By continuing you agree to the use of cookies. Paramedicine occurs in the social fabric of society. 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. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. 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. It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. 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). 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. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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. 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. Ethics part 1: what do paramedics owe patients? Using a reflective format, the article explored 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 complex situations. Such a position will help improve the system and lead to effective and fruitful results. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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. 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. Practical decision-making strategies are provided and illustrated by brief examples. 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). 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. 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. 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). 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). Psychiatric admission for assessment and subsequent treatment if required. The question of justice is another part of the paramedical performance. 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. C. vehicle safety. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. 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). @article{6040c026e1e34bd9b7239761b13480e7. 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. The ethics in paramedicine has become a field of interest for many scientists and researchers. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. 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. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. 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). If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). 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). 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? Professional practice framework, professional rights and responsibilities, record keeping, governance. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. 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. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). | Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Summary. 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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. AB - Decision-making is central to the everyday practice of paramedicine. 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. 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). 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. 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. 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. 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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. 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 author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. This exploratory case study utilized semi-structured interviews of thirteen North. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Gillick competence empowers children to exercise autonomy over their own medical decisions. Their vulnerability may impede their autonomy, which can then affect . Vulnerable patients are no exception. Journal of Paramedic Practice is the leading monthly journal for paramedics. A person's capacity depends upon the nature of their disability. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. This research aims to highlight and explore underlying values present within practice-based decisions. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. C. Follow to your local protocols and contact medical direction if unsure how to proceed. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. There were no obvious physical causes for John's behaviour at this stage. 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. 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. A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). 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. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. N2 - Decision-making is central to the everyday practice of paramedicine. 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. 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. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Utilizing a priority dispatch system allows dispatchers to send response . Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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). Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. Legal and ethical practice in care. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 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. 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. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Copyright 2023 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 153: 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. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. 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. 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. 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. 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. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). http://dx.doi.org/10.1136/pmj.79.929.151 Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Methods 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. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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).
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ethical issues in paramedic practice