The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. Copyright 2023 Using a reflective format, the article explored some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in complex situations. Reflective practice is undertaken for a variety of reasons. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Although, hallucinations, delusions etc. A sixth theme of ethical complexity was pervasive across these five themes. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. N2 - 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. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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). 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. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz 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. Samantha May Paramedic Professional Practice | Curtin University 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). 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). 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. 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. 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). Medical Ethics: Non-Maleficence - The Medic Portal Paramedic ethics, capacity and the treatment of vulnerable patients 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. 122: 10 Researching paramedic clinical practice a practical guide. 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. This research aims to highlight and explore underlying values present within practice-based decisions. 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). In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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). Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Ethical challenges in Emergency Medical Services - PubMed Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Although provider judgment plays a large role in the . Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Major incident clinical . 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. PARAMEDIC2 study: Ethical issues | Medicina Intensiva Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Like the abuse of children, the abuse of older people is a significant community concern. To assist paramedics in navigating these complex issues, the London Ambulance Service NHS Trust (2019) provides guidance on how to refer vulnerable people to services which may investigate the circumstances and ensure the safety and welfare of the patient). It can be used by . Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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). Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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. There are many ethical issues that are encountered during the prehospital care of children and adults. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). The question of justice is another part of the paramedical performance. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if 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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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). Consumer rights in advocacy and health care. The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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. ethics of paramedics - SlideShare 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. 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 . Abstract. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. By continuing you agree to the use of cookies. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. The approach to both participation and trial protocol training varied between ambulance services. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. The ethical and legal dilemmas paramedics face when managing a mental Paramedic practice must consider all of these factors to ensure ethically good care. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Exploring New Zealand Paramedic Attitudes Towards Advance Directives The ethics in paramedicine has become a field of interest for many scientists and researchers. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Legal & Ethical issues associated with paramedic practice during COVID19. 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. 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 . Maintaining a professional boundary between you and your patient (summary) Integrated health care including mental health. Paramedic attitudes and experiences of enrolling patients into the The first concern for an EMT must be: A. patient safety. D. personal safety. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 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. 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. (PDF) Reflective Practice for Paramedics - ResearchGate Paramedicine occurs in the social fabric of society. Vulnerable patients are no exception. You will see the questions are broken down into the 5 different categories you will be tested on. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. 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. John had arrived at a friend's house during the night, behaving in a strange, confused manner. While the moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. NHS Research and Development Permissions were sought and granted. 153: Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Together they form a unique fingerprint. 2 The HCPC standards of conduct, performance and ethics. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. Chat. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com 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. 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). This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able: To provide an overview of the four key ethical principles that underpin current clinical practice in the UK To explore these four ethical principles in relation to specific prehospital and clinical issues To encourage the practitioner to reflect on their own ethical practice To begin to develop the ability to share, discuss and debate the four ethical principles with colleagues and friends, in relation to your own clinical practice. For 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. Therefore, it is important to consider those principles more precisely. Principlism in paramedicine: an examination of applied healthcare ethics Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. Legal and Ethical Aspects of Paramedic Practice Article - Studentshare The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. Practice in a manner consistent with a code of ethics for registered nurses. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. Psychiatric admission for assessment and subsequent treatment if required. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Ethical Issues in Critical Care | Clinical Gate Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. As such, making John secure was a priority. 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. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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.
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