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Legal and Ethical Aspects
of Providing basic life support
Principle Key points
Good Samaritan
Principle and laws
Based on the biblical story. Prevents a rescuer who has voluntarily
helped a stranger in need from being sued for ‘wrongdoing’.
In most of North America you have no legal obligation to help
a person in need. Since governments want to encourage people
to help others, they pass Good Samaritan laws (or apply the
principle to common laws).
You are generally protected from liability as long as:
You are reasonably careful.
You act in good faith (not for reward)
You do not provide care beyond your skill level.
If you decide to help an ill or injured
person, you must not leave them until someone with equal or
more emergency training takes over- unless of course, it becomes
dangerous for you to stay.
Consent
Consent means permission. A responsive adult must agree to
receive first aid care.
“Expressed Consent'' means the victim gives his or her
permission to receive care. To get consent, first identify
yourself. Then tell the victim your level of training and
ask if it's OK to help.
“Implied Consent'' means that permission to perform
first aid care On an unresponsive victim is assumed. This
is based on the idea that a reasonable person would give their
permission to receive lifesaving first aid if they ware able.
Children
Consent must be gained from a parent or legal guardian. When
life- threatening situations exist and the parent or legal
guardian is not available, first aid care should be given
based on implied consent.
Elderly
If suffering from a disturbance in normal mental functioning,
like Alzheimer’s disease, may not understand you request
for consent. Consent must be gained from a family member of
legal guardian.
Duty to act
Duty to act means a legal obligation to do something
Those with a duty to act are typically state-licensed health
care providers who are required to provide emergency medical
care, including CPR as part of their job. However, an off-duty
response would generally be considered a “good Samaritan
Act” (voluntary).
If you are not a designated responder at work or a state licensed
health care provider, generally you do not have a duty to
act.
There are
exceptions. Three U.S. states, Vermont, Louisiana, and Minnesota
and one Canadian Province-Quebec, have failure-to-act laws
that require all citizens to assist a victim in need, as long
as you don’t endanger your own life.
Starting and Stopping BLS
Start CPR for all victims of cardiac
arrest unless:
Signs of irreversible death are present,
including:
Rigor mortis (limbs of the corpse
are stiff and impossible to move).
Lividity (settling of blood in the
lower portions of the body, causing a purplish red discoloration).
Conditions incompatible with life
(decomposition, decapitation, massive head injury, etc.).
Providing CPR would put the rescuer in danger of injury.
There are many victims (for example, of a catastrophic natural
disaster or terrorist attack). A victim who is not breathing
after two attempts to open the airway is considered dead.
This is because the time required to provide rescue breathing
and external chest compressions is not justified when there
are many victims needing first aid.
Do not
stop CPR until:
A person with equal or more training takes over.
EMS arrives or the victim shows signs of life.
You are exhausted or the scene becomes too dangerous to continue.
Note: Except
when death is obvious, irreversible brain damage or brain
death cannot be reliably assessed or predicted. Rescuers should
never make an impulsive decision about the present or future
quality of life of a cardiac arrest victim because such decisions
are often incorrect.
Advanced directives and Living wills
These are documents authorized by
state law and are usually witnessed or notarized. Also called
“a durable power of attorney”
They allow a person to appoint someone
as his or her representative to make decisions on resuscitation
and continued life-support if the person has lost their decision-making
capacity (for example, if they are in a coma).
Essentially, advanced directives
are statements about what you want done or not done if you
can’t speak for yourself. Everyone should have an advance
directive. An injury or serious illness can happen suddenly,
and if you already Have
a signed advanced directive, your wishes are more likely to
be followed.
Laws about advanced directives are different in each state.
You should be aware of the laws in your state.
Do not Resuscitate (DNR) or do not attempt
resuscitation orders
The DNR/DNAR order is a kind of advance
directive. This is a specific request not to have CPR If your
heart stops or if you stop breathing.
In the United States, a doctor’s
order is required to withhold CPR. Therefore, unless you have
a DNR order, EMS providers and hospital staff will attempt
to resuscitate you under the theory or implied consent.
People who are not likely to benefit
from CPR and may want a DNR order include victims with terminal
conditions from which they are unlikely to recover.
As with the living will, it’s
best to consider your wishes for resuscitation early, before
you are very sick and unable to make your own decisions.
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