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 . 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. They must also deliver care that is consistent with ethical. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. C. Patient care cannot be discredited based on poor documentation. 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. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Mental illness can be a challenging vulnerability for clinicians to navigate. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. He was also unable to effectively communicate his decision making process. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Purpose of the fitness to practise process. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. 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. Such a position will help improve the system and lead to effective and fruitful results. 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 Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. In other words, paramedics need to adopt the principle of confidentiality and credence. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. This exploratory case study utilized semi-structured interviews of thirteen North. 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). Capacity can fluctuate over time or as a health condition changes. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. These factors contribute to an ethically complex decision-making environment. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). D. personal safety. There were no obvious physical causes for John's behaviour at this stage. 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). The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Major incident clinical . The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Consequently, the crew had to consider alternative management plans for John. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. 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). Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. Integrated health care including mental health.
Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. On the one hand, the paramedics should not neglect the interests and intentions of the patients. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. 2 The HCPC standards of conduct, performance and ethics. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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). 4 Conducting ethical research in paramedic practice. 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. Paramedics interact with these patients every day, often during times of such vulnerability. 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). 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. 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. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. 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. keywords = "Ethics, Decision making, paramedic, complexity". In conclusion, ethical and legal principles are of great importance in paramedical practices. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Therefore, they should consider the needs and requirements of patients and act correspondingly. As such, making John secure was a priority. A person must be presumed to have capacity unless it is established that he lacks capacity. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. 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. 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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 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. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). Clinicians have an important role in supporting vulnerable patients and upholding their autonomy.
Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. 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. 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. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Although provider judgment plays a large role in the . It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Chat. A person's capacity depends upon the nature of their disability. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. 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. 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. In the forthcoming sections, these standards, guidelines and ethical principles are used to explore key issues relating to patients who are commonly considered to be vulnerable: children, older people and those with mental illness or disability. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. 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. Their vulnerability may impede their autonomy, which can then affect . Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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.
Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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).
John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). The approach to both participation and trial protocol training varied between ambulance services. N2 - Decision-making is central to the everyday practice of paramedicine. Ethics, bioethics and legal issues in paramedic practice. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Don't hesitate and rely on professionals! The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008).
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