It is second nature for physicians to help someone who is sick or injured in an emergency. When an individual suddenly becomes ill or injured, doctors instinctively stop in the midst of their vacation, their business trip, or their work to offer assistance as good Samaritans, often under trying conditions. After the incident is over, physicians may question if they could be liable for the care they provided.
In one instance, a physician attended to a fellow passenger on an international flight. The flight attendant had asked for a physician to help an individual who was short of breath. The physician recommended administering oxygen, but the flight attendant refused to follow her recommendation until receiving approval from the airline’s land-based physician. After the first physician persisted, the attendant did administer the oxygen, and the passenger stabilized. Following the incident, the physician had a number of questions for the CMPA about potential liability issues, including: could she be held liable in this situation?
Having the answers to questions about liability and risk can ease physicians’ minds about stepping in to provide care to those with an emergency need.
What are the obligations and risks?
Ethical obligations
Various medical professional bodies have created codes of ethics that make it an ethical obligation for Canadian physicians to provide emergency medical services to individuals in need. The medical regulatory authorities (Colleges) generally view physicians as having an ethical duty to do their best to attend to individuals in need of urgent care. Also, the Canadian Medical Association’s Code of Ethics and Professionalism1 states that physicians should: “Provide whatever appropriate assistance you can to any person with an urgent need for medical care.” Québec has its own code of ethics for physicians, which is enshrined in law, with similar requirements.2
Legal obligations and protection
While the ethical obligations to assist in an emergency are clear, the legal obligations can be more difficult to determine. Because emergencies can happen anywhere, at any time, physicians may find themselves being asked to provide emergency care in a variety of legal jurisdictions — within Canada or in another country, or in international airspace or waters. Different locations can mean different legal obligations.
In Canada, most jurisdictions do not impose a legal duty or obligation on physicians to provide emergency medical services. All jurisdictions, however, have legislation that protects physicians who voluntarily provide assistance at the scene of an accident or in an emergency. Québec is the only province in Canada that imposes a legal duty on physicians to come to the aid of a person in a life-threatening emergency. Québec’s Civil Code protects physicians from liability for that care.
Legislation can vary from one jurisdiction to another. Practically speaking, however, it is unlikely that courts anywhere would criticize the conduct of a physician who in good faith treated a person in need of urgent medical attention. The CMPA is unaware of any proceedings commenced against Canadian physicians in Canadian courts or in foreign courts alleging negligence in providing emergency medical attention as a good Samaritan.
What about CMPA protection?
When CMPA members provide care in an emergency as good Samaritans, they are generally eligible for CMPA assistance regardless of where the emergency care was delivered — in Canada, in other countries, or in international air space or waters — and whether to residents or non-residents of Canada. In addition, retired physicians who were previously CMPA members and who act as good Samaritans are also eligible for CMPA assistance; they do not have to retain membership solely for this possibility.
The CMPA defines good Samaritan care
In determining eligibility for CMPA assistance, the CMPA views good Samaritan care as a member offering, or being called up to provide, medical care to someone requiring urgent or emergent medical assistance when such assistance is not otherwise immediately available (e.g. sick or injured persons encountered at the scene of a motor vehicle crash, or on a domestic or international flight). This medical assistance is provided until more definitive care can be mobilized.
A best effort
So, what are the risks to physicians who act as good Samaritans? From an ethical perspective, Canadian physicians have an obligation to provide medical care in an emergency. From a legal perspective, they do not have an obligation to provide emergency care, except in Québec. The probability that a physician will be successfully sued as a result of providing good Samaritan care is extremely low.
With that in mind, the CMPA encourages its members to consider assisting when confronted with an accident or with sick or injured individuals in urgent or emergent circumstances. Physicians should treat individuals requiring care with the goal of preventing prolonged suffering and addressing imminent threats to life, limb, or health. The care that physicians can provide in an emergency may be far different from what is expected of them under normal circumstances and is more basic than what can be provided in an office, clinic or hospital. Once emergency services arrive and care has been transferred to emergency responders, physicians can leave the situation.
As soon as possible after the emergency, physicians should document the encounter in their own records. The documentation provides a record of the medical reasoning and the steps taken, may facilitate any further investigations and treatments, and provides a valuable resource if afterwards there are questions about the care.
In emergency circumstances, members should focus on practising medicine to the best of their ability and in the best interests of the patient, confident that giving their utmost effort will be enough.
References
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Canadian Medical Association, “CMA Code of Ethics and Professionalism,” 2018. Accessed June 7, 2021 from: https://www.cma.ca/cma-code-ethics-and-professionalism
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Government of Québec, “Code of Ethics of Physicians,” Section 38. Accessed June 7, 2021 from: http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=3&file=/M_9/M9R17_A.HTM
