Wednesday, December 2, 2020. Although provider judgment plays a large role in the . Ethics and law in paramedic practice: boundaries of capacity and 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). 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). Consequently, the crew began to assess for a psychological cause. Notify the family that once CPR has been initiated, you are required to transport the patient. Ethical Challenges in Emergency Medical Services: Controversies and Paramedicine occurs in the social fabric of society. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. 4 Conducting ethical research in paramedic practice. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. NHS Research and Development Permissions were sought and granted. 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). . 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). Vulnerable patients are no exception. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Abstract. 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. 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. 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 . Exploring New Zealand Paramedic Attitudes Towards Advance Directives 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 Due to this misconception, the crew then considered the MHA (1983). 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 . 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. Pre Hospital Ethics and Legal Issues - LawTeacher.net title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Ethical challenges in Emergency Medical Services - PubMed Professional practice framework, professional rights and responsibilities, record keeping, governance. 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 Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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' decisions on patients' treatment will often impact others. John had arrived at a friend's house during the night, behaving in a strange, confused manner. This was because of current UK law and a lack of access to a GP respectively. 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). The ethical and legal dilemmas paramedics face when managing a mental Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. A. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. 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. http://dx.doi.org/10.1136/pmj.79.929.151 Ethics, bioethics and legal issues in paramedic practice. B. EMTs are not liable for any actions that are accurately documented. Principlism in paramedicine: an examination of applied healthcare ethics Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This is not the case. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Paramedical ethics during acute emergency medical service referral The Paramedic'S Guide To Research: An Introduction - Google Books Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. This is a part of and more. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 40: . Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Sample Essay on Law and Ethics in Paramedical Science Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). C. vehicle safety. 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. 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). journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This exploratory case study utilized semi-structured interviews of thirteen North. Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. Continuing Professional Development: Ethical issues in paramedic practice Integrated health care including mental health. 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. 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. School of Nursing, Midwifery & Paramedic Practice Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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. Paramedics interact with these patients every day, often during times of such vulnerability. This principle refers to both physical and mental damage, which can be done to the clients. 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). In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. Dominique Moritz, Phillip Ebbs, Hamish Carver 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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). 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. To assist paramedics in navigating these complex issues, the London Ambulance Service NHS Trust (2019) provides guidance on how to refer vulnerable people to services which may investigate the circumstances and ensure the safety and welfare of the patient). Legal | Journal Of Paramedic Practice Paramedic ethics, capacity and the treatment of vulnerable patients This principle refers to both physical and mental damage, which can be done to the clients. Practical decision-making strategies are provided and illustrated by brief examples. Paramedic attitudes and experiences of enrolling patients into the This course is made up of a number of paramedic specific units and additional health care units. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Inform client/staff members of ethical issues affecting client care. Together they form a unique fingerprint. It affirms the supremacy of law and appreciation of human rights and freedom. (PDF) Reflective Practice for Paramedics - ResearchGate 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. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. PARAMEDIC2 study: Ethical issues | Medicina Intensiva 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). Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. 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. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). 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. 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). However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . 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. 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 . 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 For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. Reflective practice is undertaken for a variety of reasons. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate 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. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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. Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. 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. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Paramedics' perceptions of the care they provide to people who self 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). 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). 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). 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. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). practice with medical specialists. B. crew control. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. This will also help you learn important concepts for the exam. 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). Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Utilizing a priority dispatch system allows dispatchers to send response . 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. 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). Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. There were no obvious physical causes for John's behaviour at this stage. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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).
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