Medical, Legal, and Ethical Issues

Why this chapter matters

Every patient contact touches consent, privacy, and documentation duties.

Learning objectives (16)

1. Compare expressed consent, implied consent, and involuntary consent — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
2. Define consent and how it relates to decision making — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
3. Define ethics and morality and their implications for the EMT — Knowledge/skills objective (printed page 86); confirm wording in your course copy.
4. Describe local EMS system protocols for using forcible restraint — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
5. Describe the EMT’s legal duty to act — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
6. Describe the physical, presumptive, and definitive signs of death — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
7. Describe the relationship between patient communications, confidentiality, and the Health Insurance Portability and Accountability Act (HIPAA) — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
8. Describe the roles and responsibilities of the EMT in court — Knowledge/skills objective (printed page 86); confirm wording in your course copy.
9. Discuss consent by minors for treatment or transport — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
10. Discuss the EMT’s role and obligations if a patient refuses treatment or transport — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
11. Discuss the importance of do not resuscitate (DNR) orders and local protocols as they relate to the EMS environment — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
12. Discuss the issues of negligence, abandonment, assault and battery, and kidnapping and their implications for the EMT — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
13. Discuss the scope of practice and standards of care — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
14. Explain how to manage patients who are identified as organ donors — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
15. Explain the reporting requirements for special situations, including abuse, drug- or felony- related injuries, childbirth, and crime scenes — Knowledge/skills objective (printed page 85); confirm wording in your course copy.
16. Recognize the importance of medical identification devices in treating the patient — Knowledge/skills objective (printed page 85); confirm wording in your course copy.

Chapter outline

1. Consent: expressed, implied; capacity and decision-making; minors and surrogate decision-makers (overview; NM-specific rules from instructor)
2. Refusal of care: informed refusal elements; documentation expectations; high-risk presentations
3. Abandonment and continuity of care
4. Negligence framework (duty, breach, harm); scope of practice as legal boundary
5. Crime scenes: preservation, evidence awareness, law enforcement coordination at appropriate level for EMT-B
6. Confidentiality and HIPAA concepts for EMS (minimum necessary, sharing for treatment, secure PCR)
7. Ethical principles: autonomy, beneficence, nonmaleficence, justice; moral distress basics
8. Advance directives and DNR / POLST-style orders (terminology and “verify and honor when applicable” workflow per protocol)
9. Mandatory reporting categories (framework; NM lists from course materials)
10. Special situations: organ donation notification awareness; forensic awareness without contaminating evidence

Vocabulary (18)

Abandonment

Ending care without ensuring equivalent care or valid refusal process. Utilization: Avoid by transferring stable handoffs or staying until disposition is appropriate.

Advance directive

Written instructions about desired treatments when the patient cannot speak. Utilization: Honor when valid and applicable; coordinate with medical direction about scope limits.

Assault

Threat of unwanted touching or credible fear of harm; definitions vary by statute. Utilization: Documentation and law enforcement coordination per policy.

Battery

Unwanted touching of a competent patient without consent or valid exception. Utilization: Why consent processes matter even with good intentions.

Capacity

Ability to understand, appreciate, reason, and decide about care. Utilization: Core test for valid refusal.

Chain of custody

Documented control transfer for forensic items. Utilization: Preserve evidence integrity when crime scenes overlap EMS.

Consent

Permission for care from a patient with decision-making capacity. Utilization: Required for non-emergency touch and procedures when the patient can choose.

Duty to act

Legal or contractual obligation to respond and provide care within scope. Utilization: Varies by employment, licensure, and Good Samaritan statutes by jurisdiction.

Emancipated minor

Minor treated as adult for medical decisions per law. Utilization: Know jurisdictional rules affecting consent.

Expressed consent

Clear verbal or written agreement to treatment after adequate disclosure. Utilization: Typical model for alert adults who understand risks and benefits.

Good Samaritan laws

Statutes limiting liability for voluntary emergency aid in defined circumstances. Utilization: Read your state's conditions and scope limits.

HIPAA

Federal privacy rule limiting disclosure of protected health information. Utilization: Share PHI only for treatment, operations, and legally permitted disclosures with minimum necessary.

Implied consent

Assumed permission when the patient cannot respond and urgent care is needed. Utilization: Basis for treating unconscious patients when delay would cause harm.

Informed refusal

Competent patient declines care after risks and alternatives are explained. Utilization: Requires capacity assessment, clear explanation, signed documentation per policy, and offered alternatives.

Mandatory reporting

Legal duty to report suspected abuse/neglect or certain injuries to authorities. Utilization: Know state lists (child, elder, intimate partner violence, gunshot rules) and agency policy.

Negligence

Breach of duty that causes harm when a prudent provider would have acted differently. Utilization: Prevent by following scope, protocols, thorough assessment, and good documentation.

POLST

Portable orders about desired interventions in serious illness. Utilization: Coordinate with family and medical direction on applicability.

Slander / libel

Harmful false spoken or written statements. Utilization: Avoid defaming patients or agencies in public forums.

Sequence practice (2 puzzles on Quiz Me)

Quick fire sample (15 of 18 on Quiz Me)