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. 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. These factors contribute to an ethically complex decision-making environment. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Ethical challenges in Emergency Medical Services - PubMed Medical Ethics: Beneficence - The Medic Portal The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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 . Paramedics - Health and Care Professions Council 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. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. EMT Chapter 1 Flashcards | Quizlet This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Maintaining a professional boundary between you and your patient (summary) For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. 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). Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Vulnerable patients are no exception. 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 Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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). Exploring New Zealand Paramedic Attitudes Towards Advance Directives They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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. This is a part of and more. 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. There are many ethical issues that are encountered during the prehospital care of children and adults. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Monday, January 2, 2017. Ethics and law in paramedic practice : Boundaries of capacity and interests. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Dominique Moritz, Phillip Ebbs, Hamish Carver This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Journal of Paramedic Practice is the leading monthly journal for paramedics. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). This research aims to highlight and explore underlying values present within practice-based decisions. MA Healthcare Ltd 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. Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet 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. C. vehicle safety. 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. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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). 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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 exploratory case study utilized semi-structured interviews of thirteen North. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Copyright 2023 However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. 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. 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. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. 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). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Although provider judgment plays a large role in the . 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). This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Using a reflective format, the article explored 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 complex situations. Notify the family that once CPR has been initiated, you are required to transport the patient. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The Paramedic attitudes and experiences of enrolling patients into the This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Paramedics have professional duties toward vulnerable persons. Removed to place of safety for up to 72 hours for further assessment. They must also deliver care that is consistent with ethical. 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. Another ethical principle in paramedicine is beneficence. The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. 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.. NHS Research and Development Permissions were sought and granted. 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. 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. The Australasian College of Paramedicine Legal | Journal Of Paramedic Practice Bachelor of Paramedic Practice (ADF Conversion) (53D) For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. Community Paramedics | American Nurses Association They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. | U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. A person must be presumed to have capacity unless it is established that he lacks capacity. 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. Samantha May Gillick competence empowers children to exercise autonomy over their own medical decisions. All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. 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 . Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Reflective practice is undertaken for a variety of reasons. Continuing Professional Development: Ethical aspects of consent, duty Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. Ethical considerations in prehospital ambulance based research Although, hallucinations, delusions etc. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Our paramedic test questions are listed below. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Copyright 2023 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 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 such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Copyright 2023 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). Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. The first concern for an EMT must be: A. patient safety. Like the abuse of children, the abuse of older people is a significant community concern. Ethics in EMS: 10 things you need to know to save lives Ethical issues in medical malpractice - PubMed ethics of paramedics - SlideShare Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. 2011). Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. 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).
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