care passports). Ethical Issues in Critical Care | Clinical Gate The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own 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. 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. Bachelor of Paramedic Practice (Conversion Pathway) (53C) 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. Legal, ethical and social aspects of child abuse - NursingAnswers.net Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Continuing Professional Development: Ethical issues in paramedic practice 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 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 . 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). This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). | The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . 03 What factors affect paramedics' involvement of people with dementia This was because of current UK law and a lack of access to a GP respectively. 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. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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). Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. 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. 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). For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. This research aims to highlight and explore underlying values present within practice-based decisions. Principlism in paramedicine: An examination of applied healthcare ethics Our paramedic test questions are listed below. 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. 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. 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. PARAMEDIC2 study: Ethical issues | Medicina Intensiva 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. 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. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if 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). 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. 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. Ethical dilemmas in prehospital emergency care - SpringerLink Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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. Purpose of the fitness to practise process. Dominique Moritz, Phillip Ebbs, Hamish Carver 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. 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. Ethics and law in paramedic practice: boundaries of capacity and Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. In other words, paramedics need to adopt the principle of confidentiality and credence. Fitness to practise - Health and Care Professions Council 40: . Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. Therefore, consideration of these effects is part of how they treat patients and make decisions. Continuing Professional Development: Ethical aspects of consent, duty In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). 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. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. 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 crew's assessments and thought processes surrounding the management of John will be discussed. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). 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. keywords = "Ethics, Decision making, paramedic, complexity". Reflective practice is undertaken for a variety of reasons. There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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? The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Community Paramedics | American Nurses Association Gillick competence empowers children to exercise autonomy over their own medical decisions. Paramedic attitudes and experiences of enrolling patients into the As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 105: 9 Using quantitative research methods in paramedic practice. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. The ethical and legal dilemmas paramedics face when managing a mental He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). The use of the other sections of the MHA can require much more time (Hawley et al. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. A person's capacity depends upon the nature of their disability. 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. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. The question of justice is another part of the paramedical performance. Bachelor of Paramedic Practice (ADF Conversion) (53D) doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". The approach to both participation and trial protocol training varied between ambulance services. 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). 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Paramedics interact with these patients every day, often during times of such vulnerability. 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. | Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. This exploratory case study utilized semi-structured interviews of thirteen North. By continuing you agree to the use of cookies. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). 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). (PDF) Reflective Practice for Paramedics - ResearchGate Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. In this case, both ethical and legal principles are important. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The ethics in paramedicine has become a field of interest for many scientists and researchers. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 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). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. They must also deliver care that is consistent with ethical. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Paramedics - Health and Care Professions Council 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? D. personal safety. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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). 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. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Major incident clinical . For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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. The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. It can be used by . 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. Mental illness can be a challenging vulnerability for clinicians to navigate. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. This will also help you learn important concepts for the exam. 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. 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). Ethical problems in clinical practice | Postgraduate Medical Journal 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. B. EMTs are not liable for any actions that are accurately documented. Ethical issues in medical malpractice - PubMed A significant ethical consideration for clinicians when treating older patients is their capacity. 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. Continuing Professional Development: Ethical issues in paramedic practice Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 2 The HCPC standards of conduct, performance and ethics. Pre Hospital Ethics and Legal Issues - LawTeacher.net Ethical Practice: NCLEX-RN - Registered nursing Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). @article{6040c026e1e34bd9b7239761b13480e7. 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. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Should paramedics ever accept patients' refusal - BMC Medical Ethics Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Decision-making is central to the everyday practice of paramedicine. Principlism in paramedicine: an examination of applied healthcare ethics Another ethical principle in paramedicine is beneficence. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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.