Ethics and law in paramedic practice: Boundaries of capacity and 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. There are many ethical issues that are encountered during the prehospital care of children and adults. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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). This is a part of and more. Vulnerable patients are no exception. Methods Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. D. personal safety. These factors contribute to an ethically complex decision-making environment. 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. C. Follow to your local protocols and contact medical direction if unsure how to proceed. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Paramedic ethics, capacity and the treatment of vulnerable patients Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. practice with medical specialists. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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 dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 03 What factors affect paramedics' involvement of people with dementia Medical Ethics: Non-Maleficence - The Medic Portal It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. | Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Ethics, bioethics and legal issues in paramedic practice. Due to this misconception, the crew then considered the MHA (1983). 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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). It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. 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. 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. 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). 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. He was also unable to effectively communicate his decision making process. The approach to both participation and trial protocol training varied between ambulance services. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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). Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Principlism in paramedicine: an examination of applied healthcare ethics Capacity can fluctuate over time or as a health condition changes. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. A person's capacity depends upon the nature of their disability. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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. 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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. 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). However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. 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. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. 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. Paramedics delivering palliative and end-of-life care in community All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision 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. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Although, hallucinations, delusions etc. Together they form a unique fingerprint. C. Patient care cannot be discredited based on poor documentation. This will also help you learn important concepts for the exam. 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. Bachelor of Paramedic Practice (ADF Conversion) (53D) Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. The Paramedic'S Guide To Research: An Introduction - Google Books It affirms the supremacy of law and appreciation of human rights and freedom. This was because of current UK law and a lack of access to a GP respectively. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 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. Removed to place of safety for up to 72 hours for further assessment. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. 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. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. 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. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . 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. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Continuing Professional Development: Ethical issues in paramedic practice The use of the other sections of the MHA can require much more time (Hawley et al. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Practical decision-making strategies are provided and illustrated by brief examples. 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. Dominique Moritz, Phillip Ebbs, Hamish Carver The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Copyright 2023 By continuing you agree to the use of cookies. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. Paramedics - Health and Care Professions Council 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. 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). 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. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Purpose of the fitness to practise process. You will see the questions are broken down into the 5 different categories you will be tested on. 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. Ethics and law in paramedic practice: boundaries of capacity and Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. Therefore, it is important to consider those principles more precisely. A. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Mental illness can be a challenging vulnerability for clinicians to navigate. (PDF) Law and Ethics for Paramedics: An Essential Guide OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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 Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies This principle refers to both physical and mental damage, which can be done to the clients. 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. Gillick competence empowers children to exercise autonomy over their own medical decisions. If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007).
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