At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? This course is made up of a number of paramedic specific units and additional health care units. 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). All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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. It affirms the supremacy of law and appreciation of human rights and freedom. (PDF) Law and Ethics for Paramedics: An Essential Guide Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). The first concern for an EMT must be: A. patient safety. This is not the case. | It shall conclude with this student's position on the issue based on the discussions. Journal of Paramedic Practice: Vol 3, No 8 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 . As such, making John secure was a priority. A. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). | Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. The Australasian College of Paramedicine Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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? Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Maintaining a professional boundary between you and your patient (summary) A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). 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. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. 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. Inform client/staff members of ethical issues affecting client care. . Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . 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. There are many ethical issues that are encountered during the prehospital care of children and adults. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Paramedic ethics, capacity and the treatment of vulnerable patients 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). Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. 2011). Legal and ethical practice in care. D. Incomplete . Utilizing a priority dispatch system allows dispatchers to send response . Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Copyright 2023 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. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. In conclusion, ethical and legal principles are of great importance in paramedical practices. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. A sixth theme of ethical complexity was pervasive across these five themes. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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 . 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.. 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). 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). Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This research aims to highlight and explore underlying values present within practice-based decisions. 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. 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. 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. Due to this misconception, the crew then considered the MHA (1983). And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com 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). 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. 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. Don't hesitate and rely on professionals! Should paramedics ever accept patients' refusal - BMC Medical Ethics A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. NHS Research and Development Permissions were sought and granted. This principle refers to both physical and mental damage, which can be done to the clients. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. 40: . While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Methods The question of justice is another part of the paramedical performance. 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. Major incident clinical . Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. Paramedic practice must consider all of these factors to ensure ethically good care. 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. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Continuing Professional Development: Ethical aspects of consent, duty Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. 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. All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. C. Follow to your local protocols and contact medical direction if unsure how to proceed. D. personal safety. Paramedic attitudes and experiences of enrolling patients into the Vulnerable patients are no exception. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Legal, ethical and social aspects of child abuse - NursingAnswers.net 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.
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