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). A. Paramedic ethics, capacity and the treatment of vulnerable patients Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. In other words, paramedics need to adopt the principle of confidentiality and credence. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). 03 What factors affect paramedics' involvement of people with dementia Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Ethical Issues in Sports Medicine - In the United States - studocu.com In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Dominique Moritz, Phillip Ebbs, Hamish Carver
Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet 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. Practical decision-making strategies are provided and illustrated by brief examples. 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. 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). 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). The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Should paramedics ever accept patients' refusal - BMC Medical Ethics 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. 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. 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. 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 second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. Paramedics delivering palliative and end-of-life care in community Mental illness can be a challenging vulnerability for clinicians to navigate. MA Healthcare Ltd
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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). The ethical and legal dilemmas paramedics face when managing a mental 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). Paramedic Professional Practice | Curtin University At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. |
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, 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This was because of current UK law and a lack of access to a GP respectively. Although provider judgment plays a large role in the . 8 Quantitative research in paramedic practice an overview. Pre Hospital Ethics and Legal Issues - LawTeacher.net Copyright 2023
Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Psychiatric admission for assessment and subsequent treatment if required. Continuing Professional Development: Ethical issues in paramedic practice However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Legal & Ethical issues associated with paramedic practice during COVID19. 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. 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. MA Healthcare Ltd
Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Ethics, bioethics and legal issues in paramedic practice. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). 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. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. Removed to place of safety for up to 72 hours for further assessment. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 122: 10 Researching paramedic clinical practice a practical guide. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. Due to this misconception, the crew then considered the MHA (1983). (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. 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. They must also deliver care that is consistent with ethical. Community Paramedics | American Nurses Association Continuing Professional Development: Ethical aspects of consent, duty Methods 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. He was also unable to effectively communicate his decision making process. It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). You will see the questions are broken down into the 5 different categories you will be tested on. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. 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. . Ethics and law in paramedic practice: boundaries of capacity and Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). Integrated health care including mental health. C. Follow to your local protocols and contact medical direction if unsure how to proceed. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. 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. 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. In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. 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. Medical Ethics: Beneficence - The Medic Portal doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. 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. School of Nursing, Midwifery & Paramedic Practice journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. 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. 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). Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. 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). PROFESSIONALISM Professionalism in UK paramedic practice Prof Malcolm Exploring New Zealand Paramedic Attitudes Towards Advance Directives NHS Research and Development Permissions were sought and granted. 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. 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. 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. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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 In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. http://dx.doi.org/10.1136/pmj.79.929.151 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). In conclusion, ethical and legal principles are of great importance in paramedical practices. Such a position will help improve the system and lead to effective and fruitful results. BSc (Hons) Paramedic Science | Buckinghamshire New University 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). 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. 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. 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. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. The provider must be always stalwart in the face of challenges to. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end.
105: 9 Using quantitative research methods in paramedic practice. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. 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). keywords = "Ethics, Decision making, paramedic, complexity". B. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Paramedical ethics during acute emergency medical service referral 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). Legal | Journal Of Paramedic Practice Legal and Ethical Aspects of Paramedic Practice Article - Studentshare Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Monday, January 2, 2017. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. 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. 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.