ethical issues in paramedic practice

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. 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. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). 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. B. crew control. C. Patient care cannot be discredited based on poor documentation. 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. 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. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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. BSc (Hons) Paramedic Science | Buckinghamshire New University Purpose of the fitness to practise process. As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. 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. Ethical Issues in Sports Medicine - In the United States - studocu.com 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). This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. | 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. Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Dominique Moritz, Phillip Ebbs, Hamish Carver More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. Ethics and law in paramedic practice: boundaries of capacity and 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. Consumer rights in advocacy and health care. 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. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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). The question of justice is another part of the paramedical performance. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. @article{6040c026e1e34bd9b7239761b13480e7. 2011). This course is made up of a number of paramedic specific units and additional health care units. The crew's assessments and thought processes surrounding the management of John will be discussed. 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. Continuing Professional Development: Ethical issues in paramedic practice People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. An introduction to reflective practice for paramedics This is not the case. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. AB - Decision-making is central to the everyday practice of paramedicine. They must also deliver care that is consistent with ethical. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. 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. 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. 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. practice with medical specialists. Journal of Paramedic Practice: Vol 3, No 8 Continuing Professional Development: Ethical issues in paramedic practice Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. There are many ethical issues that are encountered during the prehospital care of children and adults. Paramedic Practice Test. Challenges UK paramedics currently face in providing fully effective B. EMTs are not liable for any actions that are accurately documented. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). To assist paramedics in navigating these complex issues, the London Ambulance Service NHS Trust (2019) provides guidance on how to refer vulnerable people to services which may investigate the circumstances and ensure the safety and welfare of the patient). Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 153: 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. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. Monday, January 2, 2017. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Pre Hospital Ethics and Legal Issues - LawTeacher.net 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. 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 . A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. The first concern for an EMT must be: A. patient safety. 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). Practice in a manner consistent with a code of ethics for registered nurses. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. This research aims to highlight and explore underlying values present within practice-based decisions. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Despite this, there remain multiple barriers to their fully effective provision of such care. Summary. 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. 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). Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Paramedic ethics, capacity and the treatment of vulnerable patients The approach to both participation and trial protocol training varied between ambulance services. 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. Confidentiality, capacity and consent. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Principlism in paramedicine: An examination of applied healthcare ethics

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