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Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Paramedicine presupposes direct interaction with individuals. 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). Journal of Paramedic Practice: Vol 3, No 8 Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Challenges UK paramedics currently face in providing fully effective 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. Medical Ethics: Non-Maleficence - The Medic Portal Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Consequently, the crew had to consider alternative management plans for John. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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). Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. N2 - Decision-making is central to the everyday practice of paramedicine. You will see the questions are broken down into the 5 different categories you will be tested on. 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). The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Ethical Challenges in Emergency Medical Services: Controversies and A consensus among paramedic supervisors B. The provider must be always stalwart in the face of challenges to. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Legal & Ethical issues associated with paramedic practice during COVID19. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. C. Follow to your local protocols and contact medical direction if unsure how to proceed. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). 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. Don't hesitate and rely on professionals! 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. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. How does a paramedic use chemistry? [FAQ!] 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). 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. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. PARAMEDIC2 study: Ethical issues | Medicina Intensiva Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 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. 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). 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. These factors contribute to an ethically complex decision-making environment. 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. 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 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. Legal, ethical and social aspects of child abuse - NursingAnswers.net prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. It can be used by . 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet 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. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. This research aims to highlight and explore underlying values present within practice-based decisions. Journal of Paramedic Practice is the leading monthly journal for paramedics. Paramedics - Health and Care Professions Council | Paramedics interact with these patients every day, often during times of such vulnerability. By continuing you agree to the use of cookies. 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.. 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. 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 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. 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. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Therefore, it is important to consider those principles more precisely. (PDF) Reflective Practice for Paramedics - Academia.edu More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? MA Healthcare Ltd 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. Ethics and law in paramedic practice: Boundaries of capacity and 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. The Australasian College of Paramedicine 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. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. Gillick competence empowers children to exercise autonomy over their own medical decisions. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. He was also unable to effectively communicate his decision making process. 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 keywords = "Ethics, Decision making, paramedic, complexity". Such a position will help improve the system and lead to effective and fruitful results. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. The question of justice is another part of the paramedical performance. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Legal | Journal Of Paramedic Practice The use of the other sections of the MHA can require much more time (Hawley et al. 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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). 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. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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). John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. 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. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 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. 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. 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. 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). Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 2011). Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . | 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Major incident clinical . Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. A person must be presumed to have capacity unless it is established that he lacks capacity. Practical decision-making strategies are provided and illustrated by brief examples. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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. There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Despite this, there remain multiple barriers to their fully effective provision of such care. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). Like the abuse of children, the abuse of older people is a significant community concern. Purpose of the fitness to practise process. Paramedics' perceptions of the care they provide to people who self 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. 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Removed to place of safety for up to 72 hours for further assessment. 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs 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). Copyright 2023 Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Paramedic Practice Test. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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. 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. C. Patient care cannot be discredited based on poor documentation. 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. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. In conclusion, ethical and legal principles are of great importance in paramedical practices. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . PDF Ethical Questions in Emergency Medical Services: Controversies and 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. D. Incomplete . This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Legal and ethical practice in care. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. 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. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. In other words, paramedics need to adopt the principle of confidentiality and credence. 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. 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. (PDF) Law and Ethics for Paramedics: An Essential Guide Samantha May 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. 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). The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. 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). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence.