relate to other people. This attitude of goodness and kindness are qualities which would not allow us to ignore other people who obviously need our help. They are also attitudes which would call on us to treat other people as we would have them treat us. In applying these principles to the case illustrated in this paper, I personally believe that goodness and kindness would call on me to help Mr. Martin in his time of need. In so doing, whatever benefits he would have gained from my actions would hopefully be looked upon with gratitude. Just as the Good Samaritan has looked upon a man in need with goodness and kindness, so shall I. Ultimately, and hopefully, these actions would entice reciprocal acts of goodness and kindness. Argument The above ethical and legal aspects should be used in order to resolve the problem uncovered in the case because they are all relevant principles and aspects that can appropriately and satisfactorily settle the issue at hand. The rules and regulations of South Australia on Consent to Medical Treatment and Palliative Care Act 1995 and the common law principles of the Good Samaritan Law constitute legal mandates that can help resolve this issue. The principles of beneficence, non-maleficence, autonomy, and justice are also principles which can be used in resolving issues and problems encountered by emergency medical services. These principles can be applied to the case because the ultimate benefits to the patient and to the principles of justice are raised in this case. Patient autonomy is also a principle which is relevant to the case because the patient claims that he had the right to refuse treatment. These four basic principles form a logical interplay of concepts which enable us to appropriately evaluate the case. Lastly, the ethical principles of consent, abandonment, good faith, goodness, and kindness are also important principles to consider in this case. Consent is important in gaining the patient’s cooperation and trust. Abandonment is an important principle which can help legally defend the paramedic’s actions in attending to the medical needs of the patient. The principle of good faith is however, the most important principle which can be used to defend the actions of the paramedics and to absolve them from liability. The principle of good faith is the principle behind the Good Samaritan Law. Where an act is done in good faith, in aid of another person in imminent danger, the person rendering aid is absolved from liability in case his actions cause injury. The paramedics saw someone unconscious by the road side. They were in a perfect position to render aid, and they did render it. They caused the patient hairline rib fractures and bruising but such injuries were a necessary consequence of life-saving measures administered to the patient. The paramedics were not grossly negligent in their actions; nor did they deliberately set out to cause the fractures and bruising on the patient. There was no malice in their actions, therefore, they should not be held liable for the patient’s injuries. Conclusion The main ethical issues being raised in this case are firstly, whether or not a paramedic may be held liable for injuries sustained by a patient in the course of life-saving measures administered to the patient. Secondly, it also seeks to address whether or not a paramedic is liable for administering care to a patient without his consent. The law being applied to this issue is the Consent to Medical Treatment and Palliative Care Act 1995, the Good Samaritan law and section 74 of the Civil Liability Act of 1936. The ethical principles of beneficence, non-maleficence, autonomy, justice, and good faith are the main principles appropriate for this case. The situation described in this paper should be dealt with by applying the principles of the Good Samaritan Law, section 74 of the Civil Liability Act of 1936, and beneficence, and good faith. The previously discussed principles in this paper are all appropriate for this case, but none more so than the principles, just now, mentioned. The paramedics should be absolved from civil liability because they rendered medical assistance to a person who was otherwise incapable of giving consent. Mr. Martin was unconscious, had no pulse, and was not breathing. Having to ask for his consent before administering care would have only further endangered Mr. Martin’s life. The paramedics should also be absolved from any liability for their actions because they acted in good faith. They did not intend to cause Mr. Martin any injury. Their life-saving measures unintentionally caused Mr. Martin bruising and fractured ribs, but such injuries were not caused with undue negligence on the part of the paramedics. They sought to render efficient and appropriate care to Mr. Martin, care that eventually saved his life. They should not be held liable for doing what they were trained to do in the first place – to save lives. Works Cited Beebe, R. & Funk, D., 2001, Fundamentals of emergency care, California: Cengage Learning Code of Ethics for Emergency Physicians, June 2008, American College of Emergency Physicians, viewed 23 September 2009 from http://meetings.acep.org/MobileArticle.aspx?id=29144&coll_id=32&parentid=748 Consent to Medical Treatment and Palliative Care, 1995, South Australia Government, viewed 23 September 2009 from http://www.legislation.sa.gov.au/LZ/C/A/CONSENT%20TO%20MEDICAL%20TREATMENT%20AND%20PALLIATIVE%20CARE%20ACT%201995/CURRENT/1995.26.UN.PDF Dixon, N., 7 March 2007, Protection for Good Samaritans under the Civil Liability (Good Samaritan) Amendment Bill 2007 (Qld), Queensland Parliament, viewed 23 September 2009 from http://www.parliament.qld.gov.au/view/publications/documents/research/ResearchBriefs/2007/RBR200709.pdf Donmez, A., 9 February 2009, Understanding the Good Samaritan Law when Responding to an Emergency, Associated Content, viewed 23 September 2009 from http://www.associatedcontent.com/article/1429850/understanding_the_good_samaritan_law_pg2.html?cat=17 Gullo, A., 2004, Anaesthesia, pain, intensive care and emergency medicine - A.P.I.C ..., Volume 2, New York: Springer Greaves, I., Hodgetts, T., & Porter, K., 1997, Emergency care: a textbook for paramedics, California: Elsevier Kerridge, I., Lowe, M., & McPhee, J., 2005, Ethics and law for the health professions, Sydney, Federation Press Lateef, F., 2008, Ethics in the Emergency Department, Find Articles, 23 September 2009 from http://findarticles.com/p/articles/mi_qa4004/is_200807/ai_n27899177/?tag=content;col1 Pollak, A. & American Academy of Orthopaedic Surgeons, 2002, Emergency care and transportation of the sick and injured, Massachusetts: Jones & Bartlett Schotke, D. & American College of Orthopaedic Surgeons, 2007, First Responder: Your First Response in Emergency Care, Massachusetts: Jones & Bartlett Schwab, N. & Gelfman, M., 2005, Legal Issues in School Health Services: A Resource for School Administrators, Nebraska: iUniverse Shelp, E., 1982, Beneficence and health care, New York: Springer Read More