ethical issues in paramedic practice

Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. It affirms the supremacy of law and appreciation of human rights and freedom. Consequently, the crew began to assess for a psychological cause. 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. Reflective practice is undertaken for a variety of reasons. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 105: 9 Using quantitative research methods in paramedic practice. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. In conclusion, ethical and legal principles are of great importance in paramedical practices. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. Maintaining a professional boundary between you and your patient (summary) Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. C. Patient care cannot be discredited based on poor documentation. Methods Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. 2 The HCPC standards of conduct, performance and ethics. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 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. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. Legal and ethical practice in care. Purpose of the fitness to practise process. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. Ethical challenges in Emergency Medical Services - PubMed Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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 is a part of and more. Practice in a manner consistent with a code of ethics for registered nurses. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. http://dx.doi.org/10.1136/pmj.79.929.151 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. Paramedics delivering palliative and end-of-life care in community These factors contribute to an ethically complex decision-making environment. 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). 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. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. 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. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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). This course is made up of a number of paramedic specific units and additional health care units. 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. Mental illness can be a challenging vulnerability for clinicians to navigate. | In other words, paramedics need to adopt the principle of confidentiality and credence. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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. 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. 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 . 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. Should paramedics ever accept patients' refusal - BMC Medical Ethics 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. 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. Continuing Professional Development: Ethical issues in paramedic practice 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. 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 This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. A person's capacity depends upon the nature of their disability. 4 Conducting ethical research in paramedic practice. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Ethical Practice: NCLEX-RN - Registered nursing Removed to place of safety for up to 72 hours for further assessment. 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. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Paramedics interact with these patients every day, often during times of such vulnerability. practice with medical specialists. Therefore, consideration of these effects is part of how they treat patients and make decisions. Journal of Paramedic Practice: Vol 3, No 8 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). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Exploring New Zealand Paramedic Attitudes Towards Advance Directives 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). 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). 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 are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015). 2011). states registered nurses are legally required to report cases of child abuse if there is a "belief on reasonable grounds that a child is in need of protection on a ground referred to in Section 162 (c) or 162 (d), or formed in the course of practicing in . However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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). Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. 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. Principlism in paramedicine: An examination of applied healthcare ethics Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Therefore, it is important to consider those principles more precisely. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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). Their vulnerability may impede their autonomy, which can then affect . Copyright 2023 In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? PDF Ethical Questions in Emergency Medical Services: Controversies and This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. MA Healthcare Ltd care passports). 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. Utilizing a priority dispatch system allows dispatchers to send response . The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. This research aims to highlight and explore underlying values present within practice-based decisions. Our paramedic test questions are listed below. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. (PDF) Reflective Practice for Paramedics - ResearchGate Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Challenges UK paramedics currently face in providing fully effective Legal and Ethical Aspects of Paramedic Practice Article - Studentshare Paramedic attitudes and experiences of enrolling patients into the The Australasian College of Paramedicine This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). Introduction. 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. Using a reflective format, the article explored some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in complex situations. 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. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. 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). Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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 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. 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 This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. The approach to both participation and trial protocol training varied between ambulance services. 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. 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. 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. (PDF) Law and Ethics for Paramedics: An Essential Guide Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Ethical Challenges in Emergency Medical Services: Controversies and Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. The provider must be always stalwart in the face of challenges to. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Psychiatric admission for assessment and subsequent treatment if required. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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).

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