Reply #47: Ok the ever so popular lesson on consent and implied consent [View All]

and medical ethics.

If I show up at a scene and a patient tells me not only no, but HELL NO... I still have the OBLIGATION to make sure they are capable of making that decision.

To do this I will ask three questions to establish her or his level of consciousness. after all it is well know that patients with a head injury may tell me HELL NO, and not be oriented times 3.

If the patient can answer all THREE questions... and trust me they are very simple. I will try to explain why a medical checkup is important, and if they still refuse, I will hand them a form, called an Against Medical Advise Form. That is essentially CYA for my ass, just in case they are hurt and don't know it yet, and die later.

For the record I have later on gone back to same patients who refused medical aid after they collapsed and transported to the hospital. Yep they were code traumas.

Mow if the patient CANNOT answer those three questions, then I am obligated to assume IMPLIED consent, that is a reasonable person in full function of their mental capacities would agree to medical care. I have to be VERY SURE of this, otherwise it could be construed as kidnapping. I have transported patients who said not only hell no, a few times under implied consent rules. I will give you two examples.

1.- Older woman, who had a broken hip, and her liver was fractured. she was bleeding inside. Believe you me, we were surprised about the hip fracture since she was standing when we met her. For the record all she could tell us was her name. We transported in backboard and full spinal precautions of course and once we started our advanced care realized she was bleeding somewhere (see liver and hip), so we started some IVs and gave her oxygen. Her orientation improved and she finally started feeling the pain.

2.- A younger man, who said no, after a major fight. Had a gash on his head, a bleeder. He again could not answer one of my questions, and of course had a pupil larger than the other. We transported. MRI revealed a nasty subdural hematoma. He survived, due to us being stubborn and not taking no for an answer.

So if you can answer all those orientation questions correctly, yes, sign my AMA and good luck. Have a good day, and hopefully you will be fine enough that I don't have to see you ever again, or at least in the next 24 hours.

Oh and before you say it, if you are a minor see Implied Consent if there are no legal guardians present every day of the week and twice on Sunday.