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). 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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]). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. 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). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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). Bachelor of Paramedic Practice (Conversion Pathway) (53C) The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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). John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). 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. 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. Analyse Legal and Ethical Issues Facing Paramedics From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). As such, making John secure was a priority. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Maintaining a professional boundary between you and your patient (summary) The Australasian College of Paramedicine author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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). All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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 Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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 . 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. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Chat. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. 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. Despite this, there remain multiple barriers to their fully effective provision of such care. BSc (Hons) Paramedic Science | Buckinghamshire New University After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Ethical Issues in Critical Care | Clinical Gate This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. C. Follow to your local protocols and contact medical direction if unsure how to proceed. 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. Vulnerable patients are no exception. Paramedicine occurs in the social fabric of society. 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). 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. In the forthcoming sections, these standards, guidelines and ethical principles are used to explore key issues relating to patients who are commonly considered to be vulnerable: children, older people and those with mental illness or disability. Copyright 2023 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. By continuing you agree to the use of cookies. Paramedics' perceptions of the care they provide to people who self 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. Samantha May Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. 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. Principlism in paramedicine: an examination of applied healthcare ethics They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. Utilizing a priority dispatch system allows dispatchers to send response . 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. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Ethical considerations in prehospital ambulance based research Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. 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). This exploratory case study utilized semi-structured interviews of thirteen North. Although provider judgment plays a large role in the . 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. | 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. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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 . The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. (PDF) Reflective Practice for Paramedics - Academia.edu Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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. 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. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 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). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Dominique Moritz, Phillip Ebbs, Hamish Carver C. vehicle safety. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". 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. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Paramedics - Health and Care Professions Council Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). 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. 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. 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. 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. 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. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. This principle refers to both physical and mental damage, which can be done to the clients. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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. 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. Community Paramedics | American Nurses Association With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. Copyright 2023 practice with medical specialists. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. He was also unable to effectively communicate his decision making process. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. These factors contribute to an ethically complex decision-making environment. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? PDF Ethical Questions in Emergency Medical Services: Controversies and People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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 All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. Another ethical principle in paramedicine is beneficence. 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. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. Pre Hospital Ethics and Legal Issues - LawTeacher.net Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet 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. Paramedic Practice Test | Answers & Explanations | Test-Guide This course is made up of a number of paramedic specific units and additional health care units.
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