ethical issues in paramedic practice

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 will also help you learn important concepts for the exam. Wednesday, December 2, 2020. Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. 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. Like the abuse of children, the abuse of older people is a significant community concern. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Bachelor of Paramedic Practice (Conversion Pathway) (53C) 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Our paramedic test questions are listed below. Mental illness can be a challenging vulnerability for clinicians to navigate. 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). Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. Ethical dilemmas in prehospital emergency care - SpringerLink C. Follow to your local protocols and contact medical direction if unsure how to proceed. Monday, January 2, 2017. 136: 11 The future for paramedic research. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Paramedic attitudes and experiences of enrolling patients into the 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. 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. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. | 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. 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). 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. 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. 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. 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies These factors contribute to an ethically complex decision-making environment. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. As such, making John secure was a priority. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz Aircraft Accidents and Emergency Management, Live People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Copyright 2023 As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Major incident clinical . Copyright 2023 Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 122: 10 Researching paramedic clinical practice a practical guide. 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. Inform client/staff members of ethical issues affecting client care. Summary. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Dominique Moritz, Phillip Ebbs, Hamish Carver Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). 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.. D. personal safety. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. MA Healthcare Ltd 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. 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). Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. Legal and ethical practice in care. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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. keywords = "Ethics, Decision making, paramedic, complexity". All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. 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? 153: Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. NHS Research and Development Permissions were sought and granted. Pre Hospital Ethics and Legal Issues - LawTeacher.net 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). A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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. C. vehicle safety. Principlism in paramedicine: an examination of applied healthcare ethics Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? practice with medical specialists. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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 . Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. Don't hesitate and rely on professionals! Download Free PDF View PDF After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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). Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. 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). This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). 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]). 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. 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. 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 . Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. It affirms the supremacy of law and appreciation of human rights and freedom. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. 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. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Foundations for paramedic practice: a theoretical perspective - Amazon Although, hallucinations, delusions etc. He was also unable to effectively communicate his decision making process. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. This is not the case. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The question of justice is another part of the paramedical performance. http://dx.doi.org/10.1136/pmj.79.929.151 On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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. Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. Introduction. If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. 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 authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. It shall conclude with this student's position on the issue based on the discussions. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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). Continuing Professional Development: Ethical issues in paramedic practice Abstract. 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. 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. The approach to both participation and trial protocol training varied between ambulance services. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. 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. 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). This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Ethical Practice: NCLEX-RN - Registered nursing Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 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. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). They must also deliver care that is consistent with ethical. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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 patient{\textquoteright}s own wishes? Ethics and law in paramedic practice: Boundaries of capacity and 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. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. D. Incomplete . Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. 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. MA Healthcare Ltd 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. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. This research aims to highlight and explore underlying values present within practice-based decisions. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. | Another ethical principle in paramedicine is beneficence. 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). 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. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals.

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