While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Ethical problems in clinical practice | Postgraduate Medical Journal The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. | There are many ethical issues that are encountered during the prehospital care of children and adults. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Vulnerable patients are no exception. In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. Legal & Ethical issues associated with paramedic practice during COVID19. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Ethics and law in paramedic practice: Boundaries of capacity and Principlism in paramedicine: an examination of applied healthcare ethics All of these actions may devaluate the positive results of treatment and harm patients health and well-being. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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). For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). 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. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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. This principle refers to both physical and mental damage, which can be done to the clients. 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 Our fitness to practise process is designed to protect the public from those who are not fit to practise. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. EMT Chapter 1 Flashcards | Quizlet 40: . In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. 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. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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. 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 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. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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). 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. Removed to place of safety for up to 72 hours for further assessment. 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. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Utilizing a priority dispatch system allows dispatchers to send response . This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). 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. C. vehicle safety. Paramedics interact with these patients every day, often during times of such vulnerability. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. MA Healthcare Ltd Psychiatric admission for assessment and subsequent treatment if required. 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 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. This exploratory case study utilized semi-structured interviews of thirteen North. 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. 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. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Principlism in paramedicine: an examination of applied healthcare ethics 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. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Journal of Paramedic Practice: Vol 3, No 8 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. 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Ethics and law in paramedic practice : Boundaries of capacity and interests. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Ethical considerations in prehospital ambulance based research Ethical Challenges in Emergency Medical Services: Controversies and 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). This research aims to highlight and explore underlying values present within practice-based decisions. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. (PDF) Reflective Practice for Paramedics - ResearchGate 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. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. The question of justice is another part of the paramedical performance. In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. By continuing you agree to the use of cookies. (PDF) Law and Ethics for Paramedics: An Essential Guide Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. A significant ethical consideration for clinicians when treating older patients is their capacity. @article{6040c026e1e34bd9b7239761b13480e7. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 2011). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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 . 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. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. Decision-making is central to the everyday practice of paramedicine. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Copyright 2023 The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . These factors contribute to an ethically complex decision-making environment. Paramedics delivering palliative and end-of-life care in community A person's capacity depends upon the nature of their disability. Integrated health care including mental health. A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. C. Follow to your local protocols and contact medical direction if unsure how to proceed. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. The Paramedic'S Guide To Research: An Introduction - Google Books 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. 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. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice.
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