Professionalism, Ethics, and Legal Issues in Emergency Care
Concepts to master
Know informed consent and its emergency exception, refusal of care and capacity assessment, confidentiality (including exceptions such as mandated reporting and imminent danger), duty to act, scope of practice, negligence elements, and documentation standards. Understand advance directives, do-not-resuscitate orders, and surrogate decision-making. Know mandatory reporting categories and the difference between civil and criminal liability.
Ethical frameworks
Understand beneficence, nonmaleficence, autonomy, and justice as they apply to emergency decisions. Autonomy governs a capacitated patient's refusal even when the clinician disagrees. In emergencies, the doctrine of implied consent allows treatment of an incapacitated patient when delay would risk harm.
Traps to watch
- Equating a patient's disagreement with incapacity; capacity requires understanding, appreciation, reasoning, and communication of choice.
- Documenting opinions rather than objective findings.
- Breaching confidentiality without a recognized exception.
- Assuming a DNR order prohibits all care rather than specific resuscitative measures.
Rule of thumb
When a capacitated adult refuses care, document capacity assessment, the risks explained, and the refusal; do not override autonomy. When capacity is absent and harm is imminent, treat under implied consent.
Worked example: An alert, oriented adult with a laceration refuses sutures after understanding the risks. The correct action is to respect the refusal and document the discussion, not to treat against the patient's wishes.