ethical issues in paramedic practice

The use of the other sections of the MHA can require much more time (Hawley et al. Legal and ethical practice in care. Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Methods He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. 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 Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. 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 . In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 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. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. 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). 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. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Together they form a unique fingerprint. 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). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. Professional practice framework, professional rights and responsibilities, record keeping, governance. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? A person is not to be treated as unable to make a decision merely because he makes an unwise decision. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. A. 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 is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. This was because of current UK law and a lack of access to a GP respectively. Copyright 2023 Preventing children from exercising their autonomy may cause ethical challenges (Box 1). 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). Like the abuse of children, the abuse of older people is a significant community concern. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. abstract = "Decision-making is central to the everyday practice of paramedicine. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Our paramedic test questions are listed below. This course is made up of a number of paramedic specific units and additional health care units. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. Legal & Ethical issues associated with paramedic practice during COVID19. 105: 9 Using quantitative research methods in paramedic practice. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. 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. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. 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. 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. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This research aims to highlight and explore underlying values present within practice-based decisions. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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 The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Ethics part 1: what do paramedics owe patients? C. Patient care cannot be discredited based on poor documentation. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. It is diffcult tp prove actions were performed if they are not included on the report. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Removed to place of safety for up to 72 hours for further assessment. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). AB - Decision-making is central to the everyday practice of paramedicine. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. A significant ethical consideration for clinicians when treating older patients is their capacity. 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. 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. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. It affirms the supremacy of law and appreciation of human rights and freedom. Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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). On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. Aircraft Accidents and Emergency Management, Live 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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. The crew's assessments and thought processes surrounding the management of John will be discussed. Consequently, the crew had to consider alternative management plans for John. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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. 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). 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). 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. 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). However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. In this case, both ethical and legal principles are important. 8 Quantitative research in paramedic practice an overview. 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. 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. 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? By continuing you agree to the use of cookies. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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. 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. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). 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. Paramedicine occurs in the social fabric of society. 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. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 4 Conducting ethical research in paramedic practice. 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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). D. personal safety. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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). This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. 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. 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. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. | Elder abuse can encompass neglect, financial duress, psychological threats and violence. As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. 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).

Triangle Borea Br03 Vs Kef Q150, Ottolenghi Chicken Tagine, Carlos Boozer Sons Height, College Principal Salary In Odisha, Articles E