Download Free PDF View PDF John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Monday, January 2, 2017. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. MA Healthcare Ltd Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. This is a part of and more. Despite this, there remain multiple barriers to their fully effective provision of such care. Ethics, bioethics and legal issues in paramedic practice. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Copyright 2023 John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. The question of justice is another part of the paramedical performance. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. Utilizing a priority dispatch system allows dispatchers to send response . D. Incomplete . Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 153: The first concern for an EMT must be: A. patient safety. By continuing you agree to the use of cookies. Our paramedic test questions are listed below. Inform client/staff members of ethical issues affecting client care. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. Removed to place of safety for up to 72 hours for further assessment. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Chat. This exploratory case study utilized semi-structured interviews of thirteen North. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. B. EMTs are not liable for any actions that are accurately documented. This course is made up of a number of paramedic specific units and additional health care units. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). | This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able: To provide an overview of the four key ethical principles that underpin current clinical practice in the UK To explore these four ethical principles in relation to specific prehospital and clinical issues To encourage the practitioner to reflect on their own ethical practice To begin to develop the ability to share, discuss and debate the four ethical principles with colleagues and friends, in relation to your own clinical practice. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. A person must be presumed to have capacity unless it is established that he lacks capacity. Therefore, consideration of these effects is part of how they treat patients and make decisions. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. Reflective practice is undertaken for a variety of reasons. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. Consequently, the crew began to assess for a psychological cause. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. B. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). The ethics in paramedicine has become a field of interest for many scientists and researchers. http://dx.doi.org/10.1136/pmj.79.929.151 Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Therefore, they should consider the needs and requirements of patients and act correspondingly. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. In other words, paramedics need to adopt the principle of confidentiality and credence. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). It affirms the supremacy of law and appreciation of human rights and freedom. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). C. Follow to your local protocols and contact medical direction if unsure how to proceed. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Gillick competence empowers children to exercise autonomy over their own medical decisions. In this case, the MCA can be applied in the normal way, to provide treatment, even if for mental health disorders, should the person lack capacity (Department of Constituational Affairs, 2007). Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015). A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. In this case, both ethical and legal principles are important. He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. A. D. personal safety. Paramedic practice must consider all of these factors to ensure ethically good care. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. Paramedicine presupposes direct interaction with individuals. N2 - Decision-making is central to the everyday practice of paramedicine. Confidentiality, capacity and consent. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. Copyright 2023 Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. MA Healthcare Ltd Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Paramedicine occurs in the social fabric of society. Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. Although, hallucinations, delusions etc. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. Samantha May Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. To assist paramedics in navigating these complex issues, the London Ambulance Service NHS Trust (2019) provides guidance on how to refer vulnerable people to services which may investigate the circumstances and ensure the safety and welfare of the patient). Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). Such a position will help improve the system and lead to effective and fruitful results. A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). The provider must be always stalwart in the face of challenges to. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. A significant ethical consideration for clinicians when treating older patients is their capacity. However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. 105: 9 Using quantitative research methods in paramedic practice. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. C. Patient care cannot be discredited based on poor documentation. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Like the abuse of children, the abuse of older people is a significant community concern. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. MA Healthcare Ltd Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Although provider judgment plays a large role in the . Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. | The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. He was also unable to effectively communicate his decision making process. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice.
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