Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. Practice in a manner consistent with a code of ethics for registered nurses. This will also help you learn important concepts for the exam. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). Copyright 2023 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. Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). | Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. 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. Ethics, bioethics and legal issues in paramedic practice. 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. 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. Consumer rights in advocacy and health care. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. Copyright 2023 However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) The approach to both participation and trial protocol training varied between ambulance services. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 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. 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. C. vehicle safety. 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? Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. 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 . In the forthcoming sections, these standards, guidelines and ethical principles are used to explore key issues relating to patients who are commonly considered to be vulnerable: children, older people and those with mental illness or disability. @article{6040c026e1e34bd9b7239761b13480e7. It shall conclude with this student's position on the issue based on the discussions. 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. Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). Paramedics interact with these patients every day, often during times of such vulnerability. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. 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). This is not the case. 40: . However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? C. Patient care cannot be discredited based on poor documentation. As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. This exploratory case study utilized semi-structured interviews of thirteen North. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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 . B. EMTs are not liable for any actions that are accurately documented. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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. In conclusion, ethical and legal principles are of great importance in paramedical practices. 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). 2011). Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. 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. 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 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. 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. Together they form a unique fingerprint. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Copyright 2023 Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. These factors contribute to an ethically complex decision-making environment. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. keywords = "Ethics, Decision making, paramedic, complexity". 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. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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). As with any patient, capacity can fluctuate, although this is more likely with older patients. Gillick competence empowers children to exercise autonomy over their own medical decisions. 136: 11 The future for paramedic research. Consequently, the crew had to consider alternative management plans for John. 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. 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. 105: 9 Using quantitative research methods in paramedic practice. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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 Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. 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). Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). A consensus among paramedic supervisors B. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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). 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). Major incident clinical . Therefore, they should consider the needs and requirements of patients and act correspondingly. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. A significant ethical consideration for clinicians when treating older patients is their capacity. 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). Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. 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). Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Paramedicine occurs in the social fabric of society. Although provider judgment plays a large role in the . Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. B. crew control. 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. The crew's assessments and thought processes surrounding the management of John will be discussed. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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). 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. 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. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. 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. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. 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. 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). Paramedics' decisions on patients' treatment will often impact others. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. The principles of non-maleficence and beneficence form an area of special interest for the paramedics since these ethical issues are of paramount importance to them. 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. 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 . This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. 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. Practical decision-making strategies are provided and illustrated by brief examples. 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). It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. AB - Decision-making is central to the everyday practice of paramedicine. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. 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. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. 122: 10 Researching paramedic clinical practice a practical guide. 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). Notify the family that once CPR has been initiated, you are required to transport the patient. 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. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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.
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