ethical issues in paramedic practice

This research aims to highlight and explore underlying values present within practice-based decisions. 136: 11 The future for paramedic research. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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). This is not the case. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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 Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. Such a position will help improve the system and lead to effective and fruitful results. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. 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. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Ethics and law in paramedic practice : Boundaries of capacity and interests. . 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. 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. 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 . Practice in a manner consistent with a code of ethics for registered nurses. 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). title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Ethics, bioethics and legal issues in paramedic practice. 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 . 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). Utilizing a priority dispatch system allows dispatchers to send response . 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. Therefore, it is important to consider those principles more precisely. 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]). It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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. Gillick competence empowers children to exercise autonomy over their own medical decisions. This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. In conclusion, ethical and legal principles are of great importance in paramedical practices. 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. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). C. Follow to your local protocols and contact medical direction if unsure how to proceed. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. practice with medical specialists. 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. Decision-making is central to the everyday practice of paramedicine. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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). 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. 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. 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. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Wednesday, December 2, 2020. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. A. 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. Their vulnerability may impede their autonomy, which can then affect . 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. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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). The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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? For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 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). In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies These factors contribute to an ethically complex decision-making environment. 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. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. 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. Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Our fitness to practise process is designed to protect the public from those who are not fit to practise. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Copyright 2023 In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Monday, January 2, 2017. In the forthcoming sections, these standards, guidelines and ethical principles are used to explore key issues relating to patients who are commonly considered to be vulnerable: children, older people and those with mental illness or disability. Paramedic Practice Test. Paramedics' decisions on patients' treatment will often impact others. They must also deliver care that is consistent with ethical. 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). 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. 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. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. 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 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. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) 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. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. 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). 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 . 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). The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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 . There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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.

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