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Bachelor of Paramedic Practice (Conversion Pathway) (53C) Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. An introduction to reflective practice for paramedics In conclusion, ethical and legal principles are of great importance in paramedical practices. 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. 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. 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. 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. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). Paramedics have professional duties toward vulnerable persons. 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. Maintaining a professional boundary between you and your patient (summary) 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. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Despite this, there remain multiple barriers to their fully effective provision of such care. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). 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. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. Consequently, the crew began to assess for a psychological cause. Should paramedics ever accept patients' refusal - BMC Medical Ethics 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. 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). It affirms the supremacy of law and appreciation of human rights and freedom. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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). 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). PDF Ethical Questions in Emergency Medical Services: Controversies and Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. By continuing you agree to the use of cookies. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Legal | Journal Of Paramedic Practice It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. practice with medical specialists. | 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). While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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). Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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. Paramedic: Legislation And And Guidance That Govern The - Edubirdie Methods Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. Legal and Ethical Aspects of Paramedic Practice Article - Studentshare They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Paramedicine occurs in the social fabric of society. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. B. EMTs are not liable for any actions that are accurately documented. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. 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. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. Ethical challenges in Emergency Medical Services - PubMed Professional practice framework, professional rights and responsibilities, record keeping, governance. 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). This principle refers to both physical and mental damage, which can be done to the clients. 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. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. The approach to both participation and trial protocol training varied between ambulance services. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Decision-making is central to the everyday practice of paramedicine. 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. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. 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). 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). 2011). 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. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. This will also help you learn important concepts for the exam. 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, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). A significant ethical consideration for clinicians when treating older patients is their capacity. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Paramedic ethics, capacity and the treatment of vulnerable patients Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. http://dx.doi.org/10.1136/pmj.79.929.151 Legal and ethical practice in care. 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). C. Patient care cannot be discredited based on poor documentation. Capacity can fluctuate over time or as a health condition changes. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Dominique Moritz, Phillip Ebbs, Hamish Carver They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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 . 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. Together they form a unique fingerprint. 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. abstract = "Decision-making is central to the everyday practice of paramedicine. Exploring New Zealand Paramedic Attitudes Towards Advance Directives As with any patient, capacity can fluctuate, although this is more likely with older patients. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. 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. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Journal of Paramedic Practice is the leading monthly journal for paramedics. 122: 10 Researching paramedic clinical practice a practical guide. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. They must also deliver care that is consistent with ethical. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Continuing Professional Development: Ethical aspects of consent, duty 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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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 essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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 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. Continuing Professional Development: Ethical issues in paramedic practice 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. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Download Free PDF View PDF From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Our paramedic test questions are listed below. are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015). On the one hand, the paramedics should not neglect the interests and intentions of the patients. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. D. Incomplete . 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). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy.