Ethical and Legal Aspects of Informed Consent

Junior (College 3rd year) ・Healthcare&Medicine ・APA ・16 Sources

Paramedics are bound by the code of ethics that the healthcare system in general is guided by. Therefore, in their work, they have to respect the rights of the patients while trying to protect their lives. One of the principles that guide the working of the paramedics is the principle of the informed consent. The informed consent is covered by the laws of the various states in the states’ Patients’ Bill of Rights. (2) The Patients’ Bills of Rights of the various states are designed to govern some types of the communication between the professionals of the healthcare systems and their patients. The laws give the directions concerning the types of knowledge the patient should have to make the decisions that are informed. The laws of informed consent affect the patients’ agreement to the medical procedures such as the medical care, the treatment, and the medical tests. The reason for picking the ethical and legal issue of informed consent is the fact that people tend to think that the paramedics work in the unique medical situations. Therefore, the paramedics may not be bound by the same rules and regulations as those that unite the professionals like nurses and doctors in the healthcare facilities. (9) Also, in many cases, the paramedics work in the emergency situations that require them to waive the informed consent and treat the patients without actually asking the patients to agree. In the case like the one of Betty, in which the person is not in an emergency, and other requirements of the informed consent are applied, the patients should be allowed to choose whether they should be treated or not.

The Law of Consent

The informed consent laws involve four of the most important aspects that must be present for any informed consent to be valid in a court of justice. One central issue of the informed consent is that the patient must have the capacity to make the approval. The common legal term for the decision-making ability is competency. (13) It should be understood that the issue of competency is more complicated than simply a yes or no answer. A person may be competent enough to make some decisions but lack the capacity to make others. Several factors determine the decision-making capability of the people. One factor is the ability to comprehend the options that are given by the medical professional. The patient should also be able to comprehend the results of all the decisions they make. (3) Thirdly, the patient should have the capability to weigh the options and know how they affect their priorities as well as the personal values. In cases, where the patient is unable to meet any of the standards required to have the necessary capacity, their decisions can be made on their behalf by the court-appointed guardians or family members. (4) Being competent does not mean that a person always makes the decisions that the healthcare professional agrees with. As long as one can understand their options and their implications, and also give rational reasons for their choices, then they are competent.

Second, there must be the disclosure from the care provider before the informed consent to be legally binding. The information given should be enough to enable the patients to make the decisions that are based on the facts and their will. (4) The practitioner does not have to give the details of the test procedure. However, they have to tell what may be substantial for any reasonable person to decide what they want. The practitioner should tell the patient about the risks and the benefits that should be expected. Also, the probabilities of the risks and the failures should be communicated in advance to enable the reasonable decision-making. The terms that are supposed to be used should be those that a layperson can understand. Third, the patient should also comprehend the information given to them. Having the capacity to understand does not always guarantee that the person will understand. Therefore, the practitioner has the role of ensuring that their patient understands the information that they give them. The ability to understand is called a competency. In law, competency is the capability of a person to make the decisions and be held responsible for their choices. (1) In medicine, the term is loosely used to mean that the individual can make decisions. However, technically, only the courts can declare people incompetent to decide. In the healthcare settings, aspects that can tell whether or not a person is competent enough to consent to treatment are the mental health and their other health conditions in general. In case an aspect of their health or age prevents them from thinking clearly, then they do not have competency.

The fourth aspect of the informed consent is the voluntary choosing to be treated or the refusal to be treated, unless the procedures are legally authorized to be involuntary. The competent patients, who the healthcare providers agree with that they have the ability to make their decisions, can make their decisions regarding the treatments. (16) Regardless of whether according to the doctor the decision is right or wrong, the patient's decisions should be respected. (14) Decisions of the competent patients are final, even if they lead to their deaths, unless the law has waived the informed consent.

Refusal of treatment is covered under CFR – Code of Federal Regulations Title 21of the Food and Drug Administration regulations. (5). In cases, where the patient has refused to accept the medication, they may be asked to sign a document that is called Against Medical Advice to relieve the practitioner of any liability in case harm befalls the person because of the decision. In case someone refuses care, the next best treatments should be offered to them. In some case, the person may refuse to be treated because of the stress, illness, injury, or some other reason. In such cases, the provider may decide that the patient lacks the ability to make the decisions and, therefore, is unable to refuse treatment. (8) The law also presumes that people would agree for treatment in most emergency situations to prevent death or disability. In other cases, there are the advanced directives as well as living wills that people compete before emergency situations that may direct on what should be done to them in the event of medical emergencies. Such legally binding documents should govern practitioners in cases of emergency. (11)

Assessment of Betty’s Case

Based on the evidence presented, Betty has been ill for five days, and she suffers from an infection that may potentially be lethal if not treated soon enough. Betty’s caregiver is her son, who reckons that he can no longer take care of her, and, therefore, she should go to the hospital. An examination on Betty proves that her condition, even though not very dangerous at the time, may develop if left untreated and she may die from the infection if it spreads. Betty is 78 years old, and therefore, she is elderly.

However, the paramedic has not reported any signs of dementia that may hinder her reasoning. Nevertheless, her son insists that she cannot think well because of her old age. Therefore, the important factors that should be considered in the case are whether or not the illness of the patient affects their ability to make the informed decisions. Also, another factor is whether the age of the patient affects their ability to make the decisions or not. It is also relevant to inquire if the son has the power to make the decisions for the elderly lady. Based on the facts presented, the lady is in a position to make the informed consent. Despite her old age, the absence of the mental conditions that come with mental age disqualifies the idea that she cannot think well because of age. (14)

Therefore, regardless of the wishes of the son, it will be wrong to declare the lady incompetent just because she is old. Also, the infection of Betty has the potential of becoming severe. Nevertheless, currently, it is not an emergency. One can only disregard the right to reject treatment in situations of crisis, because it is thought that a reasonable person would want to survive. In the case of Betty, the sickness is not a situation of urgency. Also, from the case, the patient was given the benefits of accepting to see a doctor as well as the risks of not seeing a doctor. Because as a paramedic, one cannot provide details concerning conditions that one has not tested, the only valuable information in the case was that the infection would spread with time and cause death or other adverse effects. (12) Betty also admits that she may have problems remaining at home without her son, but wants to take the risk after all. Therefore, it is clear that she understood the consequences of her choice.

Actions to Ensure That One Is in a Legally Defensive Position

Despite the fact that all the elements of informed consent were present, and the patient chose not to accept treatment, there are several things that should be done to ensure that the paramedic is not held liable for any consequences that may not be appealing to the son or the mother. (15) Considering the choice to reject being taken to the hospital, Betty may die, and the son may sue. On the other hand, Betty may sue if she is taken to the hospital to see a doctor against her will and medical malpractice. To prevent such occurrences in the case as a paramedic, it would be ensured that the disclosure was repeated so as to confirm that the patient indeed understands the consequences of her choice.

One would also ensure that it was confirmed whether or not there are symptoms of mental illness that one might have failed to notice at first. In case she is mentally well and the son is not the legal guardian, she would be asked to sign the Against Medical Advice (AMA). (6). The form would be used as evidence in a court of law to support the claim that she was indeed advised to go to the hospital for further tests and treatment, but she voluntarily rejected. It would also be offered the other alternatives to going to going to the hospital. The options would include advising for the family to hire a nurse to take care of the patient from home. (7) One would also advise that the family hires a private doctor to check Betty from home and treat her without the need to go to the hospital to ensure that the infection does not advance. (10) If the patient rejects the alternatives too, at least, as a paramedic, it will be done one’s best to save their life while at the same time respecting their right to make an informed consent or reject treatment.


Paramedics as members of the healthcare fraternity are bound by laws and ethics that guide the provision of health services. Therefore, they should also give patients the chance to make informed consent in cases, where the patients are competent, and the situations are not emergencies. Laws guiding informed consent should be followed to ensure that not only is the patient treated with dignity as a human being, but also the paramedic is not held liable by a court of law. In the case presented, Betty is a competent person despite her age. She is also given disclosure of the benefits of seeking treatment from a qualified doctor in the hospital as well as the risks of not seeing a doctor. She understands the consequences of the choices that she faces and she makes her decision to remain at home against the advice of the paramedic. Therefore, the only option that the paramedic remains with is to respect her decisions and ensure that one is not held accountable for the “bad” decisions of the patient.


1. Alderson P. Competent children? Minors’ consent to health care treatment and research. Social Science and Medicine, 2007, 65(11), 2272–2283.

2. Bernat JL. Informed consent. Muscle & Nerve, 2001 24, 614–621.

3. Department of Health. A reference guide to consent for examination or treatment. Department of Health UK, 2009, 11.

4. English A, Bass L, Boyle AD, Eshragh F. State Minor Consent Laws : A Summary. Center for Adolescent Health and the Law. 2010,

5. FDA. CFR - Code of Federal Regulations Title 21. 2016. Available from: [Accessed May 17, 2017]

6. Jeremiah J, O’Sullivan P, Stein MD. Who leaves against medical advice? Journal of General Internal Medicine, 1995, 10(7), 403–405.

7. McKneally, M. F., & Singer, P. A. (2001). Bioethics for clinicians: 25. Teaching bioethics in the clinical setting. CMAJ.

8. O’Neill O. Some limits of informed consent. Journal of Medical Ethics, 2003, 29(1), 4–7.

9. Pajonk F-G, Andresen B, Schneider-Axmann T, Teichmann A, Gartner U. Lubda J, et al. Personality traits of emergency physicians and paramedics. Emergency Medicine Journal, 2011, 28(2), 141–146.

10. Pauls M, Hutchinson RC. Bioethics for clinicians: 28. Protestant bioethics. CMAJ, 2002.

11. Quaile A. Expanding the role of paramedics. International Paramedic Practice, 2014, 4(1), 2–2.

12. Regehr C, Goldberg G, Hughes J. Exposure to human tragedy, empathy, and trauma in ambulance paramedics. American Journal of Orthopsychiatry, 2002, 72(4), 505–513.

13. Saunders J. Autonomy, consent and the law. Clinical Medicine, 2011, (Vol. 11).

14. Townsend R, Luck M. Protective jurisdiction , patient autonomy and paramedics : the challenges of applying the NSW Mental Health Act. Journal of Emergency Primary Health Care, 2009, 7(4), 1–11.

15. Tunnage B, Swain A, Waters D. Regulating our emergency care paramedics. New Zealand Medical Journal, 2015, 128(1421), 55–58.

16. Van Staden CW. Incapacity to give informed consent owing to mental disorder. Journal of Medical Ethics, 2003, 29(1), 41–43.

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