Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Don't hesitate and rely on professionals! 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 are explored. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. 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. C. Patient care cannot be discredited based on poor documentation. 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). 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. 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. 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). Together they form a unique fingerprint. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. By continuing you agree to the use of cookies. A sixth theme of ethical complexity was pervasive across these five themes. 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). Challenges UK paramedics currently face in providing fully effective 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). Paramedics have professional duties toward vulnerable persons. Ethical problems in clinical practice | Postgraduate Medical Journal 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Paramedic ethics, capacity and the treatment of vulnerable patients 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 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). In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". These factors contribute to an ethically complex decision-making environment. 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. Ethical Issues in Critical Care | Clinical Gate 4 Conducting ethical research in paramedic practice. 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. 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. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. 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. Ethical Issues in Sports Medicine - In the United States - studocu.com Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. 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. 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. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. D. Incomplete . keywords = "Ethics, Decision making, paramedic, complexity". 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 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. Medical Ethics: Beneficence - The Medic Portal However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. An introduction to reflective practice for paramedics It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . 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). Paramedics delivering palliative and end-of-life care in community It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Continuing Professional Development: Ethical aspects of consent, duty Methods 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Like the abuse of children, the abuse of older people is a significant community concern. This principle refers to both physical and mental damage, which can be done to the clients. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 105: 9 Using quantitative research methods in paramedic practice. | 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. 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. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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). In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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. Paramedicine occurs in the social fabric of society. @article{6040c026e1e34bd9b7239761b13480e7. Integrated health care including mental health. A consensus among paramedic supervisors B. Ethics, bioethics and legal issues in paramedic practice. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) 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). According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. PARAMEDIC2 study: Ethical issues | Medicina Intensiva 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). However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. Ethical Challenges in Emergency Medical Services: Controversies and A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. In this case, both ethical and legal principles are important. 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). Consumer rights in advocacy and health care. 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 . From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Professional practice framework, professional rights and responsibilities, record keeping, governance. It shall conclude with this student's position on the issue based on the discussions. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. 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. Copyright 2023 In other words, paramedics need to adopt the principle of confidentiality and credence. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. Decision-making is central to the everyday practice of paramedicine. 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). Reflective practice is undertaken for a variety of reasons. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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). A. journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. Dominique Moritz, Phillip Ebbs, Hamish Carver 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. C. vehicle safety. Capacity can fluctuate over time or as a health condition changes. Our paramedic test questions are listed below. The first concern for an EMT must be: A. patient safety. 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). Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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). D. personal safety. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. 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. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Wednesday, December 2, 2020. 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. 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. Fitness to practise - Health and Care Professions Council In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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). 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. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 2 The HCPC standards of conduct, performance and ethics. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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). In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. PDF Ethical Questions in Emergency Medical Services: Controversies and The views of families, carers and others, if appropriate, should be fully considered when taking decisions. 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Principlism in paramedicine: an examination of applied healthcare ethics To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Principlism in paramedicine: An examination of applied healthcare ethics Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics - Health and Care Professions Council He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. 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. 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. In conclusion, ethical and legal principles are of great importance in paramedical practices. Copyright 2023 The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently.