Many college and university campuses are considering, or have considered, adopting a “medical amnesty” or “Good Samaritan” policy for students who are under the influence of alcohol and may be at risk of alcohol overdose or poisoning. These policies are intended to alleviate fear on the part of students about judicial reprisal for using alcohol, so that they may present themselves, or others who may be at risk, to officials and responders who can better respond to a medical emergency.
The arguments for or against medical amnesty are myriad, depending on the unique characteristics of the particular campus, ranging from the general attitude of the student body towards campus alcohol and other drug policies, the availability of emergency services in the vicinity, the ability of campus safety officials to abide by a policy that may run counter to state law, and so on. Generally speaking, however, advocates of the policy contend that such a policy allows students to access help when a student has too much alcohol or drugs in his or her system and is in medical danger. Others may argue against the policy because it could be interpreted as “enabling” irresponsible—if not illegal—behavior on the part of students, and could appear as condoning such behavior.
What is Medical Amnesty?
Medical amnesty refers to the policy on the part of a college or university that attempts to provide some assurance to students that they will not be sanctioned by the university if they seek help for themselves or another student who may be intoxicated and in need of medical attention. In most cases, these policies do not apply to legal consequences of behavior; therefore, the amnesty relates only to a university’s judicial process. Most policies do not exempt students of judicial sanctions for other conduct, such as vandalism or damage to campus property, assaults, or other negative consequences. Policies vary in who is extended amnesty—the caller or the one in need of assistance—but many policies extend amnesty to both parties. On some campuses, these policies also extend to student organizations that host gatherings where a student may be in need of assistance. Many policies provide amnesty for the first situation in which a student requires medical assistance, but not subsequent events. Many policies provide discretion on the part of campus officials to determine whether to apply amnesty on a case by case basis.
A list of campuses with medical amnesty in place can be found at the Students for Sensible Drug Policy Web site (Note: This group is a strong advocate of medical amnesty; The information appears to have been collected in 2007, so may not be current): http://www.ssdp.org/goodsamaritan/research.
To date, only one study has been published in the scholarly literature regarding the impact of medical amnesty on a college campus. Researchers at Cornell University evaluated the effectiveness of a Medical Amnesty Protocol (MAP) in increasing the likelihood that students would call for help in alcohol-related medical emergencies and that they would receive a brief psycho-educational intervention at the university health center as a follow-up to medical treatment (Lewis & Marchell, 2006). Results found consecutive increases in alcohol-related calls for assistance to emergency medical services. Students were also less likely to report fear of getting an intoxicated person in trouble as a barrier to calling for help. The percentage of students seen by health center staff for a brief psycho-educational intervention after an alcohol-related emergency also more than doubled.
This study appears to demonstrate an increased inclination for students to refer friends for medical attention following adoption of the policy. However, a reasonable question to ask is whether students referred for medical services are at less medical risk than they were before the policy was adopted. That is, are students more inclined to call for help rather than waiting until a situation is dire?
Another important outcome of this policy was an increase in student referrals to the health center for a brief psycho-educational intervention following an alcohol-related emergency. This lends support to the notion that policies may help students who are at risk for being problematic or dependent drinkers to receive the assistance they need in the form of early intervention.
Although the policy succeeded at increasing calls for help, the data on overall drinking levels at Cornell during the study period were mixed. Therefore, it is unclear whether the policy promoted or deterred alcohol consumption on the part of students.
What is clear from the research is that there are a number of factors that play a role in students’ decision to call for help in the case of an alcohol-related medical emergency, which may play a role in the impact of a medical amnesty policy. In a 2007 NASPA Journal, Laura Oster-Aaland discusses several assumptions of a medical amnesty policy that are important to test:
- Students can identify symptoms of alcohol poisoning
- Students understand the risk associated with the symptoms of alcohol poisoning
- Students responsible for help-seeking are sober enough to adequately judge the level of risk involved
- Students are currently not calling for help due to fear of getting in trouble with the university
- Students will be more likely to call for help if they are assured that they will not get in trouble
Before implementing a policy, an institution ought to assess students’ knowledge about alcohol poisoning and their attitudes towards calling for help.
Issues and considerations
The information below highlights issues for campuses to consider when the policy of medical amnesty is being debated, and a list of recommendations for campuses to put in place if such a policy is adopted. These recommendations were drawn from a review of research and related articles published to date, along with cases of campuses that have adopted or decided against adopting such practices, and some of the considerations leading to their decisions.
In deciding whether to adopt a medical amnesty policy:
- Gather information from the student body: ask whether students are reluctant to call for help in the case of an emergency. If so, what are their reasons for not calling? Is it fear of administrative sanctions, or other reasons? Do students know the signs of acute alcohol intoxication?
- Gather information regarding the numbers of ER referrals: ask what percentage of admits are underage, and does that seem proportional to drinking rates on campus and to class size? What is the level of severity of alcohol admits to the ER—are students waiting too long to call for help? Are there cases of alcohol poisoning that have not been called in?
- What is the availability of health services on campus? How close is the campus to a critical care unit? If students are not calling for help for fear of reprisal, might potentially catastrophic situations be avoided by instituting an amnesty policy?
- Investigate the implications of adopting the procedure. What professionals on campus would it involve, and can you gain their buy-in and participation? In campuses with sworn police officers, if the policy runs counter to state law, it may be difficult to gain their support.
- Consider the implications of educational or intervention services: If the policy is adopted in conjunction with an automatic referral for education or intervention services, consider what impact this may have on service providers. Can increased support for services be gained by levying fines for students who get referred through the judicial process? Implications for services should be weighed against the potential benefit of getting more students referred to services who may need it.
- Engage in discussion with campuses similar to your own that have adopted medical amnesty, or those that have considered it and decided against it. This discussion may highlight certain aspects of adoption that may be relevant to your own campus. The considerations and implications of adopting medical amnesty are complex, and may best be uncovered in such conversations.
- Gauge campus culture with respect to alcohol policies and student conduct. Consider how other matters are treated with respect to student conduct and behavioral issues. If other “harm reduction” approaches are employed on campus, the policy would be consistent with that philosophy. If the campus philosophy promotes strong and consistent enforcement of alcohol policies, medical amnesty may appear to fly in the face of that.
- Some campuses have concluded that an unwritten policy works better than a written one. They have decided that the more explicit a policy is, the more students may try to abuse it. These campuses have found that educating students about the dangers of alcohol overdose, how to respond appropriately, and that in most cases students won’t see judicial sanctions in the case of emergency works well and avoids conflict with legal counsel and others who are opposed to adopting the policy.
- Consider the question: Can having a medical amnesty policy hurt?
If a campus decides to adopt a policy:
- A policy should clearly state who is and is not covered by the policy, what situations and behavior are covered by the policy, and the jurisdiction of the policy (on campus only, or off-campus also?).
- As with any policy effort, ongoing communication and education about the policy to both students and others on campus are critical.
- Education about how to spot the signs of alcohol/drug overdose is often necessary. The literature indicates that students are more likely to cite not knowing if a situation warrants outside assistance as a reason for not calling for help over their fear of getting into trouble with campus authorities.
- Communication to campus constituencies should clearly state the goals and rationale of the policy.
- Some students may not call for help because of perceived social barriers to intervening. Therefore, some policies refer to intervening as it relates to their code of civility and conduct, i.e., taking care of one another and the norms of the community.
- Some campuses are starting to impose sanctions on students for not calling for help when necessary. This can help to reinforce the importance of calling for help—that calling for assistance is not only possible through medical amnesty, but is expected of students.
- Most medical amnesty policies appear to leave room for discretion for campus officials to decide whether or not to waive sanctions. In the case of an explicit policy, some students may try to find a loophole.
- Coordination with other campus entities is essential. The decision of whether to waive the policy and issue a citation can often be a judgment call, so discussing situations as they arise is important as the policy is adopted and implemented.
- Once the policy is established, evaluate its impact: gather information on students’ perceptions about getting into trouble in the case of an emergency and whether they know the signs of overdose and know what do. If possible, examine rates of ER admits (not just rates of admits but BAC levels of those admitted, if you’re able to get it), judicial referrals, and the number of students being referred for intervention services. Note of caution: An increase in ER admits may be found, but need not be interpreted as a negative outcome. Had students in need of attention not been admitted, one might ask what the outcome of the situation might be. This information must be weighed against overall rates of drinking on campus (going up, down, or staying the same?), the level of severity of cases being admitted to the ER, and the number of students being tracked into early intervention services as a result of the medical amnesty policy being put in place.
- Overall drinking rates prior to and following a medical amnesty policy should be examined, both on campus and as compared to national figures. This may help determine whether the presence of a policy is “enabling irresponsible behavior” or potentially decreasing the serious medical outcomes of drinking at very high levels.
Lewis, D.K., Marchell, T C. (2006). Safety First: A Medical Amnesty Approach to Alcohol Poisoning at a U.S. University. International Journal on Drug Policy, 17, 329–338.
Oster-Aaland, L. & Eighmy, M. A. (2007). Medical Amnesty Policies: Research is Needed. NASPA Journal, 44(4), 715-727.