While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. 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. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). | While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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 . 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. The provider must be always stalwart in the face of challenges to. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. The approach to both participation and trial protocol training varied between ambulance services. Download Free PDF View PDF 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Utilizing a priority dispatch system allows dispatchers to send response . A person's capacity depends upon the nature of their disability. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. 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. 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). 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. This principle refers to both physical and mental damage, which can be done to the clients. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. Consequently, the crew had to consider alternative management plans for John. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Capacity can fluctuate over time or as a health condition changes. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). There were no obvious physical causes for John's behaviour at this stage. keywords = "Ethics, Decision making, paramedic, complexity". 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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). 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. 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 . Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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. Consequently, the crew began to assess for a psychological cause. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. C. vehicle safety. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. 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). 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. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). B. EMTs are not liable for any actions that are accurately documented. 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). 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. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. 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. 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. 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. Their vulnerability may impede their autonomy, which can then affect . However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. . 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. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. Chat. Don't hesitate and rely on professionals! Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. D. personal safety. 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. 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. 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' decisions on patients' treatment will often impact others. 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. 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). Such a position will help improve the system and lead to effective and fruitful results. 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). It can be used by . 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. 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. 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 is not to be treated as unable to make a decision merely because he makes an unwise decision. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? One of the most important legal principles in paramedicine is the preservation of patients personal information and data. These factors contribute to an ethically complex decision-making environment. 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. 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). However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. The 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). MA Healthcare Ltd 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 . Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Copyright 2023 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. 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. Another ethical principle in paramedicine is beneficence. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. 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? 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. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. 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. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Summary. This was because of current UK law and a lack of access to a GP respectively. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Introduction. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). You will see the questions are broken down into the 5 different categories you will be tested on. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. 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). A consensus among paramedic supervisors B. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Cuts in public health and community services funding have decimated programs, leaving unmet health needs. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Paramedicine occurs in the social fabric of society. 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. Practical decision-making strategies are provided and illustrated by brief examples. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. The use of the other sections of the MHA can require much more time (Hawley et al. A sixth theme of ethical complexity was pervasive across these five themes. Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. | According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Ethics, bioethics and legal issues in paramedic practice. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. B. crew control. 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.

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