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). There are many ethical issues that are encountered during the prehospital care of children and adults. 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). Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). 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). Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. Methods Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Download Free PDF View PDF It can be used by . 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. 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. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. On the one hand, the paramedics should not neglect the interests and intentions of the patients. It shall conclude with this student's position on the issue based on the discussions. Dominique Moritz, Phillip Ebbs, Hamish Carver 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). This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. A. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. 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 research aims to highlight and explore underlying values present within practice-based decisions. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 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. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). 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. | These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. The use of the other sections of the MHA can require much more time (Hawley et al. Due to this misconception, the crew then considered the MHA (1983). Therefore, they should consider the needs and requirements of patients and act correspondingly. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Another ethical principle in paramedicine is beneficence. Therefore, consideration of these effects is part of how they treat patients and make decisions. Practice in a manner consistent with a code of ethics for registered nurses. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. This exploratory case study utilized semi-structured interviews of thirteen North. Using a reflective format, the article explored some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in complex situations. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. 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. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. 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). Psychiatric admission for assessment and subsequent treatment if required. 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). Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Gillick competence empowers children to exercise autonomy over their own medical decisions. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). MA Healthcare Ltd 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. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. 4 Conducting ethical research in paramedic practice. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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). 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. 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. Paramedics' decisions on patients' treatment will often impact others. MA Healthcare Ltd Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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. 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. In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. 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. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). 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. 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. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. 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. The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. There were no obvious physical causes for John's behaviour at this stage. Aircraft Accidents and Emergency Management, Live As such, making John secure was a priority. 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). Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. N2 - Decision-making is central to the everyday practice of paramedicine. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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. The term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. Despite this, there remain multiple barriers to their fully effective provision of such care. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. It is not clear though, how professionals (especially those who do not use the MHA) are likely to know in advance if a patient is likely to meet threshold for detention under this act, and so whether the MCA seems appropriate for use or not. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. 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? Integrated health care including mental health. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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. Copyright 2023 Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. 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). This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. The crew's assessments and thought processes surrounding the management of John will be discussed. 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). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. keywords = "Ethics, Decision making, paramedic, complexity". The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. 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. 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. 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. B. EMTs are not liable for any actions that are accurately documented. 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. Professional practice framework, professional rights and responsibilities, record keeping, governance. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. The first concern for an EMT must be: A. patient safety. 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. 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. 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. 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. 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. 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.