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Medical Amnesty:

Professional Enabling or Indicated Prevention?

© 2005 Robert J. Chapman, PhD

La Salle University

NOTE: If published as a Network position, this will carry a Network by-line

As institutions of higher education successfully implement strategies consistent with an environmental approach to changing the campus drinking culture (c.f., http://www.edc.org/hec/pubs/enviro-mgnt.html ), an issue of increasing concern to many in higher education is the propensity for some students to engage in drinking to excess and becoming intoxicated "off-campus." This phenomenon is not new and the problems created by students that become intoxicated in the community exacerbate traditional town – gown tensions. But the issue of students going off-campus to drink, in larger numbers and with more frequent drinking-related consequences, would seem to be correlated with, if not the result of, consistent campus attention to employing the strategies of environmental management. Like a crackdown by police in a high crime area does not so much end the crime as move it to another location, so would it seem that consistent use of environmental management strategies have provoked a shift in where at least some students go to drink. And if they have changed the venue of their drinking as a result of effective environmental management strategies, then responding to this student migration may be a next step in addressing high-risk collegiate drinking.


Currently, when students drink to a point of intoxication, friends tend to assist them as they attempt to return to campus. The primary concern of these well-intentioned peers is to assist the inebriate, but to do so while all the time avoiding detection by the institution. In short, making sure the assisted inebriate is not written-up has primacy when students help intoxicated acquaintances get home. The inherent risk in this practice is that in attempting to avoid detection, these well intentioned friends may inadvertently "smuggle" a dangerously intoxicated peer back into a residence hall or other sanctuary to "sleep it off," never realizing that the student’s blood alcohol level had yet to peak or that the drinker had consumed some other drug(s) in addition to the alcohol that may result in coma or death.
The intent of this essay is to review the pros and cons of employing what has come to be known as a Good Samaritan Policy or what some refer to as medical amnesty. Such policies are designed to address dangerous student drinking off campus. These policies differ in their details but have a common focus in an attempt to protect the inebriate from harm by allowing students who request help—either for themselves or a peer—to do so without fear of disciplinary repercussions. But can such policies be created and implemented in such a way as to avoid the perception of enabling maladaptive student behavior or, from the perspective of members of the community surrounding the institution, favoring the rights of the student over those of residents living in the neighborhoods where students tend to party?
A person in trouble is a person in trouble, irrespective of how the trouble came to be. Just as the individual who, in a hurricane, remains in a home in spite of an evacuation order can expect to receive medical treatment without fear of arrest if injured in the storm, should an intoxicated student who requests help because of drinking be able to expect the same assistance, and if so, with no consequences? Restricted consequences? Educational consequences? Can a contemporary college or university increase the likelihood that "students in trouble" will turn to the institution for the aid and assistance that could preclude a fatal case of "alcohol poisoning?" If students eschew the institution when experiencing medical emergencies because of a fear of the disciplinary repercussions associated with receiving such help, then assuaging that fear may be another area appropriate for consideration by the institution serious about curbing dangerous collegiate drinking.

Preventing High-Risk and Dangerous Student Behavior


For more than a decade, the college health and student affairs literature has been replete with articles about high-risk and dangerous student drinking, including strategies intended to intervene with this problem. Yet during this same period there has been a shift in how prevention is viewed. This shift has been from categorizing prevention efforts as primary (prevention), secondary (intervention) or tertiary (treatment) approaches to viewing prevention as targeting universal, selective and indicated populations. In essence the shift has been from viewing prevention as primarily concerned with “what” is done to focusing on “whom” the prevention is targeting. The former consideration of prevention looked at the effort as being focused on the strategy—primary prevention was intended to keep individuals “from starting,” secondary was intended to intervene in high-risk behavior and tertiary prevention was treatment for the problem user. The current conceptualization considers a population like contemporary collegians and recognizes that in the general (universal) population there are those who do not display high-risk or problematic behavior, those who are at risk (selective) of developing a problem and those already manifesting symptoms (indicated) of a problem. These subpopulations coexist in the general population being considered by the prevention professional. Consequently contemporary prevention efforts are directed at identifying interventions appropriate for each specific target population in order to reduce the likelihood of harm, recognizing that there are numerous objectives and strategies that can be implemented concurrently. If students who go off-campus to drink are to be viewed through “lenses of prevention,” then they could be considered an indicated population.
As the role drinking plays in the social lives of students is considered, many professionals in student affairs are increasingly concerned that it is not a question of "if" one of their students will be seriously injured or die do to drinking or drugging, but "when" this will occur. This academic year (2004-2005) there have been five such student deaths in Colorado alone.
Because of the effectiveness of environmental management strategies, some students, the committed drinkers, have chosen to pursue their high-risk approach to partying in even less supervised off-campus venues. In effect, some of the high-risk drinkers have decided to shift their drinking from residences controlled by institutions of higher education to venues where they feel safer, i.e., less likely get into trouble, if only because they are less supervised.
Although there is no question as to whether institutions of higher education should provide assistance to students in crisis, doing so does present the institution with something of a dilemma: Is encouraging students in crisis off-campus to request assistance for themselves or their friends, without fear of recriminations, tantamount to condoning the student drinking that provoked the situation if not acknowledging responsibility for having created the campus climate that motivated off-campus exodus in the first place?
To address the relative merits and consequences of “Good Samaritan” policies, institutions of higher education must consider both sides of the issue. To do so will likely result in individual decisions that reflect the mission statements and administrative values of each college or university addressing this dilemma. To approach this question in an organized fashion, the “Pros” and “Cons” of such policies will be considered in turn. First the “Pros.”
Possible Merits of Good Samaritan Policies

  • Such policies represent a proactive response to the institution’s awareness that its efforts to change the campus drinking culture have been working. They can be argued as being consistent with a school’s stated mission as an institution of higher education concerned about the total well being of its students.




  • Such policies enable an institution to more effectively address the issues of civility and citizenship with its students. This issue has been receiving increased attention in higher education as a factor likely associated with student behavior, both in and out of the classroom. By widely publicizing the existence of a Good Samaritan policy, students can be taught how to assume a truly supportive role as they come to the aid of their peers and significant others. In essence, instead of enabling dangerous behavior, increasing the likelihood that it will be confronted for what it is, a medical emergency, and suggest the drinking that preceded it was high-risk and dangerous.




  • Such policies do not supersede existing institution policy. For example, if a student were found to be excessively intoxicated in the residence halls, that student could be handled in exactly the same way similar students are handled currently. In other words, if vomiting in a hallway and being confronted by an RA, a Good Samaritan policy would not allow a student to "ask for help" and therefore be excused from the consequences of his or her decision to drink. To the contrary, this is a student the institution would want to be confronted and involved in the disciplinary system in order to motivate an educational if not therapeutic intervention that can assist in preventing the likelihood of future high-risk drinking.




  • Good Samaritan policies are designed for the student who has become concerned for the well being of another at an off-campus location. They encourage contacting the institution to seek assistance so that at-risk students can be medically evaluated and, if necessary, transported to the hospital.




  • Existing policies that involve parents should a student be hospitalized would remain in effect. The difference from the current policy an institution may have regarding such hospitalization is the student taken to the hospital as the result of asking for help would not be "written-up" and referred to the campus disciplinary system as the result of the intoxication.


Possible Concerns Regarding “Good Samaritan” Policies





  • Such policies cover any and all incidents, regardless of how frequently a particular student may invoke it, inviting abuses of the policy.

  • Considering the purpose of such a policy becomes important in addressing this question. For example, if reducing the likelihood of drinking-related untoward incidents has primacy, then “how often” such untoward incidents are prevented become something of a moot point. If, on the other hand, institutions wish to reserve the ability to mandate excessively intoxicated students to some type of clinical intervention, a variation of such policies may be more appropriate. Either way, how the policy is marketed will be of significant importance to its use by students.




  • Such policies will be in conflict with existing policies regarding zero tolerance.

  • Such policies should not be a “get out of jail free card.” For example, if a nursing student reported to clinical rounds under the influence or the coach of a sports team encountered a player under the influence, that student should not be able to avoid the consequences of his or her decision by requesting assistance.

  • Such policies are tantamount to condoning if not underwriting high-risk and dangerous behavior.

  • Although an understandable argument, perhaps one that should be considered in light of the reason for considering a Good Samaritan policy in the first place.

  • Such policies suggest that an institution is aware that a problem exists. This awareness constitutes a duty to act.

  • This likely requires a legal interpretation of duty to act. It is likely that the intent of the policy will be construed as proactive.

    • The extension of medical amnesty to students engaged in high-risk behavior off-campus will be construed, as the institution’s bias in favor of student needs over the concerns of the community.

  • Involve the community in discussions on the merits and concerns of Good Samaritan policies

    • Such a policy will hinder Safety & Security's options regarding how best to address individual situations.

    1. This is yet another valid argument. Medical amnesty does not mean that representatives of the institution that become involved with excessively intoxicated students cannot hold students responsible for the consequences of their decisions. It means that if a student in need of assistance called Safety & Security, the troubled student would be assisted in receiving the appropriate level of medical care…without judicial repercussions.

    2. If the security office encountered an excessively intoxicated student vandalizing a car or engaging in a fight, then the officer would intervene in such a way as to confront the behavior. True, this may also include transport to the hospital for medical care, but the medical treatment does not preclude the fact that the student was involved in vandalism or violence, for which judicial sanctions would appropriately follow.

In summary:


1. Because of the effectiveness of efforts to address the high-risk use of alcohol on American college and university campuses, some student have taken their high-risk drinking off-campus. Environmental management strategies such as reducing the availability of alcohol on campus and the consistent enforcement of appropriate institutional alcohol policies have motivated some students to move off-campus in order to pursue their desire to drink.

2. The migration of high-risk drinking off-campus by some has led to an increased risk that alcohol poisoning may occur beyond an institution of higher education’s direct area of control. In order to reduce the likelihood of untoward incidents involving excessive intoxication off-campus, encouraging help-seeking behaviors by students caring for intoxicated peers may be an issue of primacy for colleges and universities.

3. Policies that provide some degree of immunity from disciplinary sanctions for those assisting an intoxicated peer as well as the intoxicant may reduce the risk of these alcohol-related untoward incidents occurring off-campus.

4. Such efforts to promote student health and safety should not supersede existing policy regarding student behavior on campus and be established so as to be consistent with an institution’s mission.


NOTE: Efforts to reduce the likelihood that individuals in our society will harm themselves or others are neither new nor alien. Even in situations where individuals may make a conscious decision to engage in behavior construed as high-risk, such steps can reduce the likelihood that these individuals will cause harm to themselves or problems for others. Examples include:

      1. Producing filtered and low-tar cigarettes

      2. Fire extinguishers

      3. Condom use in high-risk sexual behavior

      4. Anti-lock brakes

      5. Reconfiguring high-risk or dangerous highways

      6. No-skid treads on steps

      7. Iodized salt

      8. Flame retardant materials

      9. Fluoridated water

References


http://www.whiteplainscnr.com/article1055.html

Schools With Medical Amnesty Policies:


Cornell Universityhttp://www.gannett.cornell.edu/emergencies/types/map.html University web site to advertise the policy  http://www.medical-amnesty.cornell.edu/
University Of Pennsylvania  http://www.vpul.upenn.edu/ohe/library/drugs/amnesty.htm also an article from the 13 Jan 2005 Daily Pennsylvanian  http://www.dailypennsylvanian.com/vnews/display.v/ART/2004/09/02/4136614cb8d13
Hanover Collegehttp://www.hanover.edu/life/studentlife/handbook/communityliving/alcohol.php (scroll down to “Medical Amnesty”
NYU http://www.nyu.edu/housing/residencelife/alcoholdrug.html
Keystone Collegehttp://www.keystone.edu/Documents/StudentInformationGuide/Medical%20Amnesty.pdf
Lafayette Collegehttp://ww2.lafayette.edu/~bailey/good_samaritan.php
Schools With “Good Samaritan” Policies:
Dartmouth College  http://www.dartmouth.edu/~deancoll/documents/handbook/rules-regs/alc-drugs.html (section XI)
Lehigh University  http://www.lehigh.edu/~indost/dos/hbook_5.html (section VII.c)
College Misericordia  http://www.misericordia.edu/current/studentHB/handbook2.cfm



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