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. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . 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. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 136: 11 The future for paramedic research. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Paramedic Practice Test. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Therefore, consideration of these effects is part of how they treat patients and make decisions. Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). D. personal safety. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. As such, making John secure was a priority. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. There are many ethical issues that are encountered during the prehospital care of children and adults. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. abstract = "Decision-making is central to the everyday practice of paramedicine. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Abstract. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. 8 Quantitative research in paramedic practice an overview. Professional practice framework, professional rights and responsibilities, record keeping, governance. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Although, hallucinations, delusions etc. 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). It is diffcult tp prove actions were performed if they are not included on the report. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. It can be used by . The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". 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. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. keywords = "Ethics, Decision making, paramedic, complexity". With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. This will also help you learn important concepts for the exam. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. 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. 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. These factors contribute to an ethically complex decision-making environment. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Chat. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Notify the family that once CPR has been initiated, you are required to transport the patient. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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). In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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? John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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. People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. Decision-making is central to the everyday practice of paramedicine. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 2 The HCPC standards of conduct, performance and ethics. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. http://dx.doi.org/10.1136/pmj.79.929.151 Ethics, bioethics and legal issues in paramedic practice. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. 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. Paramedic practice must consider all of these factors to ensure ethically good care. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. 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. He was also unable to effectively communicate his decision making process. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Inform client/staff members of ethical issues affecting client care. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Elder abuse can encompass neglect, financial duress, psychological threats and violence. A. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. 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. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. AB - Decision-making is central to the everyday practice of paramedicine. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). MA Healthcare Ltd 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). Therefore, it is important to consider those principles more precisely. Paramedicine presupposes direct interaction with individuals. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. In this case, the MCA can be applied in the normal way, to provide treatment, even if for mental health disorders, should the person lack capacity (Department of Constituational Affairs, 2007). While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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 are explored. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. C. Patient care cannot be discredited based on poor documentation. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. 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 For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. 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. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 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. 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). 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. Copyright 2023 B. EMTs are not liable for any actions that are accurately documented. 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 Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. They must also deliver care that is consistent with ethical. The first concern for an EMT must be: A. patient safety. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Removed to place of safety for up to 72 hours for further assessment. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. 153: With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. The provider must be always stalwart in the face of challenges to. 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. 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 . It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 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. Ethics part 1: what do paramedics owe patients? In other words, paramedics need to adopt the principle of confidentiality and credence. As with any patient, capacity can fluctuate, although this is more likely with older patients. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Paramedics interact with these patients every day, often during times of such vulnerability.