It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Like the abuse of children, the abuse of older people is a significant community concern. Legal and ethical practice in care. Chat. 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). Methods In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. B. EMTs are not liable for any actions that are accurately documented. Our paramedic test questions are listed below. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. @article{6040c026e1e34bd9b7239761b13480e7. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Paramedics have professional duties toward vulnerable persons. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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. 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. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. C. Patient care cannot be discredited based on poor documentation. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. Legal & Ethical issues associated with paramedic practice during COVID19. Ethics, bioethics and legal issues in paramedic practice. 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. Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. keywords = "Ethics, Decision making, paramedic, complexity". Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act.
A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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 are explored. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. In conclusion, ethical and legal principles are of great importance in paramedical practices. 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. 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. 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. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This course is made up of a number of paramedic specific units and additional health care units. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. A. 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 principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. N2 - Decision-making is central to the everyday practice of paramedicine. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Practice in a manner consistent with a code of ethics for registered nurses. The approach to both participation and trial protocol training varied between ambulance services. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Copyright 2023
EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. It is diffcult tp prove actions were performed if they are not included on the report. However, children's life experiences, maturity and understanding differ from one individual to the nextdepending on factors such as their age, culture, health, upbringing, background and environmentsand their ability to process healthcare-related information also varies. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. NHS Research and Development Permissions were sought and granted. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. |
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. The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. 122: 10 Researching paramedic clinical practice a practical guide. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. 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). 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. 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). Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 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. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations.
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. 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). These factors contribute to an ethically complex decision-making environment. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). The crew's assessments and thought processes surrounding the management of John will be discussed. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? C. vehicle safety. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. This will also help you learn important concepts for the exam. 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. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Paramedicine occurs in the social fabric of society. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. 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). Such a position will help improve the system and lead to effective and fruitful results. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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. 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. 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. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. This is not the case. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? 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. In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. Although, hallucinations, delusions etc. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. 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). Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if 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). 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. In this case, both ethical and legal principles are important. It affirms the supremacy of law and appreciation of human rights and freedom. . Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 105: 9 Using quantitative research methods in paramedic practice. Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). Copyright 2023
People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. A person must be presumed to have capacity unless it is established that he lacks capacity. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment.