ethical issues in paramedic practice

However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. @article{6040c026e1e34bd9b7239761b13480e7. 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). Paramedicine occurs in the social fabric of society. Don't hesitate and rely on professionals! 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. 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. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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 . With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. 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). It affirms the supremacy of law and appreciation of human rights and freedom. 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). 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. Together they form a unique fingerprint. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. This principle refers to both physical and mental damage, which can be done to the clients. 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). They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. 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). Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. It is diffcult tp prove actions were performed if they are not included on the report. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 8 Quantitative research in paramedic practice an overview. According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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). 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. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. This will also help you learn important concepts for the exam. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. C. vehicle safety. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. | 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Wednesday, December 2, 2020. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. 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. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. 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). 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. In this case, both ethical and legal principles are important. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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]). In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. Their vulnerability may impede their autonomy, which can then affect . 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 The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Our paramedic test questions are listed below. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. There are many ethical issues that are encountered during the prehospital care of children and adults. 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? It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. 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. The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Therefore, it is important to consider those principles more precisely. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. A consensus among paramedic supervisors B. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. Although, hallucinations, delusions etc. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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). The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. 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. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. 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. Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Ethics, bioethics and legal issues in paramedic practice. 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality.

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