Chapter 3 – Legal and Ethical Issues 1

Chapter 3 – Legal and Ethical Issues

  1. Objectives

Knowledge Objectives /
  1. Describe the basic structure of the legal system in the United States.
  2. Define the terms plaintiff, defendant, statute of limitations, criminal law, civil law, and tort.
  3. Differentiate between criminal and civil law.
  4. Discuss the steps in a lawsuit.
  5. Differentiate between the scope of practice and the standard of care for Emergency Medical Responder (EMR) practice.
  6. Discuss the concept of medical oversight, including off-line medical direction and on-line medical direction, and its relationship to the EMR.
  7. Define ethics.
  8. Describe the ethical responsibilities of the EMR.
  9. Describe a three-part test used for determining a patient’s competence.
  10. Define consent and discuss the methods of obtaining consent.
  11. Differentiate between expressed and implied consent.
  12. Explain the role of consent of minors in providing care.
  13. Discuss the implications for the Emergency Medical Responder in patient refusal of transport.
  14. Explain the purpose of advance directives relative to patient care and how the EMR should care for a patient who is covered by an advance directive.
  15. Define and give examples of comfort care.
  16. Differentiate between assault and battery and describe how to avoid each.
  17. Describe what constitutes abandonment.
  18. Define negligence and describe the four elements that must be present in order to prove negligence.
  19. State the conditions necessary for the Emergency Medical Responder to have a duty to act.
  20. Explain the importance, necessity, and legality of patient confidentiality.
  21. List the actions that an Emergency Medical Responder should take to assist in the preservation of a crime scene.
  22. State the conditions that require an Emergency Medical Responder to notify local law enforcement officials.
  23. Discuss the responsibilities of the EMR relative to emergency care for patients who are potential organ donors.
  24. Describe the legal implications associated with the written report.
  25. Identify the various sections of the written report.
  26. Describe what information is required in each section of the prehospital care report and how it should be entered.

Attitude Objectives /
  1. Explain the rationale for the needs, benefits, and usage of advance directives.
  2. Explain the rationale for patient care documentation.

Skill Objectives /
  1. Given a scenario in which an EMR is presented with a conscious patient in need of care, demonstrate the process used to obtain consent.
  2. Given a scenario, demonstrate appropriate patient management and care techniques in a refusal of care situation.
  3. Given a scenario in which a patient is injured while an EMR is providing care, determine whether the four components of negligence are present.
  4. Complete a prehospital care report.

  1. Preparation

Corresponding textbook pages: /
  • 79-103

Audiovisual equipment: /
  • Chapter 3 PowerPoint® presentation
  • Computer
  • Multimedia projector

EMS equipment: /
  • None required

Course administration materials: /
  • Attendance sign-in sheet

Research before class: /
  • Review state, regional, and local legislation and protocols, including Emergency Medical Responder scope of practice, Good Samaritan law, traffic codes, the Ryan White Act, advance directives, the duty to act, and types of situations that must be reported by law (including child and elder abuse)
  • Find out the requirements for legal competence in your state
  • Find out the definitions of “intoxicated” or “altered” in your state
  • Find out when a minor child becomes of legal age to consent to his or her own treatment in your state
  • Find out your EMS system’s policies about what to do when an advance directive exists and the family—not the patient—requests emergency care be given to the patient.
  • Check your EMS agency’s policies and procedures regarding an EMR’s obligation to provide care if he is off-duty.
  • Check your EMS agency’s policies regarding patient confidentiality.
  • Find out if a Physician Orders for Life-Sustaining Treatment (POLST) program exists in your state. If so, bring copies of the form to class.

  1. Personnel

Primary instructor qualifications: /
  • One Emergency Medical Responder instructor knowledgeable in the legal aspects and ethical issues that the EMR will encounter

Assistant instructor qualifications: /
  • None required

  1. Key Terms Presented in This Lesson
  2. Abandonment Terminating patient care without making sure that care will continue at the same level or higher.
  3. Administrative Agency A governmental body responsible for implementing and enforcing particular laws.
  4. Administrative Law Rules and regulations made by the executive branch of the government.
  5. Altered Mental Status A change in a patient’s level of awareness; also called an altered level of consciousness (ALOC).
  6. Appeal When an attorney requests that a higher court hear a case in order to reverse the decision of a lower court.
  7. Assault Threatening, attempting, or causing a fear of offensive physical contact with a patient or another person.
  8. Battery The unlawful touching of another person without consent.
  9. Breach of Duty Violating the standard of care that applies in a given situation.
  10. Civil Law A branch of law that deals with complaints by individuals or organizations against a defendant for an illegal act or wrongdoing.
  11. Comfort Care Measures used to ease the symptoms of an illness or injury; also called palliative care or supportive care.
  12. Competence A patient’s ability to understand the questions you ask of him and understand the implications of the decisions he makes concerning his care.
  13. Consent Permission
  14. Criminal Law The area of law in which individuals are prosecuted on behalf of society for violating laws designed to safeguard society.
  15. Defendant A person being sued or accused in a lawsuit or criminal prosecution.
  16. Discovery Legal process to enable each side in a lawsuit or criminal prosecution to learn the facts necessary to prepare its case.
  17. Duty to Act A formal contractual or an implied legal obligation to provide care to a patient requesting services.
  18. Emancipated Minor A person who is less that the legal age of consent but who is given the rights of adults.
  19. Ethics Principles of right and wrong, good and bad, that affect our actions and lead to consequences.
  20. Expressed Consent A type of consent in which a patient gives specific permission verbally, in writing, or nonverbally for care and transport to be provided.
  21. Health Insurance Portability and Accountability Act (HIPAA) A law passed by Congress in 1996 to ensure the confidentiality of a person’s health information.
  22. Implied Consent Consent assumed from a patient requiring emergency care who is mentally, physically, or emotionally unable to provide expressed consent.
  23. Incompetence A patient who does not have the ability to understand the questions asked of her or does not understand the implications of the decisions she makes regarding her care.
  24. Informed Consent A type of consent in which the patient understands the risks and benefits of the EMR’s care.
  25. Libel Injuring a person’s character, name, or reputation by false or malicious writings.
  26. Minimum Data Set The recommended minimum information that should be included in a prehospital care report.
  27. Negligence A deviation from the accepted standard of care, resulting in further injury to the patient.
  28. Pertinent Negative A finding expected to accompany a patient’s chief complaint but not found during the patient assessment.
  29. Physician Orders for Life-Sustaining Treatment (POLST) Program for individuals with advanced chronic, progressive illness or terminal illness that further defines their end-of-life care wishes; POLSTs do not replace advance directives.
  30. Plaintiff A person or party that files a formal complaint with the court.
  31. Protected Health Information(PHI) Information that relates to a person’s physical or mental health, treatment, or payment that identifies the person or gives a reason to believe that the individual can be identified and that is transmitted or maintained in any form.
  32. Protocols Written instructions to provide emergency care for specific health-related conditions.
  33. Proximate Cause Actions or inactions of the healthcare professional that caused the injury or damages.
  34. Slander Injuring a person’s character, name, or reputation for false and malicious spoken words.
  35. Statue of Limitations The maximum period within which a plaintiff must begin a lawsuit or a prosecutor must bring charges or lose the right to file the suit.
  36. Tort Legal term for an illegal act or wrongdoing.
  1. Skills Presented in This Lesson
  • There are no skills identified for this lesson.

  1. Lesson Outline

Slide # / Instructor Notes
1 / A.Legal and Ethical Issues
2 / B.Objectives
3 / C.The Legal System
4 / 1.Branches of government
a.The United States Government is made up of three branches: legislative, executive, and judicial.
b.Each branch is the source of a different type of law.
5 / 2.Government: Legislative branch
a.The legislative branch of government is made up of Congress and government agencies such as state legislatures, city councils, district boards, and general assemblies.
b.Law made by this branch of government is called statutory or legislative law.
6 / 3.Government: Executive branch
a.The President of the United States is the head of the executive branch.
b.The Vice President, cabinet members, state governors, and state and federal administrative agencies that make rules and regulations are also part of the executive branch.
7 / c.An administrative agency is a governmental body responsible for implementing and enforcing a particular law passed by the legislative branch of government.
1)These agencies generally have the power to develop rules and regulations and to decide disputes.
d.The rules and regulations made by the executive branch of government are called administrative law.
8 / 4.Government: Judicial branch
a.The court system makes up the judicial branch of government.
b.Courts hear cases that challenge or require explanation of the laws passed by the legislative branch of government and approved by the executive branch.
c.The federal government and each of the state governments have their own court systems.
 Most cases, such as traffic violations, divorce, and disputes involving wills and estates and buying and selling property, are heard in state courts because state laws govern these areas.
9 / d.In the United States, there are generally three levels of courts.
e.Trial courts
1)Cases are first heard in trial courts and a decision is made by a judge or jury.
2)In some states, trial courts are called Circuit or District Courts.
f.Appellate courts
1)After the trial court has reached a decision, an attorney may request a higher court to hear the case to reverse the trial court’s decision. This is called an appeal.
2)Most appeals are first heard by an intermediate court, called an appellate court.
g.Supreme courts
1)Further appeals may be heard by supreme courts, which have final authority in the cases they hear.
 Some legal matters are handled by specific state courts. For example, a state probate court handles disputes pertaining to wills and estates. Similarly, some legal matters are handled by specific federal courts. For instance, U.S. Bankruptcy Courts handle bankruptcy cases. Other specialized courts that exist in the federal court system include the tax claim court, court of customs and patent appeals, admiralty courts (which deal with maritime issues), and the military court system.
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Objective 2 / 5.Lawsuit
a.In a lawsuit, the plaintiff (also called the complainant) is the party that files a formal complaint with the court.
b.The defendant is the party being sued or accused.
c.The maximum period within which a plaintiff must begin a lawsuit (in civil cases) or a prosecutor must bring charges (in criminal cases) or lose the right to file the suit is called the statute of limitations.
1)The length of the statute of limitations varies by state and may differ for cases involving adults and children.
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Objective 3 / 6.Criminal law
a.Criminal law is the area of law in which the federal, state, or local government prosecutes individuals on behalf of society for violating laws designed to safeguard society.
1)Punishable by fine, imprisonment, or both
2)In criminal cases, the plaintiff is a federal, state, or local government agency.
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Objective 3 / 7.Civil law
a.Civil law is a branch of law that deals with complaints by individuals or organizations against a defendant for an illegal act or wrongdoing (tort).
b.Examples include personal injury claims, divorce, and contract disputes.
c.In a civil case, the plaintiff asks the court to provide a remedy in the form of an award for damages.
 Examples of torts include libel, slander, professional malpractice, assault and battery, and false imprisonment.
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Objective 4 / 8.Steps in a lawsuit
a.A lawsuit begins when an incident occurs and an individual or organization find that the problems resulting from the incident require the involvement of the courts.
1)In some states it is necessary to make a formal demand by means of a “lawyer’s letter” before a suit can be filed. In this case, the party who has the complaint (the plaintiff) meets with an attorney to discuss what he claims has occurred and the remedy sought from the other party (the defendant).
2)The plaintiff’s attorney gathers available facts concerning the claim and then sends a letter to the defendant.
3)If the issue is not resolved, both parties and their attorneys may meet to discuss the claim and reach a fair resolution. If this attempt fails, the formal action of filing a lawsuit generally begins.
4)If a lawyer’s letter is not required by the state before a suit is filed, the plaintiff’s attorney begins by gathering pertinent facts, which may include interviewing witnesses and taking statements from them.
b.The attorney then prepares documents and files a written statement (the complaint) with the court.
1)The complaint explains what the plaintiff is claiming occurred and the remedy sought from the court.
c.After the complaint is filed, copies of the court documents and a summons (notice) are delivered (served) to the defendant (or his attorney) notifying him that a lawsuit has been filed against him.
1)In many areas, the summons is served by a deputy sheriff or special process server.
2)In other areas, it is served by mail.
3)Once served, the defendant has a specific period within which to answer the complaint.
4)If the defendant does not file an answer to the complaint with the time specified, the court can enter a default judgment against the defendant.
d.The defendant’s attorney prepares a response to the complaint and files it with the court.
e.A copy of the defendant’s answer is sent to the plaintiff’s attorney.
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Objective 4 / f.Discovery
1)After a lawsuit is filed, the process of discovery begins.
2)The purpose of discovery is to enable each side to learn the facts necessary to prepare its case and narrow the issues to be decided by the jury at trial.
3)To find out more details about the claim, one party may send written questions (interrogatories) to the other party.
4)Either party can also submit list of facts that must be admitted or denied in writing or request the other party to turn over documents that are relevant to the case.
5)Depositions may be taken by either party during discovery, which means asking individuals oral questions while under oath.
a)The questions and answers obtained in a deposition are recorded by a court reporter.
b)A transcript of the deposition is made a part of the case record.
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Objective 4 / g.Pre-trial conference
1)After discovery is completed, the judge will hold a pre-trial conference with the attorneys narrow the issues to be decided during the trial even further.
2)The judge will also attempt to persuade the attorneys to settle their case before the trial.
3)Most cases are settled during this period.
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Objective 4 / h.Trial
1)If no settlement is reached, the judge sets a date for the trial and the trial is conducted.
2)After the trial is finished, a decision is handed down by a judge or jury.
a)The decision determines guilt or liability and the damages and award, if any, to the plaintiff.
b)The judge then enters a judgment, which means that the decision is filed in public records.
3)Either side may appeal the decision to a higher court if they believe there were errors in law made by the court during the initial trial.
A trial held before a judge without a jury is called a bench trial. A trial held before a judge and jury is called a jury trial.
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Objective 5 / D.Scope of Practice
1.Scope of practice (also called scope of care) includes the emergency care and skills an Emergency Medical Responder (EMR) is legally allowed and expected to perform when necessary.
2.These duties are set by state laws and regulations and are also based on generally accepted standards.
 An EMR has a legal duty to his patients, his medical director, and the public. An EMR must provide for the well-being of his patients by providing necessary interventions outlined in the scope of care.
 States often use the United States Department of Transportation Emergency Medical Responder Curriculum and/or the National Education Standards to define the EMR’s scope of practice. Some states have adopted the National EMS Scope of Practice Model to define the scope of practice in their state. Some states modify an EMS professional’s scope of practice to fit the state’s needs or desires. As a result, what is accepted EMS practice in one state may not be so in another.