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. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Consequently, the crew began to assess for a psychological cause. keywords = "Ethics, Decision making, paramedic, complexity". However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Samantha May @article{6040c026e1e34bd9b7239761b13480e7. Notify the family that once CPR has been initiated, you are required to transport the patient. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Dominique Moritz, Phillip Ebbs, Hamish Carver Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. Abstract. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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 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). 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Chat. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . This was because of current UK law and a lack of access to a GP respectively. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Integrated health care including mental health. 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). This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. A. 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. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. A significant ethical consideration for clinicians when treating older patients is their capacity. 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. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. 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). For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 136: 11 The future for paramedic research. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. As such, making John secure was a priority. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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. 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Capacity can fluctuate over time or as a health condition changes. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. The approach to both participation and trial protocol training varied between ambulance services. Don't hesitate and rely on professionals! Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. The first concern for an EMT must be: A. patient safety. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. AB - Decision-making is central to the everyday practice of paramedicine. 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). Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Paramedics have professional duties toward vulnerable persons. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. 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. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. It affirms the supremacy of law and appreciation of human rights and freedom. 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 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). By continuing you agree to the use of cookies. 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. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. This research aims to highlight and explore underlying values present within practice-based decisions. 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. 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). 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. 8 Quantitative research in paramedic practice an overview. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. 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. 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. 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. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27).
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