ethical issues in paramedic practice

In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. This research aims to highlight and explore underlying values present within practice-based decisions. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. Challenges UK paramedics currently face in providing fully effective It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. There were no obvious physical causes for John's behaviour at this stage. 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. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. keywords = "Ethics, Decision making, paramedic, complexity". Due to this misconception, the crew then considered the MHA (1983). 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. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Practical decision-making strategies are provided and illustrated by brief examples. Journal of Paramedic Practice is the leading monthly journal for paramedics. Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. MA Healthcare Ltd Pre Hospital Ethics and Legal Issues - LawTeacher.net You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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. 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 and legal dilemmas paramedics face when managing a mental These factors contribute to an ethically complex decision-making environment. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. 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. 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). Ethics and law in paramedic practice: boundaries of capacity and Paramedics' decisions on patients' treatment will often impact others. 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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. 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. 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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. This is a part of and more. Aircraft Accidents and Emergency Management, Live This course is made up of a number of paramedic specific units and additional health care units. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". 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. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. 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. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Medical Ethics: Beneficence - The Medic Portal 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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). In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). 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. 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. Paramedics' perceptions of the care they provide to people who self 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. (PDF) Reflective Practice for Paramedics - Academia.edu Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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). It is diffcult tp prove actions were performed if they are not included on the report. 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). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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. Medical Ethics: Non-Maleficence - The Medic Portal They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. Samantha May NHS Research and Development Permissions were sought and granted. The first concern for an EMT must be: A. patient safety. Ethical Issues in Sports Medicine - In the United States - studocu.com In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. 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. 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). 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. 4 Conducting ethical research in paramedic practice. 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 The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. D. personal safety. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. (PDF) Law and Ethics for Paramedics: An Essential Guide 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. Removed to place of safety for up to 72 hours for further assessment. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Paramedic ethics, capacity and the treatment of vulnerable patients 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. 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). 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). Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Bachelor of Paramedic Practice (Conversion Pathway) (53C) People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Legal and ethical practice in care. 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. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz As such, making John secure was a priority. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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 approach to both participation and trial protocol training varied between ambulance services. In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A.

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