ethical issues in paramedic practice

This principle refers to both physical and mental damage, which can be done to the clients. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. MA Healthcare Ltd Although, hallucinations, delusions etc. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. 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. 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. 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. Ethical challenges in Emergency Medical Services - PubMed The ethical responsibilities of a paramedic also include acting fairly and helping any patient who needs it, regardless of their race, age, gender, religion or another personal characteristic.. MA Healthcare Ltd Copyright 2023 Reflective practice is undertaken for a variety of reasons. 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). Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. Despite this, there remain multiple barriers to their fully effective provision of such care. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. @article{6040c026e1e34bd9b7239761b13480e7. D. personal safety. Principlism in paramedicine: an examination of applied healthcare ethics 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). 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. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Paramedicine presupposes direct interaction with individuals. 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). Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Decision-making is central to the everyday practice of paramedicine. It affirms the supremacy of law and appreciation of human rights and freedom. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Monday, January 2, 2017. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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 consensus among paramedic supervisors B. 122: 10 Researching paramedic clinical practice a practical guide. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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. 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? By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 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. 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. Ethical Issues in Sports Medicine - In the United States - studocu.com Vulnerable patients are at an increased risk of harm or exploitation in healthcare. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in 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). Paramedics interact with these patients every day, often during times of such vulnerability. | Major incident clinical . 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. This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). Pre Hospital Ethics and Legal Issues - LawTeacher.net Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). 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). Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. Capacity can fluctuate over time or as a health condition changes. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Vulnerable patients are no exception. Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). This exploratory case study utilized semi-structured interviews of thirteen North. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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 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). There were no obvious physical causes for John's behaviour at this stage. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Ethical problems in clinical practice | Postgraduate Medical Journal Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. NHS Research and Development Permissions were sought and granted. C. Follow to your local protocols and contact medical direction if unsure how to proceed. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 4 Conducting ethical research in paramedic practice. A person must be presumed to have capacity unless it is established that he lacks capacity. 8 Quantitative research in paramedic practice an overview. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. B. crew control. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. 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 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. (PDF) Reflective Practice for Paramedics - Academia.edu 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. 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. 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. . The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. 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). Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Principlism in paramedicine: An examination of applied healthcare ethics 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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 . 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 paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). Journal of Paramedic Practice: Vol 3, No 8 Paramedics - Health and Care Professions Council Sample Essay on Law and Ethics in Paramedical Science Maintaining a professional boundary between you and your patient (summary) Confidentiality, capacity and consent. Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. Practice in a manner consistent with a code of ethics for registered nurses. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Mental illness can be a challenging vulnerability for clinicians to navigate. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). This course is made up of a number of paramedic specific units and additional health care units. Bachelor of Paramedic Practice (ADF Conversion) (53D) In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. The provider must be always stalwart in the face of challenges to. 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). 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. 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). Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 105: 9 Using quantitative research methods in paramedic practice. (PDF) Law and Ethics for Paramedics: An Essential Guide 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. 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. PARAMEDIC2 study: Ethical issues | Medicina Intensiva The use of the other sections of the MHA can require much more time (Hawley et al. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. This will also help you learn important concepts for the exam. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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. 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. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care?