It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. A significant ethical consideration for clinicians when treating older patients is their capacity. MA Healthcare Ltd A consensus among paramedic supervisors B. 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. C. Follow to your local protocols and contact medical direction if unsure how to proceed. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . MA Healthcare Ltd Methods 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. Dominique Moritz, Phillip Ebbs, Hamish Carver title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". PDF Ethical Questions in Emergency Medical Services: Controversies and Elder abuse can encompass neglect, financial duress, psychological threats and violence. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Summary. Practice in a manner consistent with a code of ethics for registered nurses. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Paramedics' perceptions of the care they provide to people who self Paramedics delivering palliative and end-of-life care in community 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. 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. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. This is a part of and more. Chat. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. 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 . On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. 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. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Copyright 2023 Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. The term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. These factors contribute to an ethically complex decision-making environment. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. D. personal safety. As such, making John secure was a priority. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Ethical challenges in Emergency Medical Services - PubMed 153: It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Ethical Responsibilities of Paramedics | Work - Chron.com 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). A person's capacity depends upon the nature of their disability. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. In conclusion, ethical and legal principles are of great importance in paramedical practices. Should paramedics ever accept patients' refusal - BMC Medical Ethics Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. B. EMTs are not liable for any actions that are accurately documented. Paramedics interact with these patients every day, often during times of such vulnerability. Therefore, it is important to consider those principles more precisely. 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). 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. ethics of paramedics - SlideShare Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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. 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). He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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). Ethical problems in clinical practice | Postgraduate Medical Journal 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. Analyse Legal and Ethical Issues Facing Paramedics Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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. 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 views of families, carers and others, if appropriate, should be fully considered when taking decisions. A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). Legal | Journal Of Paramedic Practice Paramedic ethics, capacity and the treatment of vulnerable patients 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). 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. Exploring New Zealand Paramedic Attitudes Towards Advance Directives @article{6040c026e1e34bd9b7239761b13480e7. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Although, hallucinations, delusions etc. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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. Paramedic practice must consider all of these factors to ensure ethically good care. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. Ethical dilemmas in prehospital emergency care - SpringerLink For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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. 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. Ethical Practice: NCLEX-RN - Registered nursing You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Practical decision-making strategies are provided and illustrated by brief examples. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 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 . Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. A. 136: 11 The future for paramedic research. 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. 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). Journal of Paramedic Practice: Vol 3, No 8 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. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. The crew's assessments and thought processes surrounding the management of John will be discussed. A sixth theme of ethical complexity was pervasive across these five themes. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Our fitness to practise process is designed to protect the public from those who are not fit to practise. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Medical Ethics: Non-Maleficence - The Medic Portal 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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 PROFESSIONALISM Professionalism in UK paramedic practice Prof Malcolm Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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 . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Together they form a unique fingerprint. 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). Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of Another ethical principle in paramedicine is beneficence. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Confidentiality, capacity and consent. Principlism in paramedicine: an examination of applied healthcare ethics However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. 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. 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. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. 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. 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. The ethical and legal dilemmas paramedics face when managing a mental practice with medical specialists. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Ethical Issues in Critical Care | Clinical Gate It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Continuing Professional Development: Ethical issues in paramedic 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. (PDF) Reflective Practice for Paramedics - ResearchGate