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. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). 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. Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. 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. 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. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy Cuts in public health and community services funding have decimated programs, leaving unmet health needs. 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). 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. 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. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. As such, making John secure was a priority. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). 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. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Legal and Ethical Aspects of Paramedic Practice Article - Studentshare Ethics and law in paramedic practice : Boundaries of capacity and interests. This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able: To provide an overview of the four key ethical principles that underpin current clinical practice in the UK To explore these four ethical principles in relation to specific prehospital and clinical issues To encourage the practitioner to reflect on their own ethical practice To begin to develop the ability to share, discuss and debate the four ethical principles with colleagues and friends, in relation to your own clinical practice. 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. 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. Chat. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Foundations for paramedic practice: a theoretical perspective - Amazon John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). 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. The Australasian College of Paramedicine Inform client/staff members of ethical issues affecting client care. | This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The views of families, carers and others, if appropriate, should be fully considered when taking decisions. 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). Bachelor of Paramedic Practice (Conversion Pathway) (53C) Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Our paramedic test questions are listed below. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Ethical challenges in Emergency Medical Services - PubMed Integrated health care including mental health. 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. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. D. Incomplete . Ethical problems in clinical practice | Postgraduate Medical Journal 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Utilizing a priority dispatch system allows dispatchers to send response . 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. . Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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. 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). Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. Legal and ethical practice in care. 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. Paramedic ethics, capacity and the treatment of vulnerable patients 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. It shall conclude with this student's position on the issue based on the discussions. 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. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Summary. This research aims to highlight and explore underlying values present within practice-based decisions. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. 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 There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Maintaining a professional boundary between you and your patient (summary) These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. B. crew control. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 8 Quantitative research in paramedic practice an overview. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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). Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Should paramedics ever accept patients' refusal - BMC Medical Ethics What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. 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). Gillick competence empowers children to exercise autonomy over their own medical decisions. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Ethics in EMS: 10 things you need to know to save lives (PDF) Reflective Practice for Paramedics - ResearchGate Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Copyright 2023 Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. There are many ethical issues that are encountered during the prehospital care of children and adults. 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Introduction. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. MA Healthcare Ltd In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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 MA Healthcare Ltd Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Ethics part 1: what do paramedics owe patients? They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Decision-making is central to the everyday practice of paramedicine. This principle refers to both physical and mental damage, which can be done to the clients. 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. 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. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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). 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). Principlism in paramedicine: an examination of applied healthcare ethics It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Bachelor of Paramedic Practice (ADF Conversion) (53D) John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Due to this misconception, the crew then considered the MHA (1983). 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. C. Patient care cannot be discredited based on poor documentation. 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). Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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. 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). B. EMTs are not liable for any actions that are accurately documented. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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. For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. 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). People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 4 Conducting ethical research in paramedic practice. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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. Don't hesitate and rely on professionals! Despite this, there remain multiple barriers to their fully effective provision of such care. 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.