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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Paramedicine occurs in the social fabric of society. Continuing Professional Development: Ethical issues in paramedic practice 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 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. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Ethical Practice: NCLEX-RN - Registered nursing 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). This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. EMT Chapter 1 Flashcards | Quizlet 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. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Paramedic ethics, capacity and the treatment of vulnerable patients Decision-making is central to the everyday practice of paramedicine. 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. Paramedics' perceptions of the care they provide to people who self Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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? For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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. 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Ethics and law in paramedic practice: Boundaries of capacity and Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of 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. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. Together they form a unique fingerprint. 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. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. 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. care passports). doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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. 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). It is diffcult tp prove actions were performed if they are not included on the report. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. School of Nursing, Midwifery & Paramedic Practice Integrated health care including mental health. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Ethics and law in paramedic practice: boundaries of capacity and 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). Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). 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. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. Medical Ethics: Beneficence - The Medic Portal 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. 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 . 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). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). All relevant services should work together to facilitate timely, safe and supportive discharge from detention. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. Another ethical principle in paramedicine is beneficence. In other words, paramedics need to adopt the principle of confidentiality and credence. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Paramedic Professional Practice | Curtin University 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. 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). 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. 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. By continuing you agree to the use of cookies. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. PDF Ethical Questions in Emergency Medical Services: Controversies and 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). Ethical Responsibilities of Paramedics | Work - Chron.com 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). @article{6040c026e1e34bd9b7239761b13480e7. 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). 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. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. The crew's assessments and thought processes surrounding the management of John will be discussed. In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 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. 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 . 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. 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. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Paramedic Practice Test. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. As such, making John secure was a priority. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. 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. Paramedicine presupposes direct interaction with individuals. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Ethical considerations in prehospital ambulance based research 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? A person must be presumed to have capacity unless it is established that he lacks capacity. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). B. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. 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. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. 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). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient.
Production Companies Accepting Pitches, Articles E