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 . A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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. Summary. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 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). As such, making John secure was a priority. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. 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. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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 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. Notify the family that once CPR has been initiated, you are required to transport the patient. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. It shall conclude with this student's position on the issue based on the discussions. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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). 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. care passports). Copyright 2023 Ethics part 1: what do paramedics owe patients? 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. 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. B. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. 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 seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. 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. 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). Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. 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. 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. 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? Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. 153: Paramedicine presupposes direct interaction with individuals. D. personal safety. MA Healthcare Ltd Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. 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 author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. B. crew control. 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. 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). Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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. A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 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. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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). In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. Confidentiality, capacity and consent. Ethics and law in paramedic practice : Boundaries of capacity and interests. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. By utilising a reflective format, the article explores 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 these situations. In this case, both ethical and legal principles are important. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. 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. 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. 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. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. D. Incomplete . 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. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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. keywords = "Ethics, Decision making, paramedic, complexity". MA Healthcare Ltd 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. @article{6040c026e1e34bd9b7239761b13480e7. 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). 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. 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. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Therefore, they should consider the needs and requirements of patients and act correspondingly. 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. . Gillick competence empowers children to exercise autonomy over their own medical decisions. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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). This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. This principle refers to both physical and mental damage, which can be done to the clients. Their vulnerability may impede their autonomy, which can then affect . Paramedicine occurs in the social fabric of society. Ethics, bioethics and legal issues in paramedic practice. Legal and ethical practice in care. 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. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Dominique Moritz, Phillip Ebbs, Hamish Carver 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. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. 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 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). This was because of current UK law and a lack of access to a GP respectively. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. | 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 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). 2011). Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. 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). | Consequently, the crew had to consider alternative management plans for John. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. 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. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Aircraft Accidents and Emergency Management, Live The question of justice is another part of the paramedical performance. These factors contribute to an ethically complex decision-making environment. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. 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. D. personal safety. 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. 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]). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Copyright 2023 Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Therefore, it is important to consider those principles more precisely. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011).