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Autonomic nervous system
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Autonomic nervous system
Autonomic nervous system innervation.
Note that the graphic contains a typo: replace 'Lacrinal gland' with 'Lacrimal gland'.
Details
Identifiers
Latin
Autonomici systematis nervosi
TA
A14.3.00.001
FMA
9905
Anatomical terminology
[edit on Wikidata]
The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs.[1] The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal.[2] This system is the primary mechanism in control of the fight-or-flight response.
Within the brain, the autonomic nervous system is regulated by the hypothalamus. Autonomic functions include control of respiration, cardiac regulation (the cardiac control center), vasomotor activity (the vasomotor center), and certain reflex actions such as coughing, sneezing, swallowing and vomiting. Those are then subdivided into other areas and are also linked to ANS subsystems and nervous systems external to the brain. The hypothalamus, just above the brain stem, acts as an integrator for autonomic functions, receiving ANS regulatory input from the limbic system to do so.[3]
The autonomic nervous system has three branches: the sympathetic nervous system, the parasympathetic nervous system and the enteric nervous system.[4][5][6][7] Some textbooks do not include the enteric nervous system as part of this system.[8] The sympathetic nervous system is often considered the "fight or flight" system, while the parasympathetic nervous system is often considered the "rest and digest" or "feed and breed" system. In many cases, both of these systems have "opposite" actions where one system activates a physiological response and the other inhibits it. An older simplification of the sympathetic and parasympathetic nervous systems as "excitory" and "inhibitory" was overturned due to the many exceptions found. A more modern characterization is that the sympathetic nervous system is a "quick response mobilizing system" and the parasympathetic is a "more slowly activated dampening system", but even this has exceptions, such as in sexual arousal and orgasm, wherein both play a role.[3]
There are inhibitory and excitatory synapses between neurons. Relatively recently, a third subsystem of neurons that have been named non-noradrenergic, non-cholinergic transmitters (because they use nitric oxide as a neurotransmitter) have been described and found to be integral in autonomic function, in particular in the gut and the lungs.[9]
Although the ANS is also known as the visceral nervous system, the ANS is only connected with the motor side.[10] Most autonomous functions are involuntary but they can often work in conjunction with the somatic nervous system which provides voluntary control.
Contents
[hide]
1 Structure
1.1 Sympathetic division
1.2 Parasympathetic division
1.3 Sensory neurons
1.4 Innervation
1.5 Motor neurons
2 Function
2.1 Sympathetic nervous system
2.2 Parasympathetic nervous system
2.3 Enteric nervous system
2.4 Neurotransmitters
3 Caffeine effects
4 See also
5 References
6 External links
Structure[edit]
Autonomic nervous system, showing splanchnic nerves in middle, and the vagus nerve as "X" in blue. The heart and organs below in list to right are regarded as viscera.
The autonomic nervous system is divided into the sympathetic nervous system and parasympathetic nervous system. The sympathetic division emerges from the spinal cord in the thoracic and lumbar areas, terminating around L2-3. The parasympathetic division has craniosacral “outflow”, meaning that the neurons begin at the cranial nerves (specifically the oculomotor nerve, facial nerve, glossopharyngeal nerve and vagus nerve) and sacral (S2-S4) spinal cord.
The autonomic nervous system is unique in that it requires a sequential two-neuron efferent pathway; the preganglionic neuron must first synapse onto a postganglionic neuron before innervating the target organ. The preganglionic, or first, neuron will begin at the “outflow” and will synapse at the postganglionic, or second, neuron’s cell body. The postganglionic neuron will then synapse at the target organ.
Sympathetic division[edit]
Main article: Sympathetic nervous system
The sympathetic nervous system consists of cells with bodies in the lateral grey column from T1 to L2/3. These cell bodies are "GVE" (general visceral efferent) neurons and are the preganglionic neurons. There are several locations upon which preganglionic neurons can synapse for their postganglionic neurons:
Paravertebral ganglia (3) of the sympathetic chain (these run on either side of the vertebral bodies)
cervical ganglia (3)
thoracic ganglia (12) and rostral lumbar ganglia (2 or 3)
caudal lumbar ganglia and sacral ganglia
Prevertebral ganglia (celiac ganglion, aorticorenal ganglion, superior mesenteric ganglion, inferior mesenteric ganglion)
Chromaffin cells of the adrenal medulla (this is the one exception to the two-neuron pathway rule: the synapse is directly efferent onto the target cell bodies)
These ganglia provide the postganglionic neurons from which innervation of target organs follows. Examples of splanchnic (visceral) nerves are:
Cervical cardiac nerves & thoracic visceral nerves, which synapse in the sympathetic chain
Thoracic splanchnic nerves (greater, lesser, least), which synapse in the prevertebral ganglia
Lumbar splanchnic nerves, which synapse in the prevertebral ganglia
Sacral splanchnic nerves, which synapse in the inferior hypogastric plexus
These all contain afferent (sensory) nerves as well, known as GVA (general visceral afferent) neurons.
Parasympathetic division[edit]
Main article: Parasympathetic nervous system
The parasympathetic nervous system consists of cells with bodies in one of two locations: the brainstem (Cranial Nerves III, VII, IX, X) or the sacral spinal cord (S2, S3, S4). These are the preganglionic neurons, which synapse with postganglionic neurons in these locations:
Parasympathetic ganglia of the head: Ciliary (Cranial nerve III), Submandibular (Cranial nerve VII), Pterygopalatine (Cranial nerve VII), and Otic (Cranial nerve IX)
In or near the wall of an organ innervated by the Vagus (Cranial nerve X) or Sacral nerves (S2, S3, S4)
These ganglia provide the postganglionic neurons from which innervations of target organs follows. Examples are:
The postganglionic parasympathetic splanchnic (visceral) nerves
The vagus nerve, which passes through the thorax and abdominal regions innervating, among other organs, the heart, lungs, liver and stomach
Sensory neurons[edit]
Main article: Sensory neuron
The sensory arm is composed of primary visceral sensory neurons found in the peripheral nervous system (PNS), in cranial sensory ganglia: the geniculate, petrosal and nodose ganglia, appended respectively to cranial nerves VII, IX and X. These sensory neurons monitor the levels of carbon dioxide, oxygen and sugar in the blood, arterial pressure and the chemical composition of the stomach and gut content. They also convey the sense of taste and smell, which, unlike most functions of the ANS, is a conscious perception. Blood oxygen and carbon dioxide are in fact directly sensed by the carotid body, a small collection of chemosensors at the bifurcation of the carotid artery, innervated by the petrosal (IXth) ganglion. Primary sensory neurons project (synapse) onto “second order” visceral sensory neurons located in the medulla oblongata, forming the nucleus of the solitary tract (nTS), that integrates all visceral information. The nTS also receives input from a nearby chemosensory center, the area postrema, that detects toxins in the blood and the cerebrospinal fluid and is essential for chemically induced vomiting or conditional taste aversion (the memory that ensures that an animal that has been poisoned by a food never touches it again). All this visceral sensory information constantly and unconsciously modulates the activity of the motor neurons of the ANS.
Innervation[edit]
Autonomic nerves travel to organs throughout the body. Most organs receive parasympathetic supply by the vagus nerve and sympathetic supply by splanchnic nerves. The sensory part of the latter reaches the spinal column at certain spinal segments. Pain in any internal organ is perceived as referred pain, more specifically as pain from the dermatome corresponding to the spinal segment.[11]

Autonomic nervous supply to organs in the human body edit
Organ
Nerves[12]
Spinal column origin[12]
stomach
PS: anterior and posterior vagal trunks
S: greater splanchnic nerves
T6, T7, T8, T9, sometimes T10
duodenum
PS: vagus nerves
S: greater splanchnic nerves
T5, T6, T7, T8, T9, sometimes T10
jejunum and ileum
PS: posterior vagal trunks
S: greater splanchnic nerves
T5, T6, T7, T8, T9
spleen
S: greater splanchnic nerves
T6, T7, T8
gallbladder and liver
PS: vagus nerve
S: celiac plexus
right phrenic nerve
T6, T7, T8, T9
colon
PS: vagus nerves and pelvic splanchnic nerves
S: lesser and least splanchnic nerves
T10, T11, T12 (proximal colon)
L1, L2, L3, (distal colon)
pancreatic head
PS: vagus nerves
S: thoracic splanchnic nerves
T8, T9
vermiform appendix
nerves to superior mesenteric plexus
T10
kidneys and ureters
PS: vagus nerve
S: thoracic and lumbar splanchnic nerves
T11, T12
Motor neurons[edit]
Main article: Motor neuron
Motor neurons of the autonomic nervous system are found in ‘’autonomic ganglia’’. Those of the parasympathetic branch are located close to the target organ whilst the ganglia of the sympathetic branch are located close to the spinal cord.
The sympathetic ganglia here, are found in two chains: the pre-vertebral and pre-aortic chains. The activity of autonomic ganglionic neurons is modulated by “preganglionic neurons” located in the central nervous system. Preganglionic sympathetic neurons are located in the spinal cord, at the thorax and upper lumbar levels. Preganglionic parasympathetic neurons are found in the medulla oblongata where they form visceral motor nuclei; the dorsal motor nucleus of the vagus nerve; the nucleus ambiguus, the salivatory nuclei, and in the sacral region of the spinal cord.
Function[edit]
Function of the autonomic nervous system [13]
Sympathetic and parasympathetic divisions typically function in opposition to each other. But this opposition is better termed complementary in nature rather than antagonistic. For an analogy, one may think of the sympathetic division as the accelerator and the parasympathetic division as the brake. The sympathetic division typically functions in actions requiring quick responses. The parasympathetic division functions with actions that do not require immediate reaction. The sympathetic system is often considered the "fight or flight" system, while the parasympathetic system is often considered the "rest and digest" or "feed and breed" system.
However, many instances of sympathetic and parasympathetic activity cannot be ascribed to "fight" or "rest" situations. For example, standing up from a reclining or sitting position would entail an unsustainable drop in blood pressure if not for a compensatory increase in the arterial sympathetic tonus. Another example is the constant, second-to-second, modulation of heart rate by sympathetic and parasympathetic influences, as a function of the respiratory cycles. In general, these two systems should be seen as permanently modulating vital functions, in usually antagonistic fashion, to achieve homeostasis. Some typical actions of the sympathetic and parasympathetic systems are listed below.
Sympathetic nervous system[edit]
Main article: Sympathetic nervous system
Promotes a fight-or-flight response, corresponds with arousal and energy generation, and inhibits digestion
Diverts blood flow away from the gastro-intestinal (GI) tract and skin via vasoconstriction
Blood flow to skeletal muscles and the lungs is enhanced (by as much as 1200% in the case of skeletal muscles)
Dilates bronchioles of the lung through circulating epinephrine, which allows for greater alveolar oxygen exchange
Increases heart rate and the contractility of cardiac cells (myocytes), thereby providing a mechanism for enhanced blood flow to skeletal muscles
Dilates pupils and relaxes the ciliary muscle to the lens, allowing more light to enter the eye and enhances far vision
Provides vasodilation for the coronary vessels of the heart
Constricts all the intestinal sphincters and the urinary sphincter
Inhibits peristalsis
Stimulates orgasm
Parasympathetic nervous system[edit]
Main article: Parasympathetic nervous system
The parasympathetic nervous system has been said to promote a "rest and digest" response, promotes calming of the nerves return to regular function, and enhancing digestion. Functions of nerves within the parasympathetic nervous system include:[citation needed]
Dilating blood vessels leading to the GI tract, increasing the blood flow.
Constricting the bronchiolar diameter when the need for oxygen has diminished
Dedicated cardiac branches of the vagus and thoracic spinal accessory nerves impart parasympathetic control of the heart (myocardium)
Constriction of the pupil and contraction of the ciliary muscles, facilitating accommodation and allowing for closer vision
Stimulating salivary gland secretion, and accelerates peristalsis, mediating digestion of food and, indirectly, the absorption of nutrients
Sexual. Nerves of the peripheral nervous system are involved in the erection of genital tissues via the pelvic splanchnic nerves 2–4. They are also responsible for stimulating sexual arousal.
Enteric nervous system[edit]
Main article: Enteric nervous system
The enteric nervous system is the intrinsic nervous system of the gastrointestinal system. It has been described as "the Second Brain of the Human Body".[14] Its functions include:
Sensing chemical and mechanical changes in the gut
Regulation secretions in the gut
Control of peristalsis and some other movements
Neurotransmitters[edit]
Main articles: Table of neurotransmitter actions in the ANS and Non-noradrenergic, non-cholinergic transmitter
At the effector organs, sympathetic ganglionic neurons release noradrenaline (norepinephrine), along with other cotransmitters such as ATP, to act on adrenergic receptors, with the exception of the sweat glands and the adrenal medulla:
Acetylcholine is the preganglionic neurotransmitter for both divisions of the ANS, as well as the postganglionic neurotransmitter of parasympathetic neurons. Nerves that release acetylcholine are said to be cholinergic. In the parasympathetic system, ganglionic neurons use acetylcholine as a neurotransmitter to stimulate muscarinic receptors.
At the adrenal medulla, there is no postsynaptic neuron. Instead the presynaptic neuron releases acetylcholine to act on nicotinic receptors. Stimulation of the adrenal medulla releases adrenaline (epinephrine) into the bloodstream, which acts on adrenoceptors, producing a widespread increase in sympathetic activity.
A full table is found at Table of neurotransmitter actions in the ANS.
Caffeine effects[edit]
Caffeine is a bio-active ingredient found in commonly consumed beverages such as coffee, tea, and sodas. Short-term physiological effects of caffeine include increased blood pressure and sympathetic nerve outflow. Habitual consumption of caffeine may inhibit physiological short-term effects. Consumption of caffeinated espresso increases parasympathetic activity in habitual caffeine consumers; however, decaffeinated espresso inhibits parasympathetic activity in habitual caffeine consumers. It is possible that other bio-active ingredients in decaffeinated espresso may also contribute to the inhibition of parasympathetic activity in habitual caffeine consumers.[15]
Caffeine is capable of increasing work capacity while individuals perform strenuous tasks. In one study, caffeine provoked a greater maximum heart rate while a strenuous task was being performed compared to a placebo. This tendency is likely due to caffeine's ability to increase sympathetic nerve outflow. Furthermore, this study found that recovery after intense exercise was slower when caffeine was consumed prior to exercise. This finding is indicative of caffeine's tendency to inhibit parasympathetic activity in non-habitual consumers. The caffeine-stimulated increase in nerve activity is likely to evoke other physiological effects as the body attempts to maintain homeostasis.[16]
The effects of caffeine on parasympathetic activity may vary depending on the position of the individual when autonomic responses are measured. One study found that the seated position inhibited autonomic activity after caffeine consumption (75 mg); however, parasympathetic activity increased in the supine position. This finding may explain why some habitual caffeine consumers (75 mg or less) do not experience short-term effects of caffeine if their routine requires many hours in a seated position. It is important to note that the data supporting increased parasympathetic activity in the supine position was derived from an experiment involving participants between the ages of 25 and 30 who were considered healthy and sedentary. Caffeine may influence autonomic activity differently for individuals who are more active or elderly.[17]
See also[edit]
Dysautonomia
International Society for Autonomic Neuroscience
Lövheim cube of emotion
References[edit]
Jump up ^ "autonomic nervous system" at Dorland's Medical Dictionary
Jump up ^ Schmidt, A; Thews, G (1989). "Autonomic Nervous System". In Janig, W. Human Physiology (2 ed.). New York, NY: Springer-Verlag. pp. 333–370.
^ Jump up to: a b Allostatic load notebook: Parasympathetic Function - 1999, MacArthur research network, UCSF
Jump up ^ Langley, J.N. (1921). The Autonomic Nervous System Part 1. Cambridge: W. Heffer.
Jump up ^ Jänig, Wilfrid (2008). Integrative action of the autonomic nervous system : neurobiology of homeostasis (Digitally printed version. ed.). Cambridge: Cambridge University Press. p. 13. ISBN 978052106754-6.
Jump up ^ Furness, John (9 October 2007). "Enteric nervous system". Scholarpedia. doi:10.4249/scholarpedia.4064. Retrieved 8 October 2017.
Jump up ^ Willis, William D. (2004). "The Autonomic Nervous System and its central control". In Berne, Robert M. Physiology (5. ed.). St. Louis, Mo.: Mosby. ISBN 0323022251.
Jump up ^ Pocock, Gillian (2006). Human Physiology (3rd ed.). Oxford University Press. pp. 63–64. ISBN 978-0-19-856878-0.
Jump up ^ Belvisi, Maria G.; David Stretton, C.; Yacoub, Magdi; Barnes, Peter J. (1992). "Nitric oxide is the endogenous neurotransmitter of bronchodilator nerves in humans". European Journal of Pharmacology. 210 (2): 221–2. doi:10.1016/0014-2999(92)90676-U. PMID 1350993.
Jump up ^ Costanzo, Linda S. (2007). Physiology. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 37. ISBN 0-7817-7311-3.
Jump up ^ Essential Clinical Anatomy. K.L. Moore & A.M. Agur. Lippincott, 2 ed. 2002. Page 199
^ Jump up to: a b Unless specified otherwise in the boxes, the source is: Moore, Keith L.; Agur, A. M. R. (2002). Essential Clinical Anatomy (2nd ed.). Lippincott Williams & Wilkins. p. 199. ISBN 978-0-7817-5940-3.
Jump up ^ Neil A. Campbell, Jane B. Reece: Biologie. Spektrum-Verlag Heidelberg-Berlin 2003, ISBN 3-8274-1352-4
Jump up ^ Hadhazy, Adam. "Think Twice: How the Gut's "Second Brain" Influences Mood and Well-Being". Archived from the original on February 12, 2010. Retrieved 12/30/2017. Check date values in: |access-date= (help)
Jump up ^ Zimmerman-Viehoff, Frank; Thayer, Julian; Koenig, Julian; Herrmann, Christian; Weber, Cora S.; Deter, Hans-Christian (May 1, 2016). "Short-term effects of espresso coffee on heart rate variability and blood pressure in habitual and non-habitual coffee consumers- a randomized crossover study". Nutritional Neuroscience. 19 (4): 169–175. Retrieved February 20, 2017.
Jump up ^ Bunsawat, Kanokwan; White, Daniel W; Kappus, Rebecca M; Baynard, Tracy (2015). "Caffeine delays autonomic recovery following acute exercise". European Journal of Preventive Cardiology. 22 (11): 1473–1479. Retrieved February 20, 2017.
Jump up ^ Monda, M.; Viggiano, An.; Vicidomini, C.; Viggiano, Al.; Iannaccone, T.; Tafuri, D.; De Luca, B. (2009). "Espresso coffee increases parasympathetic activity in young, healthy people". Nutritional Neuroscience. 12 (1): 43–48. Retrieved February 20, 2017.
External links[edit]
Autonomic nervous system article in Scholarpedia, by Ian Gibbins and Bill Blessing
ANS Medical Notes on rahulgladwin.com
NerveExpress is a fully automatic, non-invasive computer-based system designed for quantitative assessment of the autonomic nervous system (ANS) based on heart rate variability (HRV) analysis.
[show]
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Nervous system
Central nervous system
Meninges
Spinal cord
Brain
Rhombencephalon
Medulla
Pons
Cerebellum
Midbrain
Forebrain
Diencephalon
Retina
Optic nerve
Cerebrum
Limbic system
Peripheral nervous system
Somatic
Sensory nerve
Motor nerve
Cranial nerve
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Autonomic
Sympathetic
Parasympathetic
Enteric
[show]
v
t
e
Anatomy of the autonomic nervous system
Head
Sympathetic
Cervical Chain Ganglion: roots
long ciliary
Deep Petrosal
Parasympathetic
Ciliary ganglion: roots
Sensory
Parasympathetic
Short ciliary
Pterygopalatine ganglion: deep petrosal
nerve of pterygoid canal
branches of distribution: greater palatine
inferior posterior nasal branches
lesser palatine
nasopalatine
medial superior posterior nasal branches
pharyngeal
Submandibular ganglion
Otic ganglion
Neck
Sympathetic
paravertebral ganglia: Cervical ganglia
Superior
Middle
Inferior
Stellate ganglion
prevertebral plexus: Cavernous plexus
Internal carotid
Chest
Sympathetic
paravertebral ganglia: Thoracic ganglia
prevertebral plexus: Cardiac plexus
Esophageal plexus
Pulmonary plexus
Thoracic aortic plexus
splanchnic nerves: cardiopulmonary
thoracic
cardiac nerves: Superior
Middle
Inferior
Abdomen
Sympathetic
paravertebral ganglia: Lumbar ganglia
prevertebral ganglia:
Celiac ganglia
Aorticorenal
Superior mesenteric ganglion
Inferior mesenteric ganglion
prevertebral plexus:
Celiac plexus
Hepatic
Splenic
Pancreatic
aorticorenal
Abdominal aortic plexus
Renal/Suprarenal
Superior mesenteric
Gastric
Inferior mesenteric
Spermatic
Ovarian
Superior hypogastric
hypogastric nerve
Superior rectal
Inferior hypogastric
Vesical
Prostatic / Cavernous nerves of penis
Uterovaginal
Middle rectal
splanchnic nerves: Lumbar splanchnic nerves
Enteric
Submucous plexus
Myenteric plexus
Pelvis
Sympathetic
paravertebral ganglia: Sacral ganglia
Ganglion impar
splanchnic nerves: Sacral splanchnic nerves
Parasympathetic
splanchnic nerves: Pelvic splanchnic nerves
Authority control
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NDL: 00574849
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Good Samaritan law
From Wikipedia, the free encyclopedia
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Not to be confused with Duty to rescue.
The examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (December 2009) (Learn how and when to remove this template message)
Good Samaritan laws offer legal protection to people who give reasonable assistance to those who are, or who they believe to be, injured, ill, in peril, or otherwise incapacitated.[1] The protection is intended to reduce bystanders' hesitation to assist, for fear of being sued or prosecuted for unintentional injury or wrongful death. An example of such a law in common-law areas of Canada: a good Samaritan doctrine is a legal principle that prevents a rescuer who has voluntarily helped a victim in distress from being successfully sued for wrongdoing. Its purpose is to keep people from being reluctant to help a stranger in need for fear of legal repercussions should they make some mistake in treatment.[2] By contrast, a duty to rescue law requires people to offer assistance, and holds those who fail to do so liable.
Good Samaritan laws may vary from jurisdiction to jurisdiction as do their interactions with various other legal principles, such as consent, parental rights and the right to refuse treatment. Most such laws do not apply to medical professionals' or career emergency responders' on-the-job conduct, but some extend protection to professional rescuers when they are acting in a volunteer capacity.
The principles contained in good Samaritan laws more typically operate in countries in which the foundation of the legal system is English Common Law, such as Australia.[3] In many countries that use civil law as the foundation for their legal systems, the same legal effect is more typically achieved using a principle of duty to rescue.
Good Samaritan laws take their name from a parable found in the Bible, attributed to Jesus, commonly referred to as the Parable of the Good Samaritan which is contained in Luke 10:25-37. It recounts the aid given by a traveler from the area known as Samaria to another traveler of a conflicting religious and ethnic background who had been beaten and robbed by bandits.[4]
Contents
[hide]
1 Regions
1.1 Australia
1.2 Canada
1.3 China
1.4 Finland
1.5 Germany
1.6 Ireland
1.7 Israel
1.8 United States
1.9 United Kingdom
2 Common features
2.1 Duty to Assist
2.2 Imminent Peril
2.3 Reward or Compensation
2.4 Obligation to Remain
2.5 Consent
2.5.1 Implied consent
2.5.2 Parental consent
2.5.3 Laws for first responders only
3 Comparison with duty to rescue
4 See also
5 References and notes
6 External links
Regions[edit]
Australia[edit]
Most Australian states and territories have some form of good Samaritan protection. In general these offer protection if care is made in good faith, and the "good Samaritan" is not impaired by drugs or alcohol. Variations exist between states, from not applying if the "good Samaritan" is the cause of the problem (New South Wales), to applying under all circumstances if the attempt is made in good faith (Victoria).[5]
Canada[edit]
In Canada, good Samaritan acts fall under provincial jurisdiction. Each province has its own act, such as Ontario[6] and British Columbia's[7] respective Good Samaritan Acts, Alberta's Emergency Medical Aid Act,[8] and Nova Scotia's Volunteer Services Act[9] Only in Quebec, a civil law jurisdiction, does a person have a general duty to respond, as detailed in the Quebec Charter of Human Rights and Freedoms.[10][11]
An example of a typical Canadian law is provided here, from Ontario's Good Samaritan Act, 2001, section 2:
Protection from liability
2. (1) Despite the rules of common law, a person described in subsection (2) who voluntarily and without reasonable expectation of compensation or reward provides the services described in that subsection is not liable for damages that result from the person's negligence in acting or failing to act while providing the services, unless it is established that the damages were caused by the gross negligence of the person. 2001, c. 2, s. 2 (1).[12]
Yukon and Nunavut do not have good Samaritan laws.
China[edit]
There have been incidents in China, such as the Peng Yu incident in 2006,[13][14] where good Samaritans who helped people injured in accidents were accused of having injured the victim themselves.
The death of Wang Yue was caused when the toddler was run over by two vehicles. The entire incident was caught on a video, which shows eighteen people seeing the child but refusing to help. In a November 2011 survey, a majority, 71%, thought that the people who passed the child without helping were afraid of getting into trouble themselves.[15]
According to China Daily, "at least 10 Party and government departments and organizations in Guangdong, including the province's commission on politics and law, the women's federation, the Academy of Social Sciences, and the Communist Youth League, have started discussions on punishing those who refuse to help people who clearly need it."[16] Officials of Guangdong province, along with many lawyers and social workers, also held three days of meetings in the provincial capital of Guangzhou to discuss the case. It was reported that various lawmakers of the province are drafting a good Samaritan law, which would "penalize people who fail to help in a situation of this type and indemnify them from lawsuits if their efforts are in vain."[17] Legal experts and the public are debating the idea ahead of discussions and a legislative push.[18] On 1 August 2013, the nation's first good Samaritan law went into effect in Shenzhen.[19]
On 1 Oct 2017, China’s national Good Samaritan law came into force, Clause 184 in Civil Law General Principles.
Finland[edit]
The Finnish Rescue Act explicitly stipulates a duty to rescue as a "general duty to act" and "engage in rescue activities according to [one's] abilities". The Finnish Rescue Act thus includes a principle of proportionality which requires professionals to extend immediate aid further than lay persons.
The Finnish Criminal Code[20] stipulates
"Section 15 - Neglect of rescue (578/1995) A person who knows that another is in mortal danger or serious danger to his or her health, and does not give or procure such assistance that in view of his or her options and the nature of the situation can reasonably be expected, shall be sentenced for neglect of rescue to a fine or to imprisonment for at most six months."
Germany[edit]
In Germany, failure to provide first aid to a person in need is punishable under § 323c of its criminal penal code. However, any help one provides cannot and will not be prosecuted even if it made the situation worse or did not fulfill specific first aid criteria. People are thus encouraged to help in any way possible, even if the attempt is not successful.[21] Moreover, people providing first aid are covered by the German Statutory Accident Insurance in case they suffer injury, losses, or damages.[22]
Ireland[edit]
The Civil Law (Miscellaneous Provisions) Act of 2011[23] first introduced legislation specifically addressing the liability of citizen good Samaritans or volunteers in the Republic of Ireland, without introducing a duty to intervene. This act provides for exemption from liability for a person, or voluntary organisation, for anything done while providing "assistance, advice or care" to a person who is injured, in serious risk or danger of becoming injured or suffering from an illness (or apparently so). There are exclusions for cases of "bad faith" or "gross negligence" on behalf of the carer, and incidents relating to negligent use of motor vehicles. This Act only addresses situations where there is no duty of care owed by the good Samaritan or the volunteer.
Israel[edit]
In Israel, the law requires anyone to assist a person in danger or at the very least call for help. People who help in good faith are not liable for damages. Helpers are eligible for compensation for damages caused to them during their assistance.
United States[edit]
All 50 states and the District of Columbia have some type of Good Samaritan law. The details of good Samaritan laws/acts vary by jurisdiction, including who is protected from liability and under what circumstances.[24]
The 1996 Federal Emerson Act was intended to encourage donations of food and grocery products that meet quality and labeling standards imposed by federal, state and local laws and regulations, by protecting the donor and the recipient agency against liability, excepting in the case of gross negligence and/or intentional misconduct. Prior to passage of the Emerson Act differences in language and applicability between states often discouraged national and regional companies from donating, resulting in otherwise usable food being sent to landfills.
The 1998 Aviation Medical Assistance Act also provided coverage for "Good Samaritans" while in flight (Section 5b) [25]
United Kingdom[edit]
In the common law of England and Wales there is no criminal liability for failing to act in the event of another person being in danger; however, there are exceptions to this rule. In instances where there has been an assumption of responsibility by the bystander, a dangerous situation was created by them, or there is a contractual or statutory duty to act, criminal liability would be imposed on the bystander for their failure to take action. The courts are reluctant to penalize people attempting rescue and English law makes provision for the actions of 'good Samaritans,' unless their actions were grossly negligent or made a situation worse. Cases such as Donoghue v Stevenson[26] where Lord Atkin culminates the parable of the good samaritan principle to 'love your neighbour' transposed in law for negligence liability. Donoghue won the case.
Common features[edit]
Duty to Assist[edit]
In some jurisdictions, unless a caretaker relationship (such as a parent-child or doctor-patient relationship) exists prior to the illness or injury, or the "good Samaritan" is responsible for the existence of the illness or injury, no person is required to give aid of any sort to a victim. Good Samaritan statutes in the states of Minnesota and Vermont do require a person at the scene of an emergency to provide reasonable assistance to a person in need.[27][28] This assistance may be to call 9-1-1. Violation of the duty-to-assist subdivision is a petty misdemeanor in Minnesota and may warrant a fine of up to $100 in Vermont. At least five other states, including California and Nevada, have seriously considered adding duty-to-assist subdivisions to their good Samaritan statutes.[29] New York's law provides immunity for those who assist in an emergency.[30] The public policy behind the law is:
The furnishing of medical assistance in an emergency is a matter of vital concern affecting the public health, safety and welfare. Prehospital emergency medical care, the provision of prompt and effective communication among ambulances and hospitals[,] and safe and effective care and transportation of the sick and injured are essential public health services.
—  N.Y. Public Health L. § 3000.[31]
Imminent Peril[edit]
Good Samaritan provisions are not universal in application. The legal principle of imminent peril may also apply.[32] In the absence of imminent peril, the actions of a rescuer may be perceived by the courts to be reckless and not worthy of protection. To illustrate, a motor vehicle collision occurs, but there is no fire, no immediate life threat from injuries and no danger of a second collision. If someone, with good intentions, causes injury by pulling the victim from the wreckage, a court may rule that good Samaritan laws do not apply because the victim was not in imminent peril and hold the actions of the rescuer to be unnecessary and reckless.[33][34]
Reward or Compensation[edit]
Only first aid provided without intention of reward or financial compensation is covered. Medical professionals are typically not protected by good Samaritan laws when performing first aid in connection with their employment.[35] Some states make specific provisions for trained medical professionals acting as volunteers and for members of volunteer rescue squads acting without expectation of remuneration.[30][36] In Texas, a physician who voluntarily assisted in the delivery of an infant, and who proved that he had "no expectation of remuneration", had no liability for the infant's injuries due to allegedly ordinary negligence; there was "uncontroverted testimony that neither he nor any doctor in Travis County would have charged a fee to [the mother] or any other person under the circumstances of this case."[37] It was significant that the doctor was not an employee of the attending physician, but was only visiting the hospital and had responded to a "Dr. Stork" page, and had not asked or expected to be paid.[37]
Obligation to Remain[edit]
If a responder begins rendering aid, he must not leave the scene until it is necessary to call for needed medical assistance, a rescuer of equal or higher ability takes over, or continuing to give aid is unsafe. This can be as simple as a lack of adequate protection against potential diseases, such as vinyl, latex, or nitrile gloves to protect against blood-borne pathogens. A responder is never legally compelled to take risks to aid another person. The responder is not legally liable for any harm to the person assisted, as long as the responder acted rationally, in good faith and in accordance with their level of training.[38]
Consent[edit]
The responder must obtain the consent of the patient, or of the legal guardian of a patient who is a minor, unless this is not possible; failing to do so may attract a charge of assault or battery.
Implied consent[edit]
Main article: Implied consent
Consent may be implied if an unattended patient is unconscious, delusional, intoxicated or deemed mentally unfit to make decisions regarding his or her safety, or if the responder has a reasonable belief that this was so; courts tend to be very forgiving in adjudicating this, under the legal fiction that "peril invites rescue" (as in the rescue doctrine).[39] The test in most jurisdictions is that of the "average, reasonable person". To illustrate, would the average, reasonable person in any of the states described above consent to receiving assistance in these circumstances if able to make a decision?
Consent may also be implied if the legal parent or guardian is not immediately reachable and the patient is not considered an adult.
Parental consent[edit]
If the victim is a minor, consent must come from a parent or guardian. However, if the legal parent or guardian is absent, unconscious, delusional or intoxicated, consent is implied. A responder is not required to withhold life-saving treatment (e.g., CPR or the Heimlich maneuver) from a minor if the parent or guardian will not consent.[citation needed] The parent or guardian is then considered neglecting, and consent for treatment is implied by default because neglect has been committed. Special circumstances may exist if child abuse is suspected (the courts will usually give immunity to those first responders who report what they reasonably consider to be evidence of child abuse or neglect, similar to that given to those who have an actual duty to report such abuse, such as teachers or counsellors).[40]
Laws for first responders only[edit]
In some jurisdictions,[which?] good Samaritan laws only protect those who have completed basic first aid training and are certified by health organizations, such as the American Heart Association, or American Red Cross, provided that they have acted within the scope of their training.[41] In these jurisdictions, a person who is neither trained in first aid nor certified, and who performs first aid incorrectly, can be held legally liable for errors made. In other jurisdictions any rescuer is protected from liability so long as the responder acted rationally.[citation needed] In Florida, paramedics, EMTs, and Emergency Medical Responders (First Responders) are required by law to act under the Duty to Act law, which requires them to stop and give aid that falls within their practice.[citation needed]
Comparison with duty to rescue[edit]
Good Samaritan laws may be confused with the duty to rescue, as described above. U.S. and Canadian approaches to this issue differ. Under the common law, good Samaritan laws provide a defence against torts arising from the attempted rescue. Such laws do not constitute a duty to rescue, such as exists in some civil law countries,[42] and in the common law under certain circumstances. However, the duty to rescue where it exists may itself imply a shield from liability; for example, under the German law of unterlassene Hilfeleistung (an offense not to provide first aid when necessary), a citizen is obliged to provide first aid when necessary and is immune from prosecution if assistance given in good faith turns out to be harmful. In Canada, all provinces with the exception of Quebec operate on the basis of English Common Law. Quebec operates a civil law system, based in part on the Napoleonic Code, and the principle of duty to rescue does apply.[43] Similarly, in France anyone who fails to render assistance to a person in danger will be found liable before French Courts (civil and criminal liability). The penalty for this offence in criminal courts is imprisonment and a fine (under article 223–6 of the Criminal Code) while in civil courts judges will order payment of pecuniary compensation to the victims.[44]
To illustrate a variation in the concept of duty to rescue, in the Canadian province of Ontario, the Occupational Health and Safety Act provides all workers with the right to refuse to perform unsafe work. There are, however, specific exceptions to this right. When the "life, health or safety of another person is at risk," then specific groups, including "police officers, firefighters, or employees of a hospital, clinic or other type of medical worker (including EMS)" are specifically excluded from the right to refuse unsafe work.[45]
See also[edit]
Bystander effect
Duty to rescue
Medical amnesty policy
Sanhedrin (tractate)
References and notes[edit]
Jump up ^ DAN Legal Network: The Good Samaritan Law across Europe
Jump up ^ "What are good samaritan laws?". Retrieved 2018-01-24.
Jump up ^ Gulam H, Devereaux J (2007). "A brief primer on Good Samaritan Law for health care professionals". Australian Health Review. 31 (3): 478–482.
Jump up ^ Good Samaritan. (n.d.). Merriam-Webster's Dictionary of Law. Retrieved January 09, 2010, from Dictionary.com website: http://dictionary.reference.com/browse/Good+Samaritan
Jump up ^ Bird, Sara (July 2008). "Good Samaritans" (PDF). Australian Family Physician. 30 (7): 570–751. Retrieved 28 November 2017.
Jump up ^ "Good Samaritan Act, S.O., 2001 (Ontario E-laws website)". Retrieved 2015-07-27.
Jump up ^ "Good Samaritan Act [RSBC 1996] CHAPTER 172 (British Columbia Queen's Printer website)". Retrieved 2008-10-10.
Jump up ^ "Emergency Medical Aid Act (Alberta Queen's Printer website". Retrieved 2014-09-29.
Jump up ^ "Volunteer Services Act 'Good Samaritan' RSNS 1989 (amend. 1992) (Nova Scotia Legislature website)". Retrieved 2008-10-10.
Jump up ^ "Quebec Charter of Rights and Freedom". Éditeur officiel du Québec. Retrieved 2012-07-18.
Jump up ^ "Good Samaritan Law from The Canadian Association of Food Banks". Canadian Association of Food Banks (via Internet Archive). Archived from the original on 2007-12-17. Retrieved 2008-10-20.
Jump up ^ "Good Samaritan Act, 2001 ©Queen's Printer for Ontario, 2005". Archived from the original on February 13, 2007. Retrieved December 26, 2005.
Jump up ^ Martinsen, Joel (7 September 2007). "A 45,000-yuan helping hand: common sense, decency, and crowded public transportation". danwei.org. Retrieved 23 October 2011.
Jump up ^ "Ignored toddler doesn't tell the whole story about China". The Globe and Mail. 19 October 2011. Retrieved 23 October 2011.
Jump up ^ "Youths search their souls after Yue Yue's death". China.org.cn. 2 November 2011. Retrieved 3 November 2011.
Jump up ^ Zheng, Caixiong (20 October 2011). "Law mulled to make aid compulsory". chinadaily.com.cn. Retrieved 23 October 2011.
Jump up ^ Demick, Barbara (21 October 2011). "Chinese toddler's death evokes outpouring of grief and guilt". latimes.com. Retrieved 23 October 2011.
Jump up ^ Chin, Josh (October 22, 2011). "Toddler's Death Stirs Ire in China". The Wall Street Journal. Retrieved October 22, 2011.
Jump up ^ Huifeng, He (1 August 2013). "Shenzhen introduces Good Samaritan law". South China Morning Post. Retrieved January 14, 2014.
Jump up ^ http://www.finlex.fi/en/laki/kaannokset/1889/en18890039
Jump up ^ (in German) § 323c [Unterlassene Hilfeleistung] error: {{lang}}: text has italic markup (help) (Strafgesetzbuch – stgb) [ Omission to effect an easy rescue]. (in English) English version.
Jump up ^ Sozialgesetzbuch 7. §2, §13.
Jump up ^ Section 4 of the Civil Law (Miscellaneous Provisions) Act 2011 (Public Act No. 23 of 2011). Act of the Irish Parliament.
Jump up ^ The laws include: Maryland Courts and Judicial Proceedings Code § 5-603; VA § 8.01-225; NC § 20-166 and § 90-21.14; SC § 15-1-310; TN 63-6-218; GA § 51-1-29; Long list for 50 states: https://recreation-law.com/2014/05/28/good-samaritan-laws-by-state/
Jump up ^ AMAA, 1998 https://www.gpo.gov/fdsys/pkg/CRPT-105hrpt456/pdf/CRPT-105hrpt456.pdf
Jump up ^ Donoghue v Stevenson [1932] AC 562, 580 (Lord Atkin)
Jump up ^ "Vermont Good Samaritan Law". Retrieved 2008-10-17.
Jump up ^ 604A.01 MINNESOTA GOOD SAMARITAN LAW
Jump up ^ Lyons, Donna (1999-03-01). "Help Your Neighbor—It's the Law". State Legislatures. Archived from the original on 2007-09-07. Retrieved 2008-10-20.
^ Jump up to: a b N.Y. Public Health L. §§ 3000-a, 3000-b, 3013 (McKinney 2000); see also NY State Assembly website database of law. Accessed July 25, 2011.
Jump up ^ N.Y. Public Health L. § 3000 (McKinney 2000); see also NY State Assembly website database of law. Accessed July 25, 2011.
Jump up ^ "What is the Good Samaritan Law? (essortment website)". Archived from the original on 2008-12-05. Retrieved 2008-10-16.
Jump up ^ "Good samaritan law may not apply (USA Today)". 2007-03-23. Retrieved 2008-10-17.
Jump up ^ See also, California Supreme Court decision in Van Horn vs. Torti, December 18, 2008, with a similar fact pattern and limitation of protection to medical personnel rendering medical aid.
Jump up ^ "RCW 4.24.300 Immunity from liability for certain types of medical care (Washington State Legislature website)". Retrieved 2008-10-17.
Jump up ^ "Colorado Good Samaritan Law". Archived from the original on 2008-07-23. Retrieved 2008-10-17.
^ Jump up to: a b McIntyre v. Ramirez, 109 S.W.3d 741 (Tex. Sup. Ct. 2003), overturning 59 S.W.3d 821 (Tex. Ct. of Appeals) and citing Tex. Civ. Prac. & Rem. Code § 74.001 (effective in 1998, and since amended), found at Texas Courts website. Accessed July 25, 2011.
Jump up ^ Rolfsen ML (2007). "Medical care provided during a disaster should be immune from liability or criminal prosecution". The Journal of the Louisiana State Medical Society. 159 (4): 224–5, 227–9. PMID 17987961.
Jump up ^ "Implied Consent". Retrieved 2008-10-17.
Jump up ^ Foltin GL, Lucky C, Portelli I, et al. (June 2008). "Overcoming legal obstacles involving the voluntary care of children who are separated from their legal guardians during a disaster". Pediatric Emergency Care. 24 (6): 392–8. doi:10.1097/PEC.0b013e318178c05d. PMID 18562886.
Jump up ^ "Good Samaritan/Fireman's Rule". Retrieved 2008-10-17.
Jump up ^ Higuchi N (March 2008). "[Good Samaritan Act and physicians' duty to rescue]". Nippon Hoshasen Gijutsu Gakkai zasshi (in Japanese). 64 (3): 382–4. doi:10.6009/jjrt.64.382. PMID 18434681.
Jump up ^ "Canadian Law website 2". Retrieved 2008-10-16.
Jump up ^ Audrey Laur (March 2013). "Liabilities of Doctors on Aircraft". Medico-Legal Journal. 81: 31—35.
Jump up ^ "Occupational Health and Safety Act, R.S.O. (1990) (Ontario E-laws website)". Retrieved 2008-10-10.
External links[edit]
Summary of good samaritan laws for various US jurisdictions
Good Samaritan Act of Ontario, 2001
Good Samaritan Law
Good Samaritan Day
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