Practical decision-making strategies are provided and illustrated by brief examples. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. abstract = "Decision-making is central to the everyday practice of 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). The Paramedic'S Guide To Research: An Introduction - Google Books Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. 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). 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. Ethics, bioethics and legal issues in paramedic practice. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. A sixth theme of ethical complexity was pervasive across these five themes. 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. Legal, ethical and social aspects of child abuse - NursingAnswers.net 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. The approach to both participation and trial protocol training varied between ambulance services. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Using a reflective format, the article explored some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in complex situations. (PDF) Reflective Practice for Paramedics - ResearchGate 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. Purpose of the fitness to practise process. Gillick competence empowers children to exercise autonomy over their own medical decisions. | The provider must be always stalwart in the face of challenges to. Don't hesitate and rely on professionals! Bachelor of Paramedic Practice (ADF Conversion) (53D) / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Foundations for paramedic practice: a theoretical perspective - Amazon 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. A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. C. Follow to your local protocols and contact medical direction if unsure how to proceed. 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. Medical Ethics: Beneficence - The Medic Portal 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. 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 use of the other sections of the MHA can require much more time (Hawley et al. Bachelor of Paramedic Practice (Conversion Pathway) (53C) A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Practice in a manner consistent with a code of ethics for registered nurses. 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. 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). 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 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. Introduction. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. (PDF) Law and Ethics for Paramedics: An Essential Guide Integrated health care including mental health. 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. 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). The question of justice is another part of the paramedical performance. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Copyright 2023 This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. care passports). 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. 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. 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. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. C. vehicle safety. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Ethical Practice: NCLEX-RN - Registered nursing D. personal safety. Ethics in EMS: 10 things you need to know to save lives It can be used by . Psychiatric admission for assessment and subsequent treatment if required. As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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). In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Continuing Professional Development: Ethical issues in paramedic practice It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Capacity can fluctuate over time or as a health condition changes. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Paramedic ethics, capacity and the treatment of vulnerable patients EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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. In other words, paramedics need to adopt the principle of confidentiality and credence. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. C. Patient care cannot be discredited based on poor documentation. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. 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. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. http://dx.doi.org/10.1136/pmj.79.929.151 However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Despite this, there remain multiple barriers to their fully effective provision of such care. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 153: Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. By continuing you agree to the use of cookies. . Ethical problems in clinical practice | Postgraduate Medical Journal 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. 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). Major incident clinical . 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 . Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. 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. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). 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). Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Paramedic: Legislation And And Guidance That Govern The - Edubirdie Paramedic ethics, capacity and the treatment of vulnerable patients Ethics and law in paramedic practice: Boundaries of capacity and Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. 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. 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). 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Should paramedics ever accept patients' refusal - BMC Medical Ethics School of Nursing, Midwifery & Paramedic Practice However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. Paramedic Professional Practice | Curtin University 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). 136: 11 The future for paramedic research. 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). 40: . Consequently, the crew had to consider alternative management plans for John. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. You will see the questions are broken down into the 5 different categories you will be tested on. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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). Ethics and law in paramedic practice : Boundaries of capacity and interests. 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 . MA Healthcare Ltd The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Paramedic Practice Test. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. How does a paramedic use chemistry? [FAQ!]