As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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. 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. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. D. Incomplete . 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Practice in a manner consistent with a code of ethics for registered nurses. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. 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. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Due to this misconception, the crew then considered the MHA (1983). 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. 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 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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. 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. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. It affirms the supremacy of law and appreciation of human rights and freedom. B. EMTs are not liable for any actions that are accurately documented. 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). MA Healthcare Ltd 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. To assist paramedics in navigating these complex issues, the London Ambulance Service NHS Trust (2019) provides guidance on how to refer vulnerable people to services which may investigate the circumstances and ensure the safety and welfare of the patient). The crew's assessments and thought processes surrounding the management of John will be discussed. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). 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. 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. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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 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). OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. N2 - Decision-making is central to the everyday practice of paramedicine. As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. 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. MA Healthcare Ltd 4 Conducting ethical research in paramedic practice. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. You will see the questions are broken down into the 5 different categories you will be tested on. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. 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 other words, paramedics need to adopt the principle of confidentiality and credence. 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. Capacity can fluctuate over time or as a health condition changes. 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. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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. 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. Paramedic Practice Test. 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. 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). Paramedics' decisions on patients' treatment will often impact others. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. The ethics in paramedicine has become a field of interest for many scientists and researchers. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. 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. 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 . As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . Paramedicine occurs in the social fabric of society. B. crew control. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. Summary. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? In conclusion, ethical and legal principles are of great importance in paramedical practices. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. 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 . John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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 paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 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). 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. 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). Like the abuse of children, the abuse of older people is a significant community concern. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Ethics part 1: what do paramedics owe patients? A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. 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). 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. Copyright 2023 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. He was also unable to effectively communicate his decision making process. Copyright 2023 Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Samantha May @article{6040c026e1e34bd9b7239761b13480e7. Aircraft Accidents and Emergency Management, Live Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. On the one hand, the paramedics should not neglect the interests and intentions of the patients. In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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). This is not the case. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Paramedics have professional duties toward vulnerable persons. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . 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. A person's capacity depends upon the nature of their disability. practice with medical specialists. . A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). 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]). 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. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest.
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