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. Ethics, bioethics and legal issues in paramedic practice. 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 . 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. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. This will also help you learn important concepts for the exam. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. MA Healthcare Ltd
There were no obvious physical causes for John's behaviour at this stage. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet 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). Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. 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. Challenges UK paramedics currently face in providing fully effective
The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 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. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . A person must be presumed to have capacity unless it is established that he lacks capacity. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. PDF Ethical Questions in Emergency Medical Services: Controversies and 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. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Sample Essay on Law and Ethics in Paramedical Science Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Therefore, it is important to consider those principles more precisely. Ethics and law in paramedic practice : Boundaries of capacity and interests. He was also unable to effectively communicate his decision making process. Principlism in paramedicine: an examination of applied healthcare ethics The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 40: . 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. 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 must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. It is diffcult tp prove actions were performed if they are not included on the report. 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). Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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 . An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Copyright 2023
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. Mental illness can be a challenging vulnerability for clinicians to navigate. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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). The Australasian College of Paramedicine Integrated health care including mental health. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. MA Healthcare Ltd
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 can be used by . 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. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. 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. 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). 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. This research aims to highlight and explore underlying values present within practice-based decisions. 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]). As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . Legal, ethical and social aspects of child abuse - NursingAnswers.net Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Medical Ethics: Non-Maleficence - The Medic Portal With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. 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 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). A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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. 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). Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Ethics in EMS: 10 things you need to know to save lives This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. EMT Chapter 1 Flashcards | Quizlet This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. The ethics in paramedicine has become a field of interest for many scientists and researchers. practice with medical specialists. Community Paramedics | American Nurses AssociationContinuing Professional Development: Ethical issues in paramedic practice Introduction. 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. These factors contribute to an ethically complex decision-making environment. 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. Capacity can fluctuate over time or as a health condition changes. 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. Legal | Journal Of Paramedic Practice 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . Fitness to practise - Health and Care Professions Council Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. |
More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 122: 10 Researching paramedic clinical practice a practical guide. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Professional practice framework, professional rights and responsibilities, record keeping, governance. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Maintaining a professional boundary between you and your patient (summary) NHS Research and Development Permissions were sought and granted. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards.
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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. C. Patient care cannot be discredited based on poor documentation. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. 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. 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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz 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. 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). Ethical considerations in prehospital ambulance based research 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient.
