However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Paramedicine occurs in the social fabric of society. A. 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). People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. 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). 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). are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015). Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 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. He was also unable to effectively communicate his decision making process. 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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 In other words, paramedics need to adopt the principle of confidentiality and credence. 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. 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). Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. 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. By continuing you agree to the use of cookies. A person's capacity depends upon the nature of their disability. An introduction to reflective practice for paramedics Dominique Moritz, Phillip Ebbs, Hamish Carver 2 The HCPC standards of conduct, performance and ethics. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. A person must be presumed to have capacity unless it is established that he lacks capacity. 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. 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. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . The ethical and legal dilemmas paramedics face when managing a mental practice with medical specialists. Such a position will help improve the system and lead to effective and fruitful results. Medical Ethics: Non-Maleficence - The Medic Portal 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. Practical decision-making strategies are provided and illustrated by brief examples. Paramedical ethics during acute emergency medical service referral Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. Ethics in EMS: 10 things you need to know to save lives 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. 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. Although, hallucinations, delusions etc. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. D. personal safety. 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. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. | 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). 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. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). 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. Mental illness can be a challenging vulnerability for clinicians to navigate. 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). This was because of current UK law and a lack of access to a GP respectively. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. The question of justice is another part of the paramedical performance. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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). Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 40: . However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). B. EMTs are not liable for any actions that are accurately documented. This will also help you learn important concepts for the exam. Monday, January 2, 2017. Don't hesitate and rely on professionals! Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. Copyright 2023 Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). 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). Our paramedic test questions are listed below. A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Medical Ethics: Beneficence - The Medic Portal This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Ethical problems in clinical practice | Postgraduate Medical Journal Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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). This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. Principlism in paramedicine: an examination of applied healthcare ethics There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Paramedic: Legislation And And Guidance That Govern The - Edubirdie 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. 03 What factors affect paramedics' involvement of people with dementia Principlism in paramedicine: an examination of applied healthcare ethics 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). PARAMEDIC2 study: Ethical issues | Medicina Intensiva The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. How does a paramedic use chemistry? [FAQ!] However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. 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. | Journal of Paramedic Practice: Vol 3, No 8 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. Purpose of the fitness to practise process. Legal and Ethical Aspects of Paramedic Practice Article - Studentshare 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. http://dx.doi.org/10.1136/pmj.79.929.151 Consumer rights in advocacy and health care. As with any patient, capacity can fluctuate, although this is more likely with older patients. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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). Principlism in paramedicine: An examination of applied healthcare ethics 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). Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Inform client/staff members of ethical issues affecting client care. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of 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. 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. Paramedics - Health and Care Professions Council However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). The ethics in paramedicine has become a field of interest for many scientists and researchers. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). 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. 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. It affirms the supremacy of law and appreciation of human rights and freedom. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Copyright 2023 When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. ethics of paramedics - SlideShare 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. 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. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Capacity can fluctuate over time or as a health condition changes. 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. Continuing Professional Development: Ethical aspects of consent, duty While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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). OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. PDF Ethical Questions in Emergency Medical Services: Controversies and Another ethical principle in paramedicine is beneficence. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Wednesday, December 2, 2020. This principle refers to both physical and mental damage, which can be done to the clients.