It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). 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. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. 8 Quantitative research in paramedic practice an overview. Therefore, consideration of these effects is part of how they treat patients and make decisions. This will also help you learn important concepts for the exam. 153: 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). You will see the questions are broken down into the 5 different categories you will be tested on. 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. Copyright 2023 The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). 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). MA Healthcare Ltd 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. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. Gillick competence empowers children to exercise autonomy over their own medical decisions. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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). 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. 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Consequently, the crew began to assess for a psychological cause. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. By continuing you agree to the use of cookies. 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. Capacity can fluctuate over time or as a health condition changes. It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. The approach to both participation and trial protocol training varied between ambulance services. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. http://dx.doi.org/10.1136/pmj.79.929.151 In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. 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. 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. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. 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). Aircraft Accidents and Emergency Management, Live Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). 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. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. Copyright 2023 While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Professional practice framework, professional rights and responsibilities, record keeping, governance. 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. 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. Legal and ethical practice in care. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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). Don't hesitate and rely on professionals! Major incident clinical . This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). 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. This exploratory case study utilized semi-structured interviews of thirteen North. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? This is a part of and more. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? A person must be presumed to have capacity unless it is established that he lacks capacity. 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). Methods Monday, January 2, 2017. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Decision-making is central to the everyday practice of 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. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Despite this, there remain multiple barriers to their fully effective provision of such care. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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 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. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. As such, making John secure was a priority. 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). This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. 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. 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 . Therefore, it is important to consider those principles more precisely. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Such a position will help improve the system and lead to effective and fruitful results. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. A sixth theme of ethical complexity was pervasive across these five themes. The use of the other sections of the MHA can require much more time (Hawley et al. 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. Utilizing a priority dispatch system allows dispatchers to send response . This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). practice with medical specialists. 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. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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, 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. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). 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 At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. 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. Paramedics interact with these patients every day, often during times of such vulnerability. 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Summary. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. 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). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. 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). Although provider judgment plays a large role in the . Confidentiality, capacity and consent. 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 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Consumer rights in advocacy and health care. 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 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). He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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). 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 By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 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. 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? Abstract. 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. 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. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. 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). After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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). In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. This research aims to highlight and explore underlying values present within practice-based decisions. 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. 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 . Due to this misconception, the crew then considered the MHA (1983). Reflective practice is undertaken for a variety of reasons. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). Inform client/staff members of ethical issues affecting client care. 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. @article{6040c026e1e34bd9b7239761b13480e7. 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). 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. 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. 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. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. Ethics part 1: what do paramedics owe patients? In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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.

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