2 March 2021

Review of the statement on A doctor’s duty to help in a medical emergency  

The Medical Council of New Zealand (Council) is reviewing its statement on A doctor’s duty to help in a medical emergency, and is seeking your input. 

We last reviewed this statement in August 2006. While we intend to retain part of the existing statement, we have re-organised some sections to improve its flow and have re-written the draft statement in plain language for better readability. The draft statement: 
•	provides a description of a medical emergency for the purposes of this statement
•	clarifies a doctor’s obligations in a medical emergency.  

You will find the proposed draft statement A doctor’s duty to help in a medical emergency here.

The existing statement from August 2006 is available here.

The key changes to the draft statement are: 

(A)	Summary box at the outset of the statement
We have added a summary box at the outset of the statement that lists the following key points:

•	A medical emergency is a sudden, unforeseen injury, illness or complication that requires immediate or prompt treatment to save life or prevent further injury, pain or distress.

•	You have an ethical obligation as a doctor to respond promptly if asked to attend a medical emergency. If you choose not to attend a medical emergency, you must be able to justify your decision.

•	In a medical emergency, time is critical, and it may not be practical to obtain the patient’s consent before initiating treatment. It is best practice to document your actions and discuss them with the patient and their family/whānau when appropriate.

1.	Does the summary box provide an accurate overview of the statement? What changes (if any) should we make?

	

(B)	Section on ‘What is a medical emergency’ 
•	Paragraph 1 provides a description of a medical emergency, for the context of this statement. We propose the following description which we have adapted from Steven Miles’ definition of a medical emergency:

‘A medical emergency is a sudden, unforeseen injury, illness or complication that requires an immediate or prompt response to save life or prevent further injury, pain or distress. When faced with, or called to attend an emergency, a doctor should aim to apply their knowledge and skills to save life and relieve suffering. This is the basic philosophy of medicine’.

•	Paragraph 2 clarifies that a medical emergency is not the same as a ‘state of emergency’ where a government has special powers to act or impose policies during a natural disaster, civil unrest, armed conflict, pandemic, epidemic, or other biosecurity risk.

2.	Are there any further changes we should make to the section ‘What is a medical emergency’? 

	

(C)	Section on ‘What are my obligations in a medical emergency’ 
We have re-organised this section to clarify what a doctor’s obligations are in a medical emergency. For example: 

•	Paragraph 3 states that a doctor has an ethical obligation to respond promptly when asked to attend a medical emergency. 

•	Paragraph 4 acknowledges and lists seven examples where it may not be practical or appropriate for a doctor to attend a medical emergency. Paragraph 4g is a new example relating to not compromising the personal safety of those dependent on the doctor. 

•	Paragraph 5 cautions that failing to attend a medical emergency simply because it is inconvenient for the doctor is unacceptable and may result in disciplinary action. It also advises the doctor to document their reasons for not attending a medical emergency in case that decision is queried at a later date.

•	Paragraph 6 states that a doctor who attends or assists in a medical emergency has a duty of care to the patient. In instances where the doctor is unable to attend the medical emergency in person, the doctor should still make a reasonable effort to help the person find alternative, timely and appropriate care from another health professional. 

3.	Are there any further changes we should make to the section ‘What are my obligations in a medical emergency’?

(D)	Section on ‘What if I do not have the right skill to respond to a medical emergency?’ 
We have re-worded the section previously titled ‘Competence’ in the existing statement. 

Paragraph 7 acknowledges that doctors have different levels of skills and knowledge, and the doctor themselves are best placed to decide whether they have the right skills to help in a medical emergency.

Paragraph 8 encourages doctors to assist where possible, within their own skill set. 

4.	What changes, if any, should we make to the section ‘What if I do not have the right skill to respond to a medical emergency?’

(E)	Section on ‘Legal considerations in a medical emergency’  
We have removed references to criminal liability as the Crimes Act 1961 does not impose a direct obligation where a doctor fails to respond in a medical emergency. We have also made this section clearer. For example:    

•	Paragraph 9 states that a registered doctor may help in an emergency even if they do not hold a current practising certificate, or the assistance they offer is outside their registered scope of practice and any stated conditions.

•	Paragraph 10 clarifies that the help a doctor provides in a medical emergency should be to a reasonable level of care and skill, and in line with legal, ethical and other relevant standards.

•	Paragraph 11 states that everyone who has charge of a sick or injured person has a legal duty to provide what is necessary to that person and to take reasonable steps to protect that person from injury. It also says that a doctor could be liable if they fail to meet the standard of care expected of them and references section 151 of the Crimes Act 1961 about the ‘Duty to provide necessaries and to protect from injury’.  

5.	Are there any changes we should make to the section ‘Legal considerations in a medical emergency’ to improve its clarity? 

(F)	Section on ‘Ethical considerations in a medical emergency’  
We have bolstered this section so that there is more guidance on how the ethical principles of beneficence, non-maleficence, and autonomy apply in a medical emergency. For example:

•	Paragraph 12 states that the doctor should act in the patient’s best interests at all times, including in a medical emergency (which is an application of the principle of beneficence). However, paragraph 13 also advises the doctor to consider whether their actions could end up harming the patient (application of the principle of non-maleficence).

•	Paragraph 14 reflects the principle of autonomy by acknowledging that the patient’s consent is required before initiating treatment but this may not be practical in a medical emergency. In that event, doctors are advised to document the actions they take and to discuss this with the patient and their family/whānau when appropriate.  

6.	Are there any changes should we make to the section ‘Ethical considerations in a medical emergency’? 

(G)	Section on ‘Debriefing after the event’
This section is new. In light of the importance of mental health and well-being, doctors need to look after themselves and to seek support — especially after a stressful event or incident. Specifically, paragraph 16 acknowledges the toll responding to a medical emergency can have on a doctor, and recommends that a doctor debrief after the event with someone they trust, while protecting the patient’s privacy.

7.	Are there any changes we should make to the section ‘Debriefing after the event’? 

Consultation process
We value your input.

Enclosed with this consultation paper are copies of our draft statement on A doctor’s duty to help in a medical emergency (Appendix 1) and the existing August 2006 statement (Appendix 2). You are invited to review the draft statement, and give us your views on our proposed changes. You are welcome to respond to some or all of the questions in the consultation paper by completing this form, or by forwarding your feedback in a separate document. Submissions and suggestions should be sent to consultation@mcnz.org.nz by 9 April 2021.