It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. The approach to both participation and trial protocol training varied between ambulance services. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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. Ethical challenges in Emergency Medical Services - PubMed 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. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Cuts in public health and community services funding have decimated programs, leaving unmet health needs. In this case, the MCA can be applied in the normal way, to provide treatment, even if for mental health disorders, should the person lack capacity (Department of Constituational Affairs, 2007). 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. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Utilizing a priority dispatch system allows dispatchers to send response . 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. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). A person's capacity depends upon the nature of their disability. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). 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. 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. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Paramedics delivering palliative and end-of-life care in community He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. Copyright 2023 It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. A person must be presumed to have capacity unless it is established that he lacks capacity. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Capacity can fluctuate over time or as a health condition changes. 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. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. keywords = "Ethics, Decision making, paramedic, complexity". Our fitness to practise process is designed to protect the public from those who are not fit to practise. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. It can be used by . 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. 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). 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. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. 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. 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 first concern for an EMT must be: A. patient safety. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). Paramedic Professional Practice | Curtin University Paramedics have professional duties toward vulnerable persons. Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. Legal & Ethical issues associated with paramedic practice during COVID19. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Paramedics' perceptions of the care they provide to people who self Fitness to practise - Health and Care Professions Council In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. 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 It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. (PDF) Law and Ethics for Paramedics: An Essential Guide 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). 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). Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Integrated health care including mental health. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Aircraft Accidents and Emergency Management, Live The ethical and legal dilemmas paramedics face when managing a mental A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Therefore, it is important to consider those principles more precisely. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. | In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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). 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Principlism in paramedicine: An examination of applied healthcare ethics 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. 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. 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? The provider must be always stalwart in the face of challenges to. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. care passports). Ethics and law in paramedic practice: Boundaries of capacity and 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). 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015). Ethics and law in paramedic practice: boundaries of capacity and Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Journal of Paramedic Practice: Vol 3, No 8 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. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Together they form a unique fingerprint. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. You will see the questions are broken down into the 5 different categories you will be tested on. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. N2 - Decision-making is central to the everyday practice of paramedicine. A consensus among paramedic supervisors B. 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. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. This article explores 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. 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? Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. Follow to your local protocols and contact medical direction if unsure how to proceed. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Although, hallucinations, delusions etc. 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. U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. 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. 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). Ethics and law in paramedic practice: Boundaries of capacity and The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Ethical dilemmas in prehospital emergency care - SpringerLink It is not clear though, how professionals (especially those who do not use the MHA) are likely to know in advance if a patient is likely to meet threshold for detention under this act, and so whether the MCA seems appropriate for use or not. Practical decision-making strategies are provided and illustrated by brief examples. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. Legal and ethical practice in care. 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). Paramedic ethics, capacity and the treatment of vulnerable patients Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz 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). Preventing children from exercising their autonomy may cause ethical challenges (Box 1). In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 105: 9 Using quantitative research methods in paramedic practice. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. D. personal safety. A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Chat. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. 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. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. 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. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com These factors contribute to an ethically complex decision-making environment. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Ethics part 1: what do paramedics owe patients? Professional practice framework, professional rights and responsibilities, record keeping, governance. The use of the other sections of the MHA can require much more time (Hawley et al. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. An introduction to reflective practice for paramedics