Saturday, February 12, 2005

 

Michelle's Violin, CPR, Good Samaritan Laws, and Kant

6feb2005 002

This is a portrait of my violin. I'm working my way through the first book (String Builder series by Applebaum) and am about to get into some more complicated patterns of switching strings. At the last lesson I took, I experienced an interesting synchronicity moment. You can go from one string to another by anchoring off the note you are playing. This means that the fingers behind the one that is holding the string down can shift out from under this note to take up positions for the next note. This is very similar to how you find the correct location for the heel of your hand when doing CPR.

You take your index and middle fingers of your right hand and match your fingers with the bottom edge of the sternum as the patient is lying face up with their head to your left. The right-hand edge of your middle finger is on the edge of the sternum, like you are matching a hem.

Placing your two fingers (which are held together like the pope always seems to be doing in old paintings) you place the heel of your left hand immediately above and to the left of your two right-hand fingers. Move your right hand over the left hand to stack the heels as best you can.

I always watch for CPR in movies and shows because they usually have the responder with very bent arms pretending to apply CPR. Your arms should be straight, perpendicular to the ground, and you should be prepared to apply enough pressure to depress the chest by one-third its depth. That's a lot. With an older patient, you will hear ribs crack. With younger patients, you will hear cartilige complain. Living is the goal, but you don't want to compress too much, either. It's an acquired taste, I guess.

Here is a link to a file you can print out for reference to rescue breathing and CPR.

http://www.rav.vic.gov.au/media/CPRChart.pdf

So this brings up another subject that George and I were talking about. Good Samaritan Laws!

If you are not familiar with the parable of the Good Samaritan, here it is (Luke 10:25-37, NAB).

25
There was a scholar of the law who stood up to test him and said, "Teacher, what must I do to inherit eternal life?"
26
Jesus said to him, "What is written in the law? How do you read it?"
27
He said in reply, "You shall love the Lord, your God, with all your heart, with all your being, with all your strength, and with all your mind, and your neighbor as yourself."
28
He replied to him, "You have answered correctly; do this and you will live."
29
But because he wished to justify himself, he said to Jesus, "And who is my neighbor?"
30
Jesus replied, "A man fell victim to robbers as he went down from Jerusalem to Jericho. They stripped and beat him and went off leaving him half-dead.
31
12 A priest happened to be going down that road, but when he saw him, he passed by on the opposite side.
32
Likewise a Levite came to the place, and when he saw him, he passed by on the opposite side.
33
But a Samaritan traveler who came upon him was moved with compassion at the sight.
34
He approached the victim, poured oil and wine over his wounds and bandaged them. Then he lifted him up on his own animal, took him to an inn and cared for him.
35
The next day he took out two silver coins and gave them to the innkeeper with the instruction, 'Take care of him. If you spend more than what I have given you, I shall repay you on my way back.'
36
Which of these three, in your opinion, was neighbor to the robbers' victim?"
37
He answered, "The one who treated him with mercy." Jesus said to him, "Go and do likewise."

The parable of the Good Samaritan has been used as a model for charity for quite a while. At least two sets of laws have the general name "Good Samaritan Laws."

On October 1, 1996, President Clinton signed the Bill Emerson Good Samaritan Food Donation Act to "encourage the donation of food and grocery products to non-profit organizations for distribution to needy individuals."

Donors are protected from liability when donating to a non-profit. The product had to have been donated in good faith. If the product later causes harm to a recipient, but the item was donated with good intentions, then the donor is protected from liability. It standardized liability for the United States. No longer did large or interstate donors have to research liability laws that might differ across state lines. The standards for negligence and intentional misconduct were articulated. The law also addressed the problem of donating items close to their expiration date. Donating items that are about to be thrown out isn't negligent under the law. The items do need to be used quickly, but the law clarified this issue in favor of donation. Donors are not negligent just because a grocery item is almost out-of-date. The law seeks to encourage donation up to the expiry date. It's up to the recipient organizations to either use or discard, depending on need, organizational efficiency, and how close the expiry date is.

The second body of law, and the sort of law I'm a little more familiar with, is the Good Samaritan laws that protect people rendering first aid to someone in need.

Good Samaritan laws vary from state to state in the U.S. and from province to province in Canada.

Virtually all laws do however have some things in common.

First, you have to be rendering aid to someone that has not refused it. Note that there isn't a requirement of consent. There is the concept of informed consent in rendering medical aid. If a person is conscious and coherent enough to understand and accept help, that's great. However, if someone is unconscious and bleeding to death, a reasonable person would conclude that, if they were awake, they'd accept your help. This is called implied consent and is recognized as medical consent. There are a couple of other interesting consent issues in medical law, but the important idea for Good Samaritan laws is that the person hasn't refused your assistance. If you provide aid after someone has refused it, and the issue of implied consent (victim too drunk to think clearly, has mental illness that prevents reasonable conclusions, was unconscious, etc) doesn't apply, then you have committed assault, and you might be prosecuted for it.

Secondly, you must be volunteering your aid. You cannot ask the victim for payment. If you are a professional that is required to render aid to a victim, then you are not covered by Good Samaritan laws (in general). Good Samaritan laws were written for people volunteering consentual aid in an unpaid manner.

Third, you have to stick around as long as it takes to hand over the patient to someone more qualified, or when it becomes too dangerous for you to remain (fire, landslide, poison gas, don't have latex gloves to protect from disease, can't get the person away from the danger, etc). If you begin to provide assistance, then abandon the patient, you are no longer protected. Leaving to call for help does not constitute abandonment. A responder can never be forced to put him or herself in danger to aid another person.

Fourth, you have to have provided care in a calm and reasonable manner. The legal standard is something like "the responder acted as a calm and rational person of the same level of training would have under the same circumstances".

So, one way of expressing it in plain language would be "Any person who, in good faith, renders emergency medical care or assistance to an injured person at the scene of an accident or other emergency without the expectation of receiving or intending to receive compensation from such injured person for such service, shall not be liable in civil damages for any act or omission, not constituting gross negligence, in the course of such care or assistance."

The law recognizes the difficulty that you face when you try to help someone in need. The law is designed to remove the added burden of worrying about personal liability in the case that the victim suffers or dies.

The spread of AED (automatic external defibrilators) really got the Good Samaritan Laws going in North America. States that already had them updated them. States that didn't have them got them. AEDs are those packs that you see in airports and other public places that have a short, clear instruction set that allows a layperson to defibrillate someone whose heart has stopped. The term defibrillate means that the heart has lost it's rhythmic contractions. To Fibrillate means "Rapid uncoordinated twitching movements that replace the normal rhythmic contraction of the heart and may cause a lack of circulation and pulse." The AED zaps the heart back into rhythm, with luck and early application.

Ontario passed their Good Samaritan Act in 2001.

Ontario Good Samaritan Act Text

http://www.e-laws.gov.on.ca/DBLaws/Statutes/English/01g02_e.htm

**********************************
Good Samaritan Act, 2001

S.O. 2001, CHAPTER 2

No Amendments.
Definition
1. In this Act,
"health care professional" means a member of a College of a health profession set out in Schedule 1 to the Regulated Health Professions Act, 1991. 2001, c. 2, s. 1.
Protection from liability
2. (1) Despite the rules of common law, a person described in subsection (2) who voluntarily and without reasonable expectation of compensation or reward provides the services described in that subsection is not liable for damages that result from the person's negligence in acting or failing to act while providing the services, unless it is established that the damages were caused by the gross negligence of the person. 2001, c. 2, s. 2 (1).
Persons covered
(2) Subsection (1) applies to,
(a) a health care professional who provides emergency health care services or first aid assistance to a person who is ill, injured or unconscious as a result of an accident or other emergency, if the health care professional does not provide the services or assistance at a hospital or other place having appropriate health care facilities and equipment for that purpose; and
(b) an individual, other than a health care professional described in clause (a), who provides emergency first aid assistance to a person who is ill, injured or unconscious as a result of an accident or other emergency, if the individual provides the assistance at the immediate scene of the accident or emergency. 2001, c. 2, s. 2 (2).
Reimbursement of expenses
(3) Reasonable reimbursement that a person receives for expenses that the person reasonably incurs in providing the services described in subsection (2) shall be deemed not to be compensation or reward for the purpose of subsection (1). 2001, c. 2, s. 2 (3).
3. Omitted (provides for coming into force of provisions of this Act). 2001, c. 2, s. 3.
4. Omitted (enacts short title of this Act). 2001, c. 2, s. 4.

**********************************

Here we can introduce the difference between protecting someone from liability, if they meet the conditions of rendering responsible aid, and requiring someone to respond.

The question from a human rights point of view is "Do you have the right to be rescued?"

If a person decides not to render aid, are they committing a crime?

Good Samaritan Laws protect those that choose to help. The Canadian province of Quebec requires people to help someone in need.

From the web: (lost the link, my apologies)

"Quebec is unique in Canada in imposing a duty on everyone to help a person in peril. The duty to take action stems from the Quebec Charter of Human Rights and Freedoms enacted in 1975, and the Civil Code.
The Charter contains a provision that imposes an obligation to render aid if it can be accomplished without serious risk to the good samaritan or a third person. There is still little jurisprudence interpreting these provisions.
Under the Civil Code, every person is obligated to act as a bon pere de famille, broadly defined as a reasonably prudent person. Failure to do so would amount to fault and lead to legal wrong."

The requirement to render aid is authoritarian. Being able to act upon the decision to render aid out of goodwill is libertarian.

The rights of the victim do not outweigh the freedom of the responder. Those reading Paul's Kantian ethics blog entry (found here) about the man with the plank will hopefully see a similarity.

In a libertarian society, the decision to render aid is made without the force of law requiring it. When it is a requirement, it's not charity.

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