Who would be a Good Samaritan?

RECENT media publicity about a locum doctor who refused to leave his office to help an injured person has reignited debate over a doctor’s duty in situations where someone who is not under their care requires immediate medical assistance.

Firstly, doctors are reminded of their ethical obligation to assist in an emergency medical situation outside of their own practice. While this may be a rare event, it is important doctors have the confidence to act without fear of litigation.

It’s probably fair to say that the vast majority of doctors would not hesitate to help in an emergency when off duty, whether assisting a passenger on a long-haul flight or providing emergency care to someone in the street. But you should also be aware that failure to act could potentially result in a referral to the GMC.

GMC guidance in Good Medical Practice is quite specific in this regard: "In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care".

In the UK, Good Samaritan common law application offers legal protection to people who give “reasonable assistance” to those who are injured, ill, in peril or otherwise incapacitated. The protection is intended to reduce bystanders' hesitation to assist for fear of being sued or prosecuted for unintentional injury or wrongful death.

In new developments, the proposed Social Action, Responsibility and Heroism Bill which is applicable to England and Wales and may shortly become law affords three possible defences which may reassure a Good Samaritan intervenor:

• Did the negligence or breach of duty occur when the defendant was acting for the benefit of society or any of its members?
• Did the defendant demonstrate a generally responsible approach towards protecting the safety or other interests of others?
• Was the defendant acting heroically by intervening in an emergency to assist an individual in danger and without regard to his own safety or other interests?

MDDUS members often ask: "But what if I am abroad?" There are some differences in law to consider. For example, you have a legal obligation in France to stop and call for help if you see an accident. If you can do so without endangering yourself, the expectation is that you must assist someone in danger or distress.

This differs dramatically from the common law precept recognised in the UK in which a person who has no connection to another or to the situation which created the danger or distress is under no legal obligation render any assistance.

We can assure our members that MDDUS provides worldwide indemnity for Good Samaritan acts, regardless of whether the person is an existing patient or a complete stranger, as doctors have an ethical responsibility to assist anyone in need of emergency medical care. Such acts are defined as "the provision of medical and dental services in emergency situations outside the scope of an individual’s normal contractual obligations or clinical practice". It is always possible that doctors, at some point in their careers, may be asked to assist in a professional capacity outside of their normal working environment. However, when the situation is an emergency, the doctor’s intervention is all the more important. In reality, a doctor is never off duty.

We would advise doctors to consider the urgency of the situation and act in the patient’s best interests while applying common sense. Importantly, doctors should act within the limits of their own competence – for example sometimes the best course of action they can take is to ensure the person gets to a hospital where they can be provided appropriate care and treatment.

Perhaps a less likely scenario is the doctor who decides to intervene in a manner that is clearly outside of their own competence, perhaps through an inferred pressure or expectation to "do something" from bystanders . The GMC stance offers a little latitude in this area, as it states that a doctor must "take account" of their own competence when acting in the capacity of a Good Samaritan. A cautionary approach is always considered prudent but there may be circumstances in which extraordinary action is required which would not be part of a doctor’s "usual practice".

ACTION: Be aware of your legal and ethical obligations to assist individuals requiring immediate or emergency medical care. Act within the scope of your own competence and be prepared to justify your course of action with the recognition that extraordinary action may be required in rare circumstances.