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. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Another ethical principle in paramedicine is beneficence. 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). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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). On the one hand, the paramedics should not neglect the interests and intentions of the patients. Paramedics have professional duties toward vulnerable persons. 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. Consumer rights in advocacy and health care. 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. 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). This will also help you learn important concepts for the exam. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. As with any patient, capacity can fluctuate, although this is more likely with older patients. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. 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. There are many ethical issues that are encountered during the prehospital care of children and adults. B. A person must be presumed to have capacity unless it is established that he lacks capacity. 136: 11 The future for paramedic research. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. Chat. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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. 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. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. Capacity can fluctuate over time or as a health condition changes. He was also unable to effectively communicate his decision making process. 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. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Like the abuse of children, the abuse of older people is a significant community concern. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. 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. 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. 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. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Integrated health care including mental health. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy The views of families, carers and others, if appropriate, should be fully considered when taking decisions. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. This research aims to highlight and explore underlying values present within practice-based decisions. Although provider judgment plays a large role in the . 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). Elder abuse can encompass neglect, financial duress, psychological threats and violence. C. vehicle safety. It shall conclude with this student's position on the issue based on the discussions. Consequently, the crew began to assess for a psychological cause. 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. Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. MA Healthcare Ltd In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). This is a part of and more. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 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. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. care passports). 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. Aircraft Accidents and Emergency Management, Live One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Due to this misconception, the crew then considered the MHA (1983). Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Abstract. 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. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Psychiatric admission for assessment and subsequent treatment if required. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. B. crew control. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. 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. 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). To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. C. Patient care cannot be discredited based on poor documentation. Notify the family that once CPR has been initiated, you are required to transport the patient. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. Therefore, they should consider the needs and requirements of patients and act correspondingly. Despite this, there remain multiple barriers to their fully effective provision of such care. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. You will see the questions are broken down into the 5 different categories you will be tested on. Ethics, bioethics and legal issues in paramedic practice. | 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. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 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. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. There were no obvious physical causes for John's behaviour at this stage. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. 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. 2011). This principle refers to both physical and mental damage, which can be done to the clients. Practical decision-making strategies are provided and illustrated by brief examples. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 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]). Professional practice framework, professional rights and responsibilities, record keeping, governance. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. D. Incomplete . The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). 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. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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). 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). Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Inform client/staff members of ethical issues affecting client care. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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 . 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. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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). 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. 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). This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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). B. EMTs are not liable for any actions that are accurately documented. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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. Samantha May Our fitness to practise process is designed to protect the public from those who are not fit to practise. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. The first concern for an EMT must be: A. patient safety. practice with medical specialists. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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 .