ethical issues in paramedic practice ethical issues in paramedic practice

However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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. 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). author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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 In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. 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. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. 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. 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). Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. Samantha May 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. 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. 2011). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. Aircraft Accidents and Emergency Management, Live Another ethical principle in paramedicine is beneficence. This research aims to highlight and explore underlying values present within practice-based decisions. 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. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. 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. Consequently, the crew had to consider alternative management plans for John. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Their vulnerability may impede their autonomy, which can then affect . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. As with any patient, capacity can fluctuate, although this is more likely with older patients. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. 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. 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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. 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. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. 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. http://dx.doi.org/10.1136/pmj.79.929.151 For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 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. 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. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Practice in a manner consistent with a code of ethics for registered nurses. 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. It is diffcult tp prove actions were performed if they are not included on the report. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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 . 105: 9 Using quantitative research methods in paramedic practice. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. 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 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. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. Such a position will help improve the system and lead to effective and fruitful results. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Introduction. It can be used by . The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. A. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. C. Follow to your local protocols and contact medical direction if unsure how to proceed. It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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). 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). D. personal safety. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Reflective practice is undertaken for a variety of reasons. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) The principles of non-maleficence and beneficence form an area of special interest for the paramedics since these ethical issues are of paramount importance to them. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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 . The approach to both participation and trial protocol training varied between ambulance services. 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). 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. By continuing you agree to the use of cookies. 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). 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. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. Dominique Moritz, Phillip Ebbs, Hamish Carver 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. Like the abuse of children, the abuse of older people is a significant community concern. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). MA Healthcare Ltd This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). 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. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). Inform client/staff members of ethical issues affecting client care. The ethical responsibilities of a paramedic also include acting fairly and helping any patient who needs it, regardless of their race, age, gender, religion or another personal characteristic.. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Notify the family that once CPR has been initiated, you are required to transport the patient. Although provider judgment plays a large role in the . 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. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. C. Patient care cannot be discredited based on poor documentation. 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. Summary. 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. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. 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). Preventing children from exercising their autonomy may cause ethical challenges (Box 1). 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. Paramedics have professional duties toward vulnerable persons. Together they form a unique fingerprint. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his 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. 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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. Wednesday, December 2, 2020. 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. For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? Copyright 2023 All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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). 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. 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. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. In conclusion, ethical and legal principles are of great importance in paramedical practices. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. You will see the questions are broken down into the 5 different categories you will be tested on. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). 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). Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 Utilizing a priority dispatch system allows dispatchers to send response . However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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). 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). practice with medical specialists. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. Copyright 2023 In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. 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. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . Paramedic practice must consider all of these factors to ensure ethically good care. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. In other words, paramedics need to adopt the principle of confidentiality and credence.