Summary. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. 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. 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 key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. | It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. 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). Legal and ethical practice in care. It can be used by . The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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). 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. 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. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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. Together they form a unique fingerprint. Such a position will help improve the system and lead to effective and fruitful results. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. 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. Dominique Moritz, Phillip Ebbs, Hamish Carver title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Journal of Paramedic Practice is the leading monthly journal for paramedics. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. A consensus among paramedic supervisors B. 2 The HCPC standards of conduct, performance and ethics. 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). 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). Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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. Integrated health care including mental health. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. 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. Paramedicine occurs in the social fabric of society. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. 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? As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. C. Follow to your local protocols and contact medical direction if unsure how to proceed. Copyright 2023 At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. It shall conclude with this student's position on the issue based on the discussions. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. AB - Decision-making is central to the everyday practice of paramedicine. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. 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). A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? MA Healthcare Ltd Confidentiality, capacity and consent. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). Legal & Ethical issues associated with paramedic practice during COVID19. A. Vulnerable patients are no exception. 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. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. 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. Although, hallucinations, delusions etc. 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. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). practice with medical specialists. 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. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Professional practice framework, professional rights and responsibilities, record keeping, governance. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. 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. Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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 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). Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. This principle refers to both physical and mental damage, which can be done to the clients. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). 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. Mental illness can be a challenging vulnerability for clinicians to navigate. Major incident clinical . Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Copyright 2023 Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. B. EMTs are not liable for any actions that are accurately documented. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Ethics and law in paramedic practice : Boundaries of capacity and interests. 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. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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). Therefore, it is important to consider those principles more precisely. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. 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. 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. 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. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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). 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. 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). 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. Aircraft Accidents and Emergency Management, Live 2011). This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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). In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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. 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). 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. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare.
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