All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Notify the family that once CPR has been initiated, you are required to transport the patient. 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. This exploratory case study utilized semi-structured interviews of thirteen North. AB - Decision-making is central to the everyday practice of paramedicine. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Summary. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). The approach to both participation and trial protocol training varied between ambulance services. Removed to place of safety for up to 72 hours for further assessment. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). 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. 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 . Legal and ethical practice in care. C. Follow to your local protocols and contact medical direction if unsure how to proceed. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Monday, January 2, 2017. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. 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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. 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. 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). Although, hallucinations, delusions etc. While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Therefore, it is important to consider those principles more precisely. Purpose of the fitness to practise process. 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. 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. 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. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. In other words, paramedics need to adopt the principle of confidentiality and credence. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). This research aims to highlight and explore underlying values present within practice-based decisions. Introduction. The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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 first concern for an EMT must be: A. patient safety. A person must be presumed to have capacity unless it is established that he lacks capacity. It shall conclude with this student's position on the issue based on the discussions. 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). Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. 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. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. 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. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. 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. 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. . At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. Another ethical principle in paramedicine is beneficence. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. care passports). 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). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. 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. 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. 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. Consequently, the crew had to consider alternative management plans for John. 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. 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. 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. 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). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Paramedicine occurs in the social fabric of society. 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. 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. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. This will also help you learn important concepts for the exam. All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. Our paramedic test questions are listed below. 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. keywords = "Ethics, Decision making, paramedic, complexity". 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.

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