Med: Ethics in Emergencies (Part 1: Good Samaritan Law Exploration)

March 12, 2008

And he’s BACK! After the latest round of exams, I’m making my triumphant return to the blog. When I get the results to the last one, I’ll probably post an overview of that entire shitshow–and all my thinking that went into it. I actually have a lot to say, but I’d rather have the finality of the grades before I write my “how it went down” post. But that’s ok, because I have a few interesting topics I’m going to explore–the first being the Good Samaritan Law.

Today–as part of our Essentials of Clinical Medicine course–we participated in our first “special topics” session. We selected two random topics related to medicine that interested us, and have 2 sessions each about them. My first is entitled “Ethics in Emergencies.”

I didn’t really know what to expect going in, but I’ve always liked ethical debates & dilemmas so I figured I would enjoy it–and I was right. The first topic we addressed was what is known commonly as the Good Samaritan Law: a person that comes across an emergency situation and acts in good faith to help the person–but actually causes more harm than good–cannot be sued/prosecuted unless it was deemed that they caused harm on purpose. Well as it turns out, the main purpose–or at least one of them–was to ensure that doctors got involved in such situations w/o fear of malpractice.

Truth be told, the ethical standards of the AMA seem to dictate that there should never be a question in this situation–doctors have an ethical obligation to help when needed. Speaking on the “Duty to Treat,” the AMA states:

“A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.” (Principle of Medical Ethics, VI).

For the purpose of this post, I’m going to ignore the implications of this “free to choose” provision–that taps into the whole mess of the uninsured and whether or not the doctor should treat someone with a non life-threatening problem. But the ethical standards make an exception for emergencies and obligate the doctor to act.

Nevertheless, a few cases come up in the litigious United States in which a doctor–doing the best he could in an emergent situation–was blamed for a negative outcome. So while the ethical standards said one thing, the “on the ground” mentality was a bit different, thus necessitating the good samaritan law.

As it currently stands in Illinois law, it is written:

“Any person licensed under the Medical Practice Act of 1987 or any person licensed to practice the treatment of human ailments in any other state or territory of the United States who, in good faith, provides emergency care without fee to a person, shall not, as a result of his or her acts or omissions, except willful or wanton misconduct on the part of the person, in providing the care, be liable for civil damages.” (745 ILCS 49/25)

There are a few key phrases in this provision that I’d like to explore a little bit.

a) “In Good Faith.” This one is a bit obvious, but suffice to say that the doctor is generally assumed to be acting with the intent of doing GOOD for the injured.

b) “Without a fee.” This addition seems a bit strange–and was something we explored in particular cases testing this law. Payment would seem to be obviously ignored on the street, but we also talked about cases in which a woman brought her nephew into the doctor–a boy without insurance and for whom she could not pay–and the fact that the doctor acted in good faith and did not seek payment for his services aided in the use of the GS provision to throw out a malpractice claim against the doctor (For what it’s worth, there didn’t seem to be a case anyways–the woman’s testimony didn’t make sense and contradicted the medical record). The phrase is still a bit irksome, however. While a jury wouldn’t go for it, a hospital could use a defense of “Well, we didn’t charge, and it was an emergency, so you can’t sue.” Sketchy.

c) “Acts or omissions.” It’s one thing to say that the doctor performed X and it caused a bad outcome–it’s another to parade a bunch of experts out and say, “He should have done Y–that’s what we do!” So the provision is clear that the doctor is protected for what [s]he DOES and DOES NOT do.

d) “except willful or wanton misconduct.” This is the consumer-protection aspect of the provision. The doctor must still follow certain standards of care in attempting to help in order to be protected. You could imagine it would be difficult for a doctor to use the GS defense if he treated a badly sprained ankle by performing a below-knee leg amputation.

We also had an interesting discussion about the question of, “What actually defines emergency care?” It’s one of those topics that seems easy to define at first, but is actually a bit complicated. The phrase “life-threatening” is absent from the provision and, while it seems implied in “emergency,” what does this mean for non-acute cases? More specifically, why does a doctor have an obligation to treat a man bleeding on the street, yet can turn away an uninsured, overweight patient with diabetes? Maybe the diabetes won’t kill the guy TODAY, but it is life-threatening, correct?

Part 2 of this topic will address a specific case from the seminar in a bit more detail.

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