ethical issues in paramedic practice

Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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. Ethics part 1: what do paramedics owe patients? Psychiatric admission for assessment and subsequent treatment if required. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Ethics and law in paramedic practice: boundaries of capacity and Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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 disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). The crew's assessments and thought processes surrounding the management of John will be discussed. Maintaining a professional boundary between you and your patient (summary) 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 . There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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). Bachelor of Paramedic Practice (ADF Conversion) (53D) 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. 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. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Bachelor of Paramedic Practice (Conversion Pathway) (53C) Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Methods A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. 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). Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Paramedics - Health and Care Professions Council Introduction. AB - Decision-making is central to the everyday practice of paramedicine. It can be used by . / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. 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). The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Wednesday, December 2, 2020. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 4 Conducting ethical research in paramedic practice. Journal of Paramedic Practice is the leading monthly journal for paramedics. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. keywords = "Ethics, Decision making, paramedic, complexity". Paramedical ethics during acute emergency medical service referral This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. D. personal safety. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). 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. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. He was also unable to effectively communicate his decision making process. 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 . 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. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Paramedic Practice Test. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. Another ethical principle in paramedicine is beneficence. 136: 11 The future for paramedic research. Foundations for paramedic practice: a theoretical perspective - Amazon 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. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. N2 - Decision-making is central to the everyday practice of paramedicine. 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). 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. Integrated health care including mental health. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. 2 The HCPC standards of conduct, performance and ethics. 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). Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). PDF Ethical Questions in Emergency Medical Services: Controversies and Mental illness can be a challenging vulnerability for clinicians to navigate. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). 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. Abstract. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. | 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? An introduction to reflective practice for paramedics Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Ethical Issues in Sports Medicine - In the United States - studocu.com Ethical problems in clinical practice | Postgraduate Medical Journal A significant ethical consideration for clinicians when treating older patients is their capacity. 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. 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). 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 The approach to both participation and trial protocol training varied between ambulance services. Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. Although, hallucinations, delusions etc. 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Utilizing a priority dispatch system allows dispatchers to send response . Fitness to practise - Health and Care Professions Council Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Legal and ethical practice in care. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet 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. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). As such, making John secure was a priority. 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. 40: . Paramedics delivering palliative and end-of-life care in community Consequently, the crew had to consider alternative management plans for John. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. 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). 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). Copyright 2023 This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? Although provider judgment plays a large role in the . Paramedic ethics, capacity and the treatment of vulnerable patients BSc (Hons) Paramedic Science | Buckinghamshire New University EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Chat. Ethical Challenges in Emergency Medical Services: Controversies and This course is made up of a number of paramedic specific units and additional health care units. 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. 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). MA Healthcare Ltd 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). Ethical Practice: NCLEX-RN - Registered nursing Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Consequently, the crew began to assess for a psychological cause. 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. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. B. crew control. This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 03 What factors affect paramedics' involvement of people with dementia Principlism in paramedicine: an examination of applied healthcare ethics 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 Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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). 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 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). 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. Don't hesitate and rely on professionals! Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. MA Healthcare Ltd 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. 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). Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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. 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, 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. 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. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Paramedics' decisions on patients' treatment will often impact others. Therefore, it is important to consider those principles more precisely. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards.

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