ethical issues in paramedic practice

Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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). 03 What factors affect paramedics' involvement of people with dementia Foundations for paramedic practice: a theoretical perspective - Amazon Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 2011). 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). Elder abuse can encompass neglect, financial duress, psychological threats and violence. Medical Ethics: Beneficence - The Medic Portal C. Follow to your local protocols and contact medical direction if unsure how to proceed. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. 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. Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. 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. 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. 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. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. 105: 9 Using quantitative research methods in paramedic practice. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. 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. Our paramedic test questions are listed below. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. 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). Sample Essay on Law and Ethics in Paramedical Science Purpose of the fitness to practise process. 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. Paramedical ethics during acute emergency medical service referral 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. MA Healthcare Ltd 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 wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. On the one hand, the paramedics should not neglect the interests and intentions of the patients. NHS Research and Development Permissions were sought and granted. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. PDF Ethical Questions in Emergency Medical Services: Controversies and Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. Aircraft Accidents and Emergency Management, Live Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. D. personal safety. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. 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. Methods Paramedicine occurs in the social fabric of society. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). 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. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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. 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. Paramedic Professional Practice | Curtin University Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. It affirms the supremacy of law and appreciation of human rights and freedom. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. 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. 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). Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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). 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. 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement 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 . Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Copyright 2023 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 MA Healthcare Ltd Legal and ethical practice in care. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Dominique Moritz, Phillip Ebbs, Hamish Carver A. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. The term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. It is diffcult tp prove actions were performed if they are not included on the report. 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. 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. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Removed to place of safety for up to 72 hours for further assessment. 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). Ethical problems in clinical practice | Postgraduate Medical Journal PARAMEDIC2 study: Ethical issues | Medicina Intensiva 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 4 Conducting ethical research in paramedic practice. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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. Bachelor of Paramedic Practice (Conversion Pathway) (53C) Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. http://dx.doi.org/10.1136/pmj.79.929.151 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. In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. C. vehicle safety. Ethics and law in paramedic practice: boundaries of capacity and | 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). Copyright 2023 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Samantha May 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. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. A consensus among paramedic supervisors B. 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. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? This will also help you learn important concepts for the exam. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . abstract = "Decision-making is central to the everyday practice of paramedicine. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Paramedic practice must consider all of these factors to ensure ethically good care. Ethics part 1: what do paramedics owe patients? Due to this misconception, the crew then considered the MHA (1983). Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). 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 . In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. @article{6040c026e1e34bd9b7239761b13480e7. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. 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. How does a paramedic use chemistry? [FAQ!] This principle refers to both physical and mental damage, which can be done to the clients. 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. Paramedic attitudes and experiences of enrolling patients into the A person is not to be treated as unable to make a decision merely because he makes an unwise decision. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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. This research aims to highlight and explore underlying values present within practice-based decisions. 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. The question of justice is another part of the paramedical performance. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). 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). Confidentiality, capacity and consent. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The crew's assessments and thought processes surrounding the management of John will be discussed. 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). Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Pre Hospital Ethics and Legal Issues - LawTeacher.net Legal and Ethical Aspects of Paramedic Practice Article - Studentshare However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. An introduction to reflective practice for paramedics Gillick competence empowers children to exercise autonomy over their own medical decisions. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Principlism in paramedicine: an examination of applied healthcare ethics 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 .