Consequently, the crew had to consider alternative management plans for John. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This was because of current UK law and a lack of access to a GP respectively. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. 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 According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? One of the most important legal principles in paramedicine is the preservation of patients personal information and data. | 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. 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. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. 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. Bachelor of Paramedic Practice (Conversion Pathway) (53C) Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Paramedics - Health and Care Professions Council Inform client/staff members of ethical issues affecting client care. They must also deliver care that is consistent with ethical. Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. 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. Fitness to practise - Health and Care Professions Council 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. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? BSc (Hons) Paramedic Science | Buckinghamshire New University 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. 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 You will see the questions are broken down into the 5 different categories you will be tested on. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. It affirms the supremacy of law and appreciation of human rights and freedom. 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). 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? C. Patient care cannot be discredited based on poor documentation. Continuing Professional Development: Ethical issues in paramedic practice Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of MA Healthcare Ltd Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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). 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. The Paramedic'S Guide To Research: An Introduction - Google Books In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Bachelor of Paramedic Practice (ADF Conversion) (53D) 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). Reflective practice is undertaken for a variety of reasons. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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. 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. Ethics and law in paramedic practice: Boundaries of capacity and 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. The ethical responsibilities of a paramedic also include acting fairly and helping any patient who needs it, regardless of their race, age, gender, religion or another personal characteristic.. Ethics and law in paramedic practice: Boundaries of capacity and For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 Principlism in paramedicine: an examination of applied healthcare ethics However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Another ethical principle in paramedicine is beneficence. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The Australasian College of Paramedicine 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 . 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 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? Removed to place of safety for up to 72 hours for further assessment. Ethical Issues in Critical Care | Clinical Gate Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. states registered nurses are legally required to report cases of child abuse if there is a "belief on reasonable grounds that a child is in need of protection on a ground referred to in Section 162 (c) or 162 (d), or formed in the course of practicing in . Paramedic attitudes and experiences of enrolling patients into the A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. 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. Legal and Ethical Aspects of Paramedic Practice Article - Studentshare 2011). 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. In conclusion, ethical and legal principles are of great importance in paramedical practices. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Ethical Issues in Sports Medicine - In the United States - studocu.com All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Paramedics delivering palliative and end-of-life care in community 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. Integrated health care including mental health. 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. 40: . 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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. 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. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. 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. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. 136: 11 The future for paramedic research. Sample Essay on Law and Ethics in Paramedical Science 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. 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. 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. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Utilizing a priority dispatch system allows dispatchers to send response . Such a position will help improve the system and lead to effective and fruitful results. Decision-making is central to the everyday practice of paramedicine. Although provider judgment plays a large role in the . The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). There were no obvious physical causes for John's behaviour at this stage. 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). 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. These factors contribute to an ethically complex decision-making environment. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. @article{6040c026e1e34bd9b7239761b13480e7. Samantha May After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. 4 Conducting ethical research in paramedic practice. 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. 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. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Paramedics have professional duties toward vulnerable persons. A sixth theme of ethical complexity was pervasive across these five themes. 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. 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? The approach to both participation and trial protocol training varied between ambulance services. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Continuing Professional Development: Ethical issues in paramedic practice Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. PARAMEDIC2 study: Ethical issues | Medicina Intensiva Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. D. personal safety. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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). By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Ethical Practice: NCLEX-RN - Registered nursing C. Follow to your local protocols and contact medical direction if unsure how to proceed. Paramedic ethics, capacity and the treatment of vulnerable patients

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