Basic Principles of Critical Care

1. LEGAL ASPECTS OF ICU CARE
Gradian Health Systems
Basic Principles of Critical Care
ETHICAL AND LEGAL
DIMENSIONS OF CARE

2. Disclaimer
Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications
regarding medical care and clinical service delivery. The tables, checklists, and other clinical
documents referenced in this training have not been validated in all settings. These documents are
intended to serve as examples only. We recognize that all clinical training content and activities
must be customized to meet the needs of each facility and its clinical staff, factoring in available
resources, practitioner skill level, and other environmental considerations.
For any questions regarding the contents or applications of this training,
please contact Gradian Health Systems:
40 W 25th St, 6th Floor
New York, NY 10010 USA
+1 212-537-0340
training@gradianhealth.org
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

3. Module 7
Gradian Health Systems
Basics Principles of Critical Care
Ethical and Legal Dimensions of Care

4. Module 7: Ethical and Legal Dimensions of Care
MODULE OVERVIEW
Lesson 1 I Ethical Aspects of ICU Care
Lesson 2 I Legal Aspects of ICU Care
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

5. Components of the Gradian CCV SystemLesson 2: Legal Aspects of ICU Care
Lesson Objectives
• Discuss legal decisions related to ICU care
• Discuss patient rights related to ICU care
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

6. Components of the Gradian CCV SystemLesson 2: Legal Aspects of ICU Care
Key Concepts
• Informed consent
• Medical documentation
• Brain dead declaration
• Use of restraint
• Patient rights
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

7. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Legal Decisions in ICU
• Informed consent
• Medical documentation
• Declaration of brain dead
• Use of restraint
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

8. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Informed Consent
Informed consent is based on the principle of autonomy. Issues may arise when
critically ill patients are not able to make decisions about their own treatment.
• Consent must be given voluntarily
• If patient is not mentally capable, informed consent should be obtained from
legal next of kin; must be a person of sound mind and over 18 years old
• Requires the disclosure of basic information considered necessary for
decision making
• Patients providing consent should be free from pain and depression
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

9. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Medical Documentation
• Proper medical documentation is a legal necessity
• A good record should be correct, clear, comprehensive, and in chronological
order
• Incident reports document the occurrence of anything out of ordinary that
results in, or has the potential result in, harm to a patient, employee or visitor
Remember: if you did not document, you did not do it
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

10. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Declaration of Brain Dead
• Requires a physician who has not been not involved in patient’s treatment to
document and another physician to confirm the findings
• Three essential findings in brain death are:
• Coma
• Absence of brainstem reflexes
• Apnea
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

11. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Use of Restraint
• Restraint limits a person’s freedom to move
• Can be physical or chemical
• Physical restraint causes skin trauma and increases patients agitation
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

12. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Medical Legal Cases
• All cases of injuries
• All cases of burns
• Alleged cases of assault
• All cases of suspected or evident of poisoning or intoxication
• Case referred from court
• Cases of suspected or evident criminal abortion
• Cases of unconscious or comatose where cause is not natural or not clear
• Cases brought dead/dead on arrival/sudden unexpected death
• Cases of suspected self-inflicted injuries or attempted suicide
Basic Principles of Critical Care Training I Legal Aspects of ICU Care

13. Components of the Gradian CCV SystemLegal Aspects of ICU Care
Patient’s Bill of Rights
• Right to considerate and respectful care
• Right to information
• Right to make decisions
• Right to have advance directive
• Right to privacy
• Right to confidentiality
• Right to review of records
• Right to proper treatment and referral
• Right to reasonable continuity of care
• Right to consent to participate in research
• Right to be informed of hospital policies
Basic Principles of Critical Care Training I Legal Aspects of ICU Care