ARTICLES

Good Samaritan acts

Authors: Camilla Boyton 

Publication date:  08 Sep 2007


Camilla Boyton examines the legal and ethical issues

On a recent holiday I was skiing on a sunny mountainside, concentrating hard on remaining upright, when two skiers collided at speed a short distance in front of me. One of them was clearly injured and I found myself kneeling in the snow assessing the casualty without a second thought. Afterwards, as I watched the injured woman being whisked away by ski patrol I began to wonder if I had done the right things. Then I began to worry that there might be legal consequences arising from my involvement. Talking to friends afterwards it became clear that many doctors have been in similar situations and have worried about the potential consequences of getting involved. It can be very daunting when your skills are called upon out of the working environment, away from the support of colleagues, and very possibly dealing with an area in which you do not usually practise. However, fear of a potential legal action arising from “good Samaritan acts” need not be a source of worry.

What is a good Samaritan act?

A good Samaritan act is usually understood to be where medical assistance is provided in an emergency, free of charge, and where the doctor is present in a personal rather than a professional capacity.

How common are they?

Being asked to act in a professional capacity outside of the working environment is a relatively common experience, but the chances of being involved in a serious emergency are slim. All of the colleagues I spoke to who had acted in an emergency had encountered situations that were relatively easy to manage. Despite this, discussion with other doctors revealed that a high level of dread surrounds these incidents. One scenario where people are especially fearful is being asked to assist on a plane, and one US study suggested there were 500 airborne medical incidents a week. Most of these are relatively minor, however; British Airways report that they commonly involve faints, diarrhoea and vomiting, or sprains. A serious enough problem to cause diversion of a flight, such as chest pain, occurs on only 0.1% of flights. Other examples of situations that my colleagues have found themselves involved in are as diverse as road traffic accidents, supermarket incidents, and public events such as football games, although your skills could be called on in almost any situation imaginable.

What is the legal situation?

In the United Kingdom there is no legal obligation to give assistance (the exception to this is the contractual duty under the core General Medical Services contract of a GP to provide treatment in an emergency within the practice during “core hours”) provided that the incident occurs away from your place of work (with the exception of some general practitioners who have a duty of care within their practice area as set out in their contract). But many countries have good Samaritan laws. In some areas, such as the USA and most Canadian provinces, these laws are designed to protect the “Samaritan” from legal claims for damages. In others there is actually a requirement to assist in an emergency unless doing so would endanger you. This is the case in Quebec, Japan, and also many European countries such as France and Germany. There is also the possibility that the European Convention of Human Rights article 2 (the right to life) might provide the grounds for action if there were consequences arising by non-involvement of a doctor.

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Despite differences in the legal situation, however, there is a strong ethical duty to help. Guidance from the General Medical Council (GMC) on this point is unequivocal, and with the exception of a situation where there was a real personal danger it would be difficult ethically to justify non-intervention.

What standard would be expected of you?

Once you have given any kind of assistance a duty of care is established. In the UK, away from work a duty of care does not arise until a doctor actually becomes involved in the care of a patient. But once you have become involved, what standard would the courts expect of you? Certainly, at the very least you would be expected not to make the victim's condition worse, but the likely standard would be higher than this. Of course an emergency could arise anywhere; you could be dealing with lack of necessary equipment and working in unfamiliar territory. You would be expected to behave as a “reasonable, responsible and respectable doctor,” the GMC suggests the standard to be treatment you could “reasonably” be expected to offer. It is reassuring to know that courts would not expect all doctors to measure up to a trauma specialist, for example, and that there is a generally understanding approach to emergency situations—“an emergency may overburden the available resources, and, if an individual is forced by circumstances to do too many things at once, the fact that he does one of them incorrectly should not be taken as negligence.”

There is a strong ethical duty to help. Guidance from the General Medical Council (GMC) on this point is unequivocal

It is worth noting that in a public situation there may be other individuals available to help, some with more appropriate training for emergencies, such as a paramedic who could assist or take over care. You might also feel that your ability is limited, for example by alcohol, language barrier, or tiredness. Although the GMC requires doctors to recognise and work within their competence, in an emergency you might have little choice but to treat someone in less than ideal circumstances. The Medical Defence Union's advice in such a situation is to explain this to the patient beforehand if possible.

Some pointers

  • Keep up to date on first aid and resuscitation skills. If you do not use these regularly there are many excellent courses available

  • Don't forget that there may be other people present with relevant skills

  • Find out what the legal situation is before travelling abroad

  • If in doubt about the situation in the area where you are travelling, check with your insurance provider before you travel, and inform them of any incident as soon as possible

  • The situation is different for doctors as part of an expedition, or those working at public events in their professional capacity and they are likely to need specialist cover

  • Document all actions taken, times, etc

  • Provide your contact details at the scene

  • Don't be unduly fearful.

You should make notes to record the events and your actions (retrospectively if necessary), as you would in other clinical settings and you should also give your details to those at the scene such as police or airline crew.

What happens afterwards?

After the event it might be advisable to contact your medical defence organisation with a written report of the incident regardless of whether you think legal consequences might follow. In the unlikely event of legal action arising, both commonly used defence organisations offer worldwide protection to their members. The Medical Defence Union provide a guaranteed insurance policy and the Medical Protection Society provide cover on a discretionary basis as part of their policy. In addition to this some airlines offer indemnity to good Samaritan doctors. Both major defence organisations were keen to emphasise the extreme rarity of medicolegal problems arising from such actions and neither were aware of such a situation arising recently.

The threat of legal action is one that is ever present in medicine, but it is happily not a common result of good Samaritan acts. If you do find your skills being called upon in an emergency fear of litigation should not worry you unduly. The injured skier I encountered made a full recovery from her injuries, and I was faced with a far more typical response from a patient after the event—a letter thanking me for my help.

References

  1. De John C, Veronneau S, Wolbrink A, Larcher J. Evaluation of in-flight medical care aboard selected US carriers: 1996 to 97. Flight Safety Foundation, Cabin Crew Safety  2000;35(2): 1-20.
  2. General Medical Council. Good medical practice  . Paragraph 11 London: GMC, 2006. [Link]
  3. House of Lords. Judgment  . Bolith v City and Hackney Health Authority. 1997. [Link] .

Camilla Boyton F1 doctor Colchester General Hospital  camilla.boyton@essexrivers.nhs.uk

Cite this as BMJ Careers ; doi: