I saw on television last night and read it in the newspaper this morning that Malaysia plans to enact the Good Samaritan Law to encourage more people to become lifesavers in an emergency here:
Today I like to discuss a
little bit on the Good Samaritan law that will legally protect members of
the public from being sued should they render aid to a casualty in a medical
emergency even if the rescuer does it wrongly or caused more damage when they
are not medically qualified or trained.
Since the Good Samaritan law protects the ordinary man-in-the -street who helps the injured, but does it protect doctors, paramedics, emergency medical technicians (EMT), first responders, first-aiders who are trained and qualified, but they do more harm than good? Follow me all the way down as I shall address these difficult questions.
Malaysia currently has no
Good Samaritan law yet but will soon be passing a law for this. However, there
are a number of countries that have the Good Samaritan law. I shall try to
answer all these very interesting questions here.
The Good Samaritan Law
proposal in Malaysia, which has been gaining attention recently, is a
significant step toward promoting altruism and civic responsibility. This law,
if enacted, would aim to protect individuals who voluntarily offer assistance
in emergencies from legal liability. The goal is to encourage people to act in
good faith without fear of legal repercussions should unintended consequences
arise during their attempt to help.
Currently, there are
concerns in Malaysia about the legal risks for individuals providing aid in
emergencies, which often discourages people from stepping forward.
The Malaysian government
plans to table this proposal in Parliament for further discussion, reflecting
Malaysia's effort to align with global legal practices and foster a more
compassionate society. This initiative also underscores the importance of community
responsibility and mutual aid in emergencies.
The law is intended to
address this issue, creating a framework similar to laws in other countries
that protect "Good Samaritans." For instance, in many jurisdictions,
these laws shield helpers from civil lawsuits or criminal charges, provided their
actions are reasonable and not grossly negligent.
Even Singapore does not yet
have a specific Good Samaritan law that provides blanket legal protection to
bystanders rendering medical aid. However, the Singapore Civil Law Act (Section
7) has provisions to encourage assistance during emergencies. It protects
healthcare professionals and Good Samaritans acting in good faith, provided
their actions are not grossly negligent. Additionally, under Singapore's Penal
Code (Section 89), individuals are generally not held liable if they act in
good faith for the benefit of another person, such as in a medical emergency.
Despite these general protections, there is no codified "Good Samaritan Law" except those in the U.S., Canada, or Australia.
However, many countries have
implemented Good Samaritan laws in one form or another to encourage bystanders to assist in
emergencies without fear of legal repercussions. Here are some of
these countries:
In the United States Good
Samaritan laws exist in all 50 states. Each state has variations, but they
generally protect individuals who provide emergency aid in good faith and
without gross negligence. The Aviation Medical Assistance Act (1998) extends similar
protections for in-flight emergencies.
In Canada, most provinces
have Good Samaritan laws, such as the Good Samaritan Act (2001) in Ontario,
protecting anyone who voluntarily provides aid.
In the United Kingdom
though they have no formal Good Samaritan law, common law principles shield
rescuers acting in good faith from legal action, provided they are not
negligent.
In Australia, all
Australian states and territories have Good Samaritan laws that protect
volunteers providing first aid or assistance, such as the Civil Liability Act
(2002) in New South Wales.
India has the Good
Samaritan Guidelines (2016) that protect bystanders helping road accident
victims. It ensures they won’t be harassed by police or hospitals.
France and Germany
are very exceptional. French law explicitly requires individuals to
render assistance during an emergency, whether trained or not, under Article
223-6 of the French Penal Code. Failing to do so can result in criminal
charges. France’s approach to making it mandatory by law for bystanders to
render aid in emergencies is unique and worth exploring. Under Article 223-6 of
the French Penal Code, individuals who fail to assist someone in danger can
face. Fines: Up to €75,000 and imprisonment up to 5 years.
This law applies to anyone
witnessing an emergency, not just medical professionals, unless assisting poses
a risk to the rescuer's safety.
Germany’s Criminal Code
(Section 323c) also makes it mandatory for bystanders to assist in emergencies.
Failure to act can lead to fines or imprisonment.
China passed a Good
Samaritan Law (2017) that protects people from being sued or held liable for
rendering emergency aid.
Japan’s Good Samaritan laws
provide limited protection to rescuers but hold them liable if their actions
are negligent or exceed their training.
Other Countries like New
Zealand, South Africa, Sweden, and Italy also have versions of Good Samaritan
laws or common-law protections for emergency aid.
My Opinion on Mandatory Aid Laws.
Mandatory aid laws like
France's are both admirable and complex. Here are the key considerations:
Pros of Mandatory Aid Laws,
encourages a culture of responsibility. Such laws reinforce the moral and
ethical duty to help others, fostering a more compassionate society. In
emergencies, timely intervention by bystanders can save lives (e.g., CPR or
stopping severe bleeding).
Deters Inaction:
These laws address the
"bystander effect," where individuals fail to help because they
assume someone else will step in.
By making inaction
punishable, these laws ensure more people take responsibility in emergencies.
Boosts Public Awareness:
Mandating aid encourages
governments to invest in public education on basic first aid, making more
people confident and capable of responding to emergencies.
Challenges of Mandatory Aid
Laws:
Risk to the Rescuer:
In some situations,
rendering aid may endanger the rescuer (e.g., a dangerous accident site,
exposure to infectious diseases). The law must account for these scenarios.
Lack of Training:
Forcing untrained
bystanders to assist may result in well-meaning but harmful actions (e.g.,
incorrect CPR techniques or improper handling of spinal injuries).
Potential for Misuse:
In countries with strict litigation cultures, mandatory aid laws might expose rescuers to accusations of negligence if the outcome is unfavourable, even if they acted in good faith.
I believe encouraging
voluntary aid through Good Samaritan protections is generally more effective
than mandating aid. While mandatory laws like those in France promote altruism,
they should also:
Provide clear exceptions
for situations where aiding would endanger the rescuer.
Include robust public
education programs to ensure citizens have the necessary skills to assist
effectively.
A hybrid approach might
work best, where citizens are encouraged (and sometimes obligated) to act, but
also protected by Good Samaritan principles when doing so.
Some discussions around the
proposal highlight potential challenges, such as defining the scope of
"reasonable assistance" and ensuring the law isn't abused. Legal
scholars have also debated how the law would balance the need to protect Good
Samaritans while safeguarding victims' rights
However, I think most
people will act instinctively in good faith to help an injured person in a road
accident or rescue someone from drowning or in a fire, with or without the Good
Samaritan law unless it poses a danger to himself or others acting in good
faith. I don't think they will think of the legal aspect in an emergency
I believe in many cases,
people instinctively step in to help during emergencies, driven by human
empathy rather than a concern for legal consequences. Whether it's pulling
someone from a car wreck, attempting CPR, or rescuing someone from a fire or
drowning, these actions are often reflexive and motivated by the desire to save
a life or alleviate suffering.
However, fear of potential
legal repercussions can weigh heavily on people's minds in certain scenarios,
particularly in countries where no Good Samaritan protections exist. This is
especially true for situations where the helper is unsure about the consequences
of their actions, such as inadvertently causing harm while attempting CPR or
moving an injured person. The uncertainty about being sued or facing criminal
charges might discourage some individuals from acting, even when they feel
compelled to help.
The enactment of Good
Samaritan laws aims to reduce this hesitation, providing peace of mind that
acting in good faith will not lead to punishment. These laws serve not only as
a safety net but also as a societal encouragement for bystanders to step forward
and assist without fear. However, most individuals don’t deliberate on legal
matters in the heat of the moment; their primary instinct is to save a life,
especially if they believe they can make a difference without significant risk
to themselves or others.
In cases of imminent
danger—like a fire, drowning, or other life-threatening emergencies—people
often weigh the risks to themselves before acting. Good Samaritan laws do not
compel people to put themselves in harm's way, but they do promote a culture of
mutual aid and responsibility by protecting those who act in good faith.
France’s mandatory duty to assist reflects this ideal, though it raises
questions about personal freedom and the line between moral and legal
obligations.
In Malaysia’s context,
while the instinct to help exists widely, implementing a Good Samaritan law can
further reassure the public, fostering a stronger sense of community and
ensuring legal clarity for those willing to help. It bridges the gap between moral
duty and legal safety.
Let me explain how the law
is going to apply for various groups.
1. Members
of the Public (Untrained Rescuers):
Protection scope for these
individuals is generally the primary focus of Good Samaritan laws. If a
bystander with no formal medical training tries to help but unintentionally
causes harm (e.g., performing CPR improperly or exacerbating an injury), they
are protected as long as:
They acted in good faith.
They did not act with gross
negligence or reckless behaviour.
They did not demand
compensation for their help.
2. Medically
Trained Individuals (Doctors, EMTs, Paramedics, Nurses, First Responders, and
Trained First-Aiders)
Protection for Volunteering
Off-Duty: If these individuals voluntarily offer help outside their
professional setting (e.g., witnessing an accident while off-duty), they are
usually protected under Good Samaritan laws, provided they:
Act within the scope of
their training and competence.
Render assistance in good
faith without reckless or wilful misconduct.
Liability for Errors: The
law generally assumes that trained professionals are held to a higher standard
of care than untrained individuals. If a trained rescuer performs a procedure
incorrectly or goes beyond their expertise (e.g., attempting surgery at the
scene), they could be at risk of liability if the act is deemed negligent.
Does the Law Protect Them
if They Do More Harm?
The key issue here is
negligence vs. reasonable effort in an emergency:
Reasonable Effort: If a
trained professional acted in good faith and provided care that would be
considered reasonable given the circumstances, they are often protected. For
example, a doctor performing CPR may accidentally break ribs; this would likely
fall under protected actions because broken ribs are a common side effect of
proper chest compressions.
Gross Negligence or Wilful
Misconduct:
If a trained individual
acts recklessly, beyond their expertise, or in a way that shows disregard for
the standard of care expected of them, they may lose protection. For example, a
paramedic performing an unnecessary invasive procedure at a scene without
proper tools or justification.
A first responder failing
to follow basic protocols they were trained to observe.
Key Differences Between
Untrained and Trained Rescuers:
Standard of Care: Trained
individuals are generally held to a higher standard than untrained bystanders.
Courts may evaluate whether their actions was in line with the expectations of their
training.
Professional Duty: In some
jurisdictions, doctors or EMTs may have a legal obligation to assist in
emergencies (even off-duty), unlike laypersons who can choose not to intervene.
This duty adds another layer of complexity to liability questions.
What Else Influences the
Protection?
Jurisdiction:
Good Samaritan laws vary by
country and state. Some provide explicit protection for trained individuals;
others are less clear about this.
In certain jurisdictions,
off-duty professionals may be treated differently from lay rescuers or those
acting within the scope of their job.
Compensation:
Good Samaritan laws
typically apply only when the help is voluntary and unpaid. If the rescuer is
on duty or compensated for their aid, they may be judged under different legal
standards.
Consent:
If a conscious individual refuses aid, and a rescuer still intervenes against their wishes, this could complicate liability. During my training in emergency medicine, I was told there are people who wish to die, and they tattooed on their chest this message:
"Do Not Resuscitae (DNR)"
A DNR order means they do not want any CPR in the event their hearts or breathing stop. We have to comply
However, in emergencies
where the casualty is unconscious or unable to consent, implied consent is
assumed.
Recommendations for Trained
Rescuers
To reduce the risk of
liability while still helping:
1. Stay
within the scope of your training.
2. Clearly
communicate your actions to bystanders and the casualty (if conscious).
3. Provide
aid that is reasonable under the circumstances.
4. Avoid
invasive procedures unless necessary to save a life.
Trained individuals are generally protected by Good Samaritan laws, but their higher standard of care means they are more vulnerable to legal scrutiny if their actions deviate from accepted medical practices. Ensuring that their assistance aligns with their training and is delivered in good faith is key to retaining legal protection.
I was told during my
advanced training in medical emergency and trauma care at the University
Hospital of the National University of Malaysia (HUKM) and also during my
training at the Kuala Lumpur Hospital, as well as in Selayang Hospital when I
joined St. John Ambulance Malaysia as a Regional Staff Officer for Training
that doctors need to be careful in rendering any medical treatment
even in an medical emergency in a passenger aircraft flying over
the air space of another country because their medical qualifications may not
be recognized above that country, and even if it is recognized, was not
registered for any medical treatment or practice in the air space of a foreign
country.
This is a fascinating legal
and ethical question that underscores the complexity of practicing medicine in
emergencies, especially in international airspace or foreign jurisdictions. The
situation touches on jurisdictional law, licensing requirements,
and Good Samaritan principles. Here are the relevant considerations
1. Jurisdictional
Challenges in International Airspace
Territorial Law: When an
emergency occurs on a passenger aircraft flying over a foreign country, the
legal framework governing the situation can be ambiguous. Generally:
The Law of the Country of
Aircraft Registration: Most international conventions, including the Tokyo
Convention (1963), state that the aircraft is governed by the laws of the
country in which it is registered, even if it is flying over another nation's airspace.
Foreign Jurisdiction:
However, if the aircraft lands in a foreign country for an emergency (e.g., a
medical evacuation), the doctor’s actions may be subject to that country’s
laws. In such cases, the doctor might face issues related to licensing or malpractice
claims.
2. Licensing
and Recognition of Qualifications
Medical Licensing Laws:
Most countries require medical practitioners to be licensed and registered
within their borders to practice medicine legally. Even if a doctor’s
qualifications are recognized globally, they are not automatically authorized
to practice in every country unless registered.
For example, a doctor
licensed in Malaysia, or the UK may not be registered to practice in the U.S.
or Germany, leading to potential liability if they render care without legal
standing.
Good Samaritan Protection:
Some jurisdictions and
airlines extend Good Samaritan protection to doctors providing emergency
assistance during a flight, as long as the care is given in good faith and
within their scope of training.
However, this protection
may not universally apply in all countries.
3. Ethical
Duty vs. Legal Risk
Doctors often face a
dilemma in such scenarios:
Ethical Duty to Assist. The
Hippocratic Oath and professional ethical standards obligate doctors to assist
in emergencies whenever possible, regardless of location.
Refusing to help in a
life-threatening situation could lead to moral, ethical, or even reputational
consequences.
Legal Risk: Doctors may
worry about malpractice lawsuits, particularly in countries with a litigious
culture, even if their actions are well-intentioned.
Some countries’ laws might
hold them to a higher standard of care due to their professional training,
increasing the risk of liability compared to an untrained rescuer.
4. Protections
for Doctors Assisting on Flights
Airlines' Policies:
Many airlines encourage
doctors to assist in emergencies and have procedures in place to mitigate their
liability. Some airlines explicitly extend indemnity coverage or Good Samaritan
protection to doctors who step in to help.
Medical Kits and Ground
Support:
Airlines are required to
carry medical kits and often provide real-time medical consultation with
ground-based professionals to support doctors onboard.
If a doctor works under the
guidance of airline protocols or ground medical advice, their liability may be
reduced.
5. Practical
Considerations for Doctors
Identify Yourself Clearly:
If asked to assist, the
doctor should inform the crew of their qualifications, experience, and any
limitations (e.g., a cardiologist may not be familiar with paediatric
emergencies).
Document Actions:
Keep a clear record of the
assistance provided, including steps taken and the reasoning behind them.
Ensure actions are limited
to what is necessary and within the scope of their training.
Act in Good Faith:
The focus should always be
on doing what is reasonable to save a life or prevent further harm, given the
circumstances.
6. International
Conventions and Legal Precedents
Tokyo Convention (1963):
Provides a legal framework for actions taken on international flights,
generally applying the laws of the aircraft’s country of registration.
Good Samaritan Laws and
Airline Practices: Some countries and airlines extend legal protections to
doctors rendering emergency aid during flights. For example:
The U.S. Aviation Medical
Assistance Act (1998) protects individuals providing emergency medical
assistance on flights to or from the U.S.
Other jurisdictions may not
have similar explicit protections.
My opinion is, while the
concern about licensing and legal recognition in foreign jurisdictions is
valid, I believe the ethical obligation to assist in life-threatening
emergencies outweighs the potential legal risks in most cases. Key
considerations include:
Good Faith and Reasonableness:
If a doctor acts within their training and in good faith, most
legal systems and airlines will offer some protection against liability.
Moral Responsibility:
As a
physician, providing aid could mean the difference between life and death. Even
if legal concerns exist, rendering assistance balances well with the fundamental
values of the medical profession.
Practical Safeguards:
Doctors should communicate their limitations, follow established protocols, and
document actions carefully to mitigate risks.
Ultimately, each doctor must weigh their ethical duty against the potential legal implications, but in most cases, stepping in to help during an emergency is the right decision both ethically and practically.
See another separate essay I wrote published on Wednesday, March 6, 2024
Doctors Facing Medical Emergencies:
What They Can and Cannot Do?
https://scientificlogic.blogspot.com/2024/03/doctors-facing-medical-emergencies-what.html
I shall write how effective is CPR and other medical emergencies for my next article, followed by a few other articles on health, nutrition, medicine, drugs, ..
Acute myocardial infraction (heart attack) is not the only medical emergency we need to manage. There are dozens of other emergencies too
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