Legal and Ethical Issues

• Review legal and ethical issues
• Discuss care of family members

It is clear healthcare professionals performing their duties within the workplace have a duty of care which includes rendering assistance to persons in need of emergency care and performing resuscitation. This duty to respond is not so straight forward for healthcare professionals who are off-duty.  There are differences in legal obligations between various State and Territory legislation.  The Northern Territory has legislation which requires all persons to provide resuscitation or assistance to any person in need of urgent attention (Criminal Code Act 2014, s155).  In New South Wales and Western Australia, Medical Officers, and possibly other healthcare professionals, have an obligation to provide assistance outside their usual place of work if requested to do so.  This obligation has not been tested in other States or Territories.  It is recommended by ANZCOR that off-duty healthcare professionals’ offer ‘assistance if requested to do so even when they may have no duty to rescue provided their own safety is not threatened’.  ‘Health professionals are bound by codes of conduct and legislation in their jurisdiction and therefore need to be aware of the obligations. They must perform their tasks to a standard expected of a reasonably competent person with their training and experience’.  ANZCOR, 2021, Guideline 10.5

Every person has the right to autonomy and self-determination, therefore consent to treat or offer assistance must be obtained before treating a competent person.  If the person’s ability to make decisions is impaired and no substitute decision maker is present, the legal requirement to obtain consent prior to offering assistance or treatment is waived under Common Law and Statute Law in a number of circumstances.  Healthcare professionals may provide emergency care to a patient where there is imminent risk to the person’s life or health, hence to prevent a serious threat to the person’s life, providing it is in the ‘best interests’ of the person.  It is recommended by ANZCOR that healthcare professionals obtain consent to provide assistance or treatment when possible, however if the person is incapable of consenting, ‘a rescuer may give treatment to preserve life and health without consent unless an advance care directive prohibits such treatment’.  ANZCOR, 2021, Guideline 10.5

Important note:  The information provided in this section does not constitute legal advice and is provided for general discussion purposes only.  Organisations and individuals should seek legal advice pertaining to their specific jurisdiction.

‘The decision to start, continue and terminate resuscitative efforts is based on the balance of the risks, benefits, and burdens these interventions place on patients, family members, and healthcare providers’.There are a number of ethical issues to consider in relation to resuscitation efforts which include:

• Decisions made before the cardiac arrest such as standardised orders for limitations on life-sustaining activities (e.g.  ‘Do not attempt resuscitation’; ‘Advanced health directives’; ‘Acute Resuscitation Plan’)
• Termination-of-resuscitation rules
• Quality of life expected post resuscitation and likelihood of success
• Decisions to cease resuscitation require clinical judgement and assessment of the probability of ROSC and patient’s prognosis of survival

Hazinski, et al, 2015; State of Queensland (Queensland Health), 2020