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Also see Medic 51, who apparently started this whole topic with the well written Kidnapping Patients.
Happy Medic comments on Happy Medic’s Rules for Kidnapping, in which I commented on Kidnapping – The Cowtipping of EMS –
All excelent points Rogue. I think you expanded on my post however. My post refers to the patient who agrees to be seen, yet refuses to be seen at an appropriate facility for their chief complaint. Many would argue that it is a cut and dry kidnapping since I took them somewhere besides their intended destination. If so a number of cab drivers are in for a shock!
If a cab driver tells a person that the cab driver knows where they need to go and the cab driver is taking them there regardless of the person’s ability to make decisions for himself, then it is wrong and probably illegal.
Whether EMS is engaging in kidnapping or some other form of abduction by using our authority to coerce people is for a court to decide.
Agreeing to be treated is not the same as agreeing to be treated by whomever we want to treat the patient, or being treated wherever we decide to transport the patient.
The patient does have the right to give informed consent/refusal to each individual treatment and to transport. Consent to one part of treatment does not require consent to all of treatment and transport.
Consent is à la carte.
I may agree to let you check my rhythm on a monitor, because of an irregular pulse. That does not give you consent to give me amiodarone for couplet PVCs. It may be in your protocol to automatically treat couplet PVCs, but you still need my consent as long as I have the capacity to make informed decisions for myself.
My desire to avoid this treatment and your desire to follow protocol may be at odds, but that does not give you any authority to treat me against my will.
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I expanded on my “already transporting” post in a comment where I expanded and mentioned the comments you refer to in large red letters. And I agree with 1/2 of what you have Happy saying. In the event I assess a condition that warrants further evaluation I am the expert in that situation, not the patient. If someone needs to be seen and refuses I make my best effort to convince them. We can all agree that is step 1. Then it’s onto the “seizure, coma death” talk to try to scare them, but that could in some circles be seen as intimidation. Then we do the medical control route and turf the decision to an MD who has no more authority to force a patient to the hospital without court order than I do.
We are the experts. OK. Then we should be able to convince the person, as experts. We should not behave as thugs.
Can we convince the person without resorting to the What if . . . ? stories?
Let me rephrase that – Can we convince the patient with an informed discussion of the real possibilities, without resorting to scare tactics that in EMS are often based on an arrogant misunderstanding of medicine?
If we cannot, is that a sign of a mental defect on the part of the patient, a sign of a mental defect on our part, or a sign of something else – perhaps just a sign of a reasonable disagreement?
What is needs to be seen?
What need?
What evidence do we have that this person does not have a better understanding of what is the best treatment than we have?
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So, where does that leave us?
That should leave us at the destination the person requested, unless we have honestly changed the person’s mind.
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A person presents with a medical or traumatic condition, they are a patient. I must assess, treat and reassess, transporting when indicated. If the person refuses we do our best to convince them of the best care plan.
As long as the person has the capacity to make informed decisions, that person can refuse any part of, or all of what we are offering.
Offering? That makes it seem as if we are providing a service to people, rather than the people being there to meet our needs.
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You mention, “If this is right, why can’t you convince a person, who has the capacity to make informed decisions, that this is a good idea?” Because they are making a financial decision, not a medical one most times (situational dependant obviously).
Maybe some people are making financial decisions. Do our rights have an exemption for people who are considering the financial consequences of their decisions?
Why is a financial decision the wrong decision?
If the pperson is having cardiac chest pain, and is very worried about finances, is it good patient care to increase their stress level by forcing something unwanted on them?
Are we causing more harm than any potential benefit?
If not, on what do we base that claim?
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If a patient refuses care but can’t stand, walk, reach a phone and has a condition that warrants further treatment, we are shifting from perceived to actual liability. Gathering a signature and saying goodbye is not in their best interests if we’ve gotten this far.
None of those are mental disqualifications from making an informed decision.
If the person does have the capacity to make informed decisions about his care, then what law permits us to abduct the person against his will?
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But it is not kidnapping. That is the point I’m trying to get across.
Does it matter what we call this?
Is this wrong?
A rose by any other name would smell as sweet.
Abduction might not be kidnapping, but that does not make it right.
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Continued in –
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