EMT-Basic Exam: The Basics of Legal and Ethical Issues

EMT-Basics must obey laws pertaining to patient care and behave in an ethical manner. When EMT-Basics demonstrate ethics, they treat their patients with respect and offer them the best possible care. Suppose an EMT-Basic responds to a call to help an elderly man who may be suffering a heart attack. He assesses the patient and helps him take his nitroglycerine. When the EMT’s cell phone rings, he steps away from the patient to speak to a friend. Is this EMT’s behavior legal? Is it ethical? No! The EMT-Basic could be charged with abandonment, and his behavior is definitely not ethical. Some questions on the EMT-Basic exam will assess your knowledge of legal and ethical issues.

1. Consent
As you may recall from your training, patients have the right to consent to or refuse medical treatment. An adult who is mentally competent and of legal age must give expressed consent before receiving treatment. A patient may give expressed consent verbally or may simply nod his or her head. In some situations, expressed consent involves a written document that is signed by the patient. Prior to receiving the treatment, the patient should obtain details about the procedure and the risks involved. Once the patient has all the necessary information, he or she can give the EMT-Basic informed consent. If a patient is unconscious and no family members are available to consult, the EMT-Basic may initiate medical treatment if it’s in the patient’s best interest. This is called implied consent.
A parent or guardian must give consent for a child or a mentally incompetent adult to receive treatment. However, if a life-threatening situation exists and the parent or guardian isn’t available, you may assume implied consent. You don’t need to consult a parent or guardian for a child who is emancipated. An emancipated child may not be of legal age, but may be pregnant, a parent, or married. An emancipated child may also be a member of the armed services, or he or she may be a financially independent individual who no longer lives with his or her parents.

Tip: Patients under the influence of drugs or alcohol can’t give expressed consent because they are unable to make rational decisions. If a scenario is given on the EMT-Basic exam in which the patient is intoxicated and the question asks what type of consent you need to administer medical treatment, don’t choose expressed consent. Implied consent is a better choice.

2. Confidentiality
The Health Insurance Portability and Accountability Act, or HIPAA, has made rules regarding patient confidentiality more strict. While laws regarding patient confidentiality vary from state to state, most states consider the following information confidential:
- Patient interviews
- Patient assessments
- Treatments that a patient has undergone
You can’t release this information to a patient’s friends or family without the patient’s permission. In most states, you may release patient information to other health care professionals and insurance companies. When a crime is involved, such as a rape or a shooting, you must report it to legal authorities. You can also be subpoenaed for information. If this is the case, you’re legally bound to release the information.

3. Refusal of Care
Suppose you’re administering care to an unconscious patient who awakens and refuses to let you continue the medical treatment. What should you do? You must respect the patient’s wishes and stop treatment. You should also have the patient sign a “release from liability” form, which states that the patient has been advised to undergo medical treatment but has refused to do so. This form protects EMT-Basics and other health care professionals from being sued if the patient suffers additional illness or injury resulting from the refusal of care. If the patient refuses to sign the form, have a family member or a police officer sign the form and indicate that they have witnessed the patient refusing treatment. If you continue to treat a patient who has refused care, you may be charged with assault and battery. If you assault a patient, you threaten him or her or try to touch the patient in an offensive way. If you do touch the patient in an offensive way, you’re guilty of battery. The EMT-Basic exam often includes questions about what an EMT-Basic should do when a patient refuses care.
Patients may only refuse care if they’re mentally competent and of legal age. If a patient is intoxicated or in shock, the patient’s judgment may be impaired. When this is the case, ask a family member to allow you to continue treatment.
The following might help you convince a patient to undergo treatment if the patient refuses to do so:
- Inform the patient of the potential consequences of refusing medical treatment.
- Ask the patient’s family or friends to help you convince the patient of the benefits of treatment. However, be careful not to betray the patient’s confidentiality.
- Ask the patient to go to the hospital to receive further care.
- Consult with your medical direction physician and have him or her speak to the patient.
- Remain on the scene in case the patient changes his or her mind.

4. Advanced Directives
Because EMT-Basics treat patients who may be in life-threatening situations, they should be familiar with advanced directives. You may be asked questions about these directives on the EMT-Basic exam. Advanced directives are documents patients use to convey their wishes when they are unable to do so.
a. Do Not Resuscitate (DNR) Orders
A physician usually writes Do Not Resuscitate (DNR) orders at the patient’s request. These orders state that few, if any, measures should be taken if the patient suffers cardiac arrest. Terminally ill patients often have DNR orders. When examining a DNR order, check to ensure that it has been signed by a physician and that it’s in effect and not past an expiration date. You must see the order—it’s not enough for the patient or a family member to tell you that one exists. Whenever you’re in doubt, begin resuscitating the patient and consult your medical direction physician.
b. Living Wills
A living will states what medical treatments a patient wants, or doesn’t want, if he or she becomes incapacitated. A living will might state that a patient wants only basic life support or it may state that the patient wants all efforts to be made to save his or her life. Living wills only apply in the administration of life-sustaining treatment, meaning situations of life or death. If a patient suffers a moderate or severe injury that is not life-threatening, always administer treatment.

5. Organ Donation
EMT-Basics must be familiar with laws regarding organ donation. Patients who are organ donors must have a legal, signed document stating this. This document may be a sticker on the patient’s driver’s license or an organ donor card. Be aware that saving a patient’s life must always be your first priority regardless of whether the patient wishes to donate his or her organs.

6. Negligence
EMT-Basics have a duty to act. This means that they are legally bound to provide emergency medical care when the need arises. If an EMT-Basic does not do this, he or she may be charged with negligence. The following must be proven before an EMT-Basic is considered negligent:

1. The EMT-Basic had a duty to act. This means it was the EMT-Basic’s responsibility to provide a patient with medical treatment. (Whether an EMT-Basic has a duty to act when off duty depends on the laws in his or her state.)

2. The EMT-Basic failed to act. This might also mean that the EMT-Basic failed to provide satisfactory medical treatment.

3. Damage occurred because the EMT-Basic did not act. This means that the patient suffered physical or emotional injury because the EMT-Basic didn’t act.

4. The injury the patient suffered was caused by the EMT-Basic’s inaction. This is called proximate cause.

7. Abandonment
If an EMT-Basic starts to provide patient care but then stops without the patient’s consent, the EMT-Basic may be guilty of abandonment. The only time EMT-Basics are allowed to stop giving a patient care is if another EMT-Basic or a person with equal or higher medical training takes over the patient’s care. EMT-Basics may stop patient care once a patient arrives at a hospital, if the patient no longer needs or wants treatment, or if the EMT-Basic’s safety is threatened.

Related Topics You Should Review:
- Crime scenes
- Identification insignia (a bracelet, necklace, or card indicating that a person has a pre-existing condition)