Chapter 3
1
EMT NOTES CHAPTER 3:
MEDICAL, LEGAL AND ETHICAL
ISSUES |UPDATED 2024
Chapter 3 – Medical, Legal and Ethical Issues
Knowledge Objectives
1. Define consent and how it relates to decision making. (p 85)
➢ A person receiving care must give permission, or consent, for treatment.
*Consent is permission to render care.
➢ An adult who is conscious, rational, and capable of making informed decisions has a legal right
to refuse care.
➢ A patient may also consent to some aspects of care and deny consent for others.
➢ If the patient refuses care, you may not care for the patient.
o Doing so may be grounds for both criminal and civil action.
➢ Consent can be expressed (actual) or implied.
➢ Decision-making capacity is the ability of a patient to understand the information you are
providing, coupled with the ability to process that information and make an informed choice
regarding medical care.
➢ The right of a patient to make decisions concerning his or her health is known as patient
autonomy.
➢ Decision-making capacity and competence are often used interchangeably, but there is a
distinction:
o Competence is generally regarded as a legal term.
▪ Determinations regarding competence are typically made by a court of law.
o Decision-making capacity is the term more commonly used in health care to
determine whether or not a patient is capable of making health care decisions.
Determining Decision-Making Capacity
➢ The following factors should be considered when determining a patient’s decision-making
capacity:
o Is the patient’s intellectual capacity impaired by mental limitation or any type of dementia?
o Is the patient of legal age (18 years of age in most states)?
o Is the patient impaired by alcohol or drug intoxication or serious injury or illness?
o Does the patient appear to be experiencing significant pain?
o Does the patient have a significant injury that could distract him from a more serious injury?
o Are there any apparent hearing or visual problems?
o Is a language barrier present? Do you and your patient speak the same language?
o Does the patient appear to understand what you are saying?
o Does he or she ask rational questions that demonstrate an understanding of the information
you are trying to share?
2. Compare expressed consent, implied consent, and involuntary consent. (pp 86–87)
, Chapter 3
2
Expressed consent
➢ Expressed consent (or actual consent) is the type of consent given when the patient verbally or
otherwise acknowledges that he or she wants you to provide care or transport.
➢ Expressed consent may be nonverbal.
, Chapter 3
2
➢ To be valid, the consent the patient provides must be informed consent, which means that you
explained the nature of the treatment being offered, along with the potential risks, benefits,
and alternatives to treatment, as well as potential consequences of refusing treatment, and
the patient has given consent.
➢ Paramedics will often provide additional information if advanced life support interventions are
necessary.
o There is a greater potential for side effects and other adverse responses associated with drug
administration and other forms of advanced care.
➢ Informed consent is valid if given orally, but it may be difficult to prove at a later point in time.
➢ Remember, a patient may agree to certain types of emergency medical care but not to others.
Implied consent
➢ When a person is unconscious or otherwise incapable of making a rational, informed decision
about care, and unable to give consent, the law assumes that the patient would consent to care
and transport to a medical facility if he or she were able to do so.
o Patients who are intoxicated by drugs or alcohol, mentally impaired, or suffering from
certain conditions such as head injury might be included in this category.
➢ Implied consent applies only when a serious medical condition exists and should never be used
unless there is a threat to life or limb.
*Implied consent – Type of consent in which a pt who is unable to give consent is given
treatment under the legal assumption that he or she would want treatment.
➢ The principle of implied consent is known as the emergency doctrine.
*Emergency doctrine – The principle of law that permits a health care provide to treat a pt in an
emergency situation when the pt is incapable of granting consent because of an altered level of
consciousness, disability, the effects of drugs or alcohol, or the pt’s age.
➢ Sometimes what represents a “serious threat” may be unclear and may result in legal
proceedings and a medicolegal judgment, which should be supported by your best efforts to
obtain consent and a thoroughly documented run report.
*Medicolegal – Relating to medical jurisprudence (law) or forensic medicine.
➢ In most instances, the law allows a spouse, a close relative, or next of kin to give consent for an
injured person who is unable to do so.
➢ Treatment should never be delayed when the patient has imminently life-threatening injuries.
➢ If a patient being treated based on implied consent were to regain consciousness and appear
capable of making an informed decision, the doctrine of implied consent would no longer apply.
Involuntary consent
➢ An adult patient who is mentally incompetent is not able to give informed consent.
➢ Consent for emergency care should be obtained from someone who is legally responsible for the
patient, such as a guardian or conservator.
➢ Many states have protective custody statutes allowing such a person to be taken, under law
enforcement authority, to a medical facility.
➢ Under certain conditions, law enforcement and prison officials are legally permitted to give
consent for any individual who is incarcerated or has been placed under arrest.
1
EMT NOTES CHAPTER 3:
MEDICAL, LEGAL AND ETHICAL
ISSUES |UPDATED 2024
Chapter 3 – Medical, Legal and Ethical Issues
Knowledge Objectives
1. Define consent and how it relates to decision making. (p 85)
➢ A person receiving care must give permission, or consent, for treatment.
*Consent is permission to render care.
➢ An adult who is conscious, rational, and capable of making informed decisions has a legal right
to refuse care.
➢ A patient may also consent to some aspects of care and deny consent for others.
➢ If the patient refuses care, you may not care for the patient.
o Doing so may be grounds for both criminal and civil action.
➢ Consent can be expressed (actual) or implied.
➢ Decision-making capacity is the ability of a patient to understand the information you are
providing, coupled with the ability to process that information and make an informed choice
regarding medical care.
➢ The right of a patient to make decisions concerning his or her health is known as patient
autonomy.
➢ Decision-making capacity and competence are often used interchangeably, but there is a
distinction:
o Competence is generally regarded as a legal term.
▪ Determinations regarding competence are typically made by a court of law.
o Decision-making capacity is the term more commonly used in health care to
determine whether or not a patient is capable of making health care decisions.
Determining Decision-Making Capacity
➢ The following factors should be considered when determining a patient’s decision-making
capacity:
o Is the patient’s intellectual capacity impaired by mental limitation or any type of dementia?
o Is the patient of legal age (18 years of age in most states)?
o Is the patient impaired by alcohol or drug intoxication or serious injury or illness?
o Does the patient appear to be experiencing significant pain?
o Does the patient have a significant injury that could distract him from a more serious injury?
o Are there any apparent hearing or visual problems?
o Is a language barrier present? Do you and your patient speak the same language?
o Does the patient appear to understand what you are saying?
o Does he or she ask rational questions that demonstrate an understanding of the information
you are trying to share?
2. Compare expressed consent, implied consent, and involuntary consent. (pp 86–87)
, Chapter 3
2
Expressed consent
➢ Expressed consent (or actual consent) is the type of consent given when the patient verbally or
otherwise acknowledges that he or she wants you to provide care or transport.
➢ Expressed consent may be nonverbal.
, Chapter 3
2
➢ To be valid, the consent the patient provides must be informed consent, which means that you
explained the nature of the treatment being offered, along with the potential risks, benefits,
and alternatives to treatment, as well as potential consequences of refusing treatment, and
the patient has given consent.
➢ Paramedics will often provide additional information if advanced life support interventions are
necessary.
o There is a greater potential for side effects and other adverse responses associated with drug
administration and other forms of advanced care.
➢ Informed consent is valid if given orally, but it may be difficult to prove at a later point in time.
➢ Remember, a patient may agree to certain types of emergency medical care but not to others.
Implied consent
➢ When a person is unconscious or otherwise incapable of making a rational, informed decision
about care, and unable to give consent, the law assumes that the patient would consent to care
and transport to a medical facility if he or she were able to do so.
o Patients who are intoxicated by drugs or alcohol, mentally impaired, or suffering from
certain conditions such as head injury might be included in this category.
➢ Implied consent applies only when a serious medical condition exists and should never be used
unless there is a threat to life or limb.
*Implied consent – Type of consent in which a pt who is unable to give consent is given
treatment under the legal assumption that he or she would want treatment.
➢ The principle of implied consent is known as the emergency doctrine.
*Emergency doctrine – The principle of law that permits a health care provide to treat a pt in an
emergency situation when the pt is incapable of granting consent because of an altered level of
consciousness, disability, the effects of drugs or alcohol, or the pt’s age.
➢ Sometimes what represents a “serious threat” may be unclear and may result in legal
proceedings and a medicolegal judgment, which should be supported by your best efforts to
obtain consent and a thoroughly documented run report.
*Medicolegal – Relating to medical jurisprudence (law) or forensic medicine.
➢ In most instances, the law allows a spouse, a close relative, or next of kin to give consent for an
injured person who is unable to do so.
➢ Treatment should never be delayed when the patient has imminently life-threatening injuries.
➢ If a patient being treated based on implied consent were to regain consciousness and appear
capable of making an informed decision, the doctrine of implied consent would no longer apply.
Involuntary consent
➢ An adult patient who is mentally incompetent is not able to give informed consent.
➢ Consent for emergency care should be obtained from someone who is legally responsible for the
patient, such as a guardian or conservator.
➢ Many states have protective custody statutes allowing such a person to be taken, under law
enforcement authority, to a medical facility.
➢ Under certain conditions, law enforcement and prison officials are legally permitted to give
consent for any individual who is incarcerated or has been placed under arrest.
