Legal and Ethical Issues in Trauma Care

Abstract

The mechanism, nature and severity of injury, or specific patient circumstances, will often trigger responsibilities that extend beyond the immediate clinical management. The involvement and expectations of police, health and safety executive and mental health services in life, or the coroner after death, generate many challenges in decision-making. There is no concise, consistent, accessible set of rules that covers every possible scenario, and an additional layer of complexity on this subject is generated by different legal systems even within the United Kingdom. These issues create the potential for individual and institutional jeopardy when decisions, interventions and standards of documentation are reviewed retrospectively. This chapter highlights conflict between confidentiality and disclosure, justifiable access to patients by police, duty to the coroner, responsibility for other healthcare workers, information governance, duty of candour following iatrogenic complications, and diverse topics including domestic violence, disputes with next-of-kin and responding to requests to either continue or discontinue life-sustaining medical treatment. Discharging our broader responsibilities and avoiding professional jeopardy involves awareness of these issues and ensuring that documentation demonstrates both awareness of and compliance with accepted principles and directives whether at law or from the regulatory body.

Appendix: Post Mortem Narrative Tool

	CLINICAL SUMMARY PRIOR TO POST-MORTEM:
Name:
DoB:
Unit No:

Date of Hospital Admission:		Date of ICU Admission:
Date of Death:		Place of Death:
Parent Specialty:		Named Consultant:
Key Injuries or pathologies on admission to intensive care: 1 2 3 4
Past Medical History 1. 2. 3. 4.

Surgical interventions after admission to intensive care:
1
2
3
4

ICU interventions:
Advanced monitoring:
Organ support:
Key drug treatments:
Procedures: (drains, tracheostomy)
Other:

Significant Events on Intensive Care 1. 2. 3. 4.
Relevant Investigation Results:
Microbiology
Biochemistry
Haematology
Radiology

Death occurred;  1. Despite ongoing provision of full support

2. After limitation or withdrawal of active support

(please delete appropriately)

If after limitation or withdrawal of active support this was due to:

1. Physiological futility (unable to achieve survival despite full support)

2. Qualitative futility (unable to achieve the broader goals of intensive care)

3. Both physiological and qualitative futility.

(please delete appropriately)

Medical devices removed after death: none/the following:

Provisional intensive care opinion as to Cause of Death;

1a

1b

1c

11

If cause of death not apparent, pathologies/diagnoses felt likely to be contributing to death or to need evaluation at post-mortem;
1
2
3
4

Completed by:	Status: Consultant/SpR Critical Care
If completed by SpR, details of ICU consultant with whom discussed;
Name:
Mobile:
e-mail:
Date:	Signature: