The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Reflective practice is undertaken for a variety of reasons. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. This principle refers to both physical and mental damage, which can be done to the clients. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Paramedical ethics during acute emergency medical service referral In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). Therefore, they should consider the needs and requirements of patients and act correspondingly. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. keywords = "Ethics, Decision making, paramedic, complexity". 122: 10 Researching paramedic clinical practice a practical guide.
Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. A person must be presumed to have capacity unless it is established that he lacks capacity. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Analyse Legal and Ethical Issues Facing Paramedics This research aims to highlight and explore underlying values present within practice-based decisions. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department.
The principles of non-maleficence and beneficence form an area of special interest for the paramedics since these ethical issues are of paramount importance to them. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Copyright 2023
John had arrived at a friend's house during the night, behaving in a strange, confused manner. Exploring New Zealand Paramedic Attitudes Towards Advance Directives Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness 153: Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. 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. abstract = "Decision-making is central to the everyday practice of paramedicine. Paramedic ethics, capacity and the treatment of vulnerable patients The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. Paramedics' decisions on patients' treatment will often impact others. 40: . 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. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Ethics and law in paramedic practice : Boundaries of capacity and interests.
Inform client/staff members of ethical issues affecting client care. There were no obvious physical causes for John's behaviour at this stage. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. While the moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. They must also deliver care that is consistent with ethical. As such, making John secure was a priority. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Together they form a unique fingerprint. C. vehicle safety. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 2 The HCPC standards of conduct, performance and ethics. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. PDF Ethical Questions in Emergency Medical Services: Controversies and Dominique Moritz, Phillip Ebbs, Hamish Carver
Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. 2011). Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). Practice in a manner consistent with a code of ethics for registered nurses. 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. D. personal safety. Paramedic practice must consider all of these factors to ensure ethically good care. In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). The ethical principle of non-maleficence means that paramedicine practitioners should discuss the probable negative consequences of their decisions and prevent them in order not to harm the patients. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. How does a paramedic use chemistry? [FAQ!] 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Notify the family that once CPR has been initiated, you are required to transport the patient. NHS Research and Development Permissions were sought and granted. Methods Due to this misconception, the crew then considered the MHA (1983). C. Patient care cannot be discredited based on poor documentation. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. 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). Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. Decision-making is central to the everyday practice of paramedicine. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. 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. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. By continuing you agree to the use of cookies. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com D. personal safety. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Paramedic Professional Practice | Curtin University Consequently, the crew began to assess for a psychological cause. 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). Paramedic ethics, capacity and the treatment of vulnerable patients Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. B. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Ethics part 1: what do paramedics owe patients? However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Ethical challenges in Emergency Medical Services - PubMed It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Confidentiality, capacity and consent. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 Such a position will help improve the system and lead to effective and fruitful results. Paramedicine presupposes direct interaction with individuals. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. Samantha May
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. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. You will see the questions are broken down into the 5 different categories you will be tested on. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). Ethical Responsibilities of Paramedics | Work - Chron.com Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Major incident clinical . Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . 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. This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). Foundations for paramedic practice: a theoretical perspective - Amazon 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. Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. The approach to both participation and trial protocol training varied between ambulance services. 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . This course is made up of a number of paramedic specific units and additional health care units. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The
Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. practice with medical specialists. A. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. Ethical dilemmas in prehospital emergency care - SpringerLink A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. Ethics and law in paramedic practice: boundaries of capacity and For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties.