The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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 Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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). The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). 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. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. Chat. Removed to place of safety for up to 72 hours for further assessment. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. A. It shall conclude with this student's position on the issue based on the discussions. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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? It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. care passports). 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). 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. This is not the case. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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). 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. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 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. There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. 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. The approach to both participation and trial protocol training varied between ambulance services. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. 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. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. | 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. 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). The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. NHS Research and Development Permissions were sought and granted. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Practice in a manner consistent with a code of ethics for registered nurses. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Reflective practice is undertaken for a variety of reasons. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. Monday, January 2, 2017. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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 . A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. He was also unable to effectively communicate his decision making process. Although provider judgment plays a large role in the . Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. C. Patient care cannot be discredited based on poor documentation. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. 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. There were no obvious physical causes for John's behaviour at this stage. 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. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. This exploratory case study utilized semi-structured interviews of thirteen North. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Aircraft Accidents and Emergency Management, Live They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. 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. Samantha May The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. 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. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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). Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. As such, making John secure was a priority. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. John had arrived at a friend's house during the night, behaving in a strange, confused manner. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Psychiatric admission for assessment and subsequent treatment if required. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Summary. 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). 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 Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). The ethical responsibilities of a paramedic also include acting fairly and helping any patient who needs it, regardless of their race, age, gender, religion or another personal characteristic.. 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. Confidentiality, capacity and consent. 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. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). B. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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 have an important role in supporting vulnerable patients and upholding their autonomy. 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. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. 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. Elder abuse can encompass neglect, financial duress, psychological threats and violence. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 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. 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. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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). D. personal safety. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Another ethical principle in paramedicine is beneficence. Notify the family that once CPR has been initiated, you are required to transport the 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. Paramedics have professional duties toward vulnerable persons. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Legal & Ethical issues associated with paramedic practice during COVID19. 136: 11 The future for paramedic research. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). The question of justice is another part of the paramedical performance. 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. A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. Download Free PDF View PDF For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? 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. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. By continuing you agree to the use of cookies. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. 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.
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