The medical and legal aspect of emergency care is unique and quite complicated. Emergency Physician should be knowledgeable and competent enough to use their skills in a consistent manner with the highest possible ethical standards of the medical practice. Concern for the injured or dying person should be upmost in their thinking. They should act to preserve life and prevent death. Unfortunately, fear of potential legal liability deters some physicians from acting decisively. This article is trying to put the basics of physicians’ right and duties, together to avoid medico-legal problems and to satisfy legal obligation.
This write-up sets forth the General Legal Perspective regarding emergency care in three different situation,1) outside the health facility, 2) the emergency department situation and 3) emergency in practice situation. The rights and duties of a physician vary in different situation. Physicians must understand the Legal Status of patient in evaluating rights and duties in the emergency setting. Next Section deals with responsibility of emergency care physician.
GENERAL PRINCIPLE
Legal obligations generally commence at the beginning of the physician -patient and hospital- patient relationship. In general, physician do not have legal obligation to provide medical care to every person seeking or in need of such care.
The law has regarded the relationship between physician and patient as a voluntary relationship in which both parties freely agree to participate. Emergency Setting bears exceptions of this general principle.
In a situation, when an injured patient needs emergency medical care outside of a health care facility, although physician generally have an ethical obligation to provide medical care, but do not have a legal obligation to do so. In the Emergency Department Situation, courts have generally held that a health care facility that operates an emergency department has a legal obligation to provide care to those people who came to the facility with an identifiable emergency and are relying upon implied offer of emergency care. The third situation, emergency in practice, in which a patient who is already receiving medical care becomes in need of emergency medical care, physician-patient relationship existed before the emergency. Therefore legal obligations had already placed.
Once the relationship is established, physicians have a legal obligation to provide an acceptable quality of medical care. In general physician is expected to do what a reasonable physician would do in the same or similar circumstances. It is standard of ordinary and customary practice that is deeply rooted in the standards of medical community (Malpractice system approach).
Legal Status of Patient:
The informed competent and voluntary consent of patients before treatment is provided. Consent implies the mechanism by which patients vindicate their right to self determination and participate in health care decision. There are two standards of consent are in practice. First, the traditonal standard is borrowed from malpractice system. A physician is expected to disclose to a patient what a reasonable physician would disclose in the same and similar circumstances. In other words, it is determined by medical community. It includes, nature of medical condition, the treatment proposed, risks of the procedure, possible side effects, and alternative procedure (if any) and their risk and side effects. After evaluating this information, the patient is free to refuse and accept treatment.
In second least practiced modern standard shifts focus from the physician to the patient. It requires that a physician disclose what a reasonable patient would need to know to make an intelligent decision concerning treatment. This includes all the above mentioned with traditional consent in terms of “significant “.
In emergency medicine situation, to take consent is dificult. Often steps must be taken quickly to preserve life, to stabiles a dangerous condition, or to prevent possible deterioration.
Some basic principles are as follows:
1. The consent of adult of sound mind should be sought, and their refusal to accept treatment should generally be respected.
2.People who have been declared legally incompetent or who are, in fact, incompetent without formal legal recognition of the incompetence, the ability of the individual victim to have or to express a preference for treatment or no treatment is either suspect or clearly not present. If an adult is rendered incompetent and a life threatening emergency exists and neither the patient nor the person with legal authority to consent is in position to give consent, the emergency physician should imply the consent and provide the treatment. Law generally permits that is, to assume that if the patient were competent she or he would prefer treatment to non treatment.
3. In the case of minors, mentally ill people, or mentally retarded people, a parent or legal guardian is generally appointed by the court. If such a person is available, his or her consent should be obtained. In life threatening situation, and such a person is not available, the physician should imply the necessary consent and proceed the treatment.
TO NOTE, UNAVAILABILITY OF A CONSENTING PERSON SHOULD NOT BE AN EXCUSE FOR ALLOWING A TREATABLE PATIENT TO SUFFER AN AVOIDABLE DEATH.
Next Blog: Emergency Medicine: Basic Medico-legal Consideration (PART II) responsibility of emergency care physician
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