However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). 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 other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Samantha May For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. 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). 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). Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). Cuts in public health and community services funding have decimated programs, leaving unmet health needs. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. (PDF) Reflective Practice for Paramedics - Academia.edu 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. 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 article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Paramedicine occurs in the social fabric of society. 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. Paramedics' perceptions of the care they provide to people who self 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. In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Ethical Issues in Critical Care | Clinical Gate The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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. School of Nursing, Midwifery & Paramedic Practice 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). Practice in a manner consistent with a code of ethics for registered nurses. C. Follow to your local protocols and contact medical direction if unsure how to proceed. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. 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). 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). 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). In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). 2011). The approach to both participation and trial protocol training varied between ambulance services. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 136: 11 The future for paramedic research. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Paramedic Practice Test. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 2 The HCPC standards of conduct, performance and ethics. Ethical considerations in prehospital ambulance based research 122: 10 Researching paramedic clinical practice a practical guide. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. 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. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). Integrated health care including mental health. 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. 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. 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. 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). Download Free PDF View PDF 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). 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. 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. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. Aircraft Accidents and Emergency Management, Live NHS Research and Development Permissions were sought and granted. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? This will also help you learn important concepts for the exam. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Bachelor of Paramedic Practice (ADF Conversion) (53D) In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. care passports). EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz 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. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Reflective practice is undertaken for a variety of reasons. Chat. Legal and ethical practice in care. MA Healthcare Ltd The ethical and legal dilemmas paramedics face when managing a mental Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Legal & Ethical issues associated with paramedic practice during COVID19. A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). How does a paramedic use chemistry? [FAQ!] Principlism in paramedicine: an examination of applied healthcare ethics This principle refers to both physical and mental damage, which can be done to the clients. 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 article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 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). From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. Exploring New Zealand Paramedic Attitudes Towards Advance Directives This exploratory case study utilized semi-structured interviews of thirteen North. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. 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. Paramedical ethics during acute emergency medical service referral Therefore, they should consider the needs and requirements of patients and act correspondingly. 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. 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. It affirms the supremacy of law and appreciation of human rights and freedom. 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness Mental illness can be a challenging vulnerability for clinicians to navigate. Continuing Professional Development: Ethical issues in paramedic practice 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. A sixth theme of ethical complexity was pervasive across these five themes. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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. Should paramedics ever accept patients' refusal - BMC Medical Ethics He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. 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. 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. ethics of paramedics - SlideShare Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally.