Ethical considerations in prehospital ambulance based research 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. 2011). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. ethics of paramedics - SlideShare However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. | After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. The Australasian College of Paramedicine Ethical problems in clinical practice | Postgraduate Medical Journal It is not clear though, how professionals (especially those who do not use the MHA) are likely to know in advance if a patient is likely to meet threshold for detention under this act, and so whether the MCA seems appropriate for use or not. Another ethical principle in paramedicine is beneficence. As such, making John secure was a priority. 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 ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). The term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. Vulnerable patients are no exception. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. C. Patient care cannot be discredited based on poor documentation. A. This will also help you learn important concepts for the exam. 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. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet 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). Fitness to practise - Health and Care Professions Council 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 There were no obvious physical causes for John's behaviour at this stage. 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). / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. 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. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. 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. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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). Consequently, the crew had to consider alternative management plans for John. Despite this, there remain multiple barriers to their fully effective provision of such care. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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 Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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 Medical Ethics: Non-Maleficence - The Medic Portal From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? NHS Research and Development Permissions were sought and granted. 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. 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Ethical Issues in Sports Medicine - In the United States - studocu.com All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. Legal, ethical and social aspects of child abuse - NursingAnswers.net Paramedic: Legislation And And Guidance That Govern The - Edubirdie Dominique Moritz, Phillip Ebbs, Hamish Carver 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). This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). PROFESSIONALISM Professionalism in UK paramedic practice Prof Malcolm 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). Ethical challenges in Emergency Medical Services - PubMed PARAMEDIC2 study: Ethical issues | Medicina Intensiva Removed to place of safety for up to 72 hours for further assessment. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Paramedic ethics, capacity and the treatment of vulnerable patients All relevant services should work together to facilitate timely, safe and supportive discharge from detention. D. personal safety. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. Major incident clinical . 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. 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement 105: 9 Using quantitative research methods in paramedic practice. Paramedicine presupposes direct interaction with individuals. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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). Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. 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. 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). Foundations for paramedic practice: a theoretical perspective - Amazon 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. 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. 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. The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. John had arrived at a friend's house during the night, behaving in a strange, confused manner. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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. This exploratory case study utilized semi-structured interviews of thirteen North. A person's capacity depends upon the nature of their disability. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. 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. A consensus among paramedic supervisors B. 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. 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. It can be used by . 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Samantha May 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. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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. Continuing Professional Development: Ethical issues in paramedic practice Principlism in paramedicine: an examination of applied healthcare ethics The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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]). Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Ethics and law in paramedic practice: Boundaries of capacity and Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 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? 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. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. School of Nursing, Midwifery & Paramedic Practice (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 136: 11 The future for paramedic research. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. 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). D. personal safety. 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. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Ethical Challenges in Emergency Medical Services: Controversies and Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Maintaining a professional boundary between you and your patient (summary) A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. Ethical issues in medical malpractice - PubMed A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. This principle refers to both physical and mental damage, which can be done to the clients. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. In this case, both ethical and legal principles are important. EMT Chapter 1 Flashcards | Quizlet The question of justice is another part of the paramedical performance. Decision-making is central to the everyday practice of paramedicine. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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). Integrated health care including mental health. 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). Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Cuts in public health and community services funding have decimated programs, leaving unmet health needs. 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. Therefore, it is important to consider those principles more precisely. Paramedic ethics, capacity and the treatment of vulnerable patients What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). The ethics in paramedicine has become a field of interest for many scientists and researchers. Their vulnerability may impede their autonomy, which can then affect . The ethical and legal dilemmas paramedics face when managing a mental These factors contribute to an ethically complex decision-making environment. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com This research aims to highlight and explore underlying values present within practice-based decisions. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011).

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