NHS Research and Development Permissions were sought and granted. Introduction. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. School of Nursing, Midwifery & Paramedic Practice 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. 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. Mental illness can be a challenging vulnerability for clinicians to navigate. Ethics and law in paramedic practice: Boundaries of capacity and Legal and Ethical Aspects of Paramedic Practice Article - Studentshare Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 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. 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. Consequently, the crew had to consider alternative management plans for John. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. Ethical dilemmas in prehospital emergency care - SpringerLink Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. Medical Ethics: Non-Maleficence - The Medic Portal John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. Paramedic Practice Test. Ethical Issues in Sports Medicine - In the United States - studocu.com For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Ethical Practice: NCLEX-RN - Registered nursing 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Paramedics have professional duties toward vulnerable persons. Chat. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Although provider judgment plays a large role in the . While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. 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. Community Paramedics | American Nurses Association 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. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. A significant ethical consideration for clinicians when treating older patients is their capacity. Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). Psychiatric admission for assessment and subsequent treatment if required. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). (PDF) Reflective Practice for Paramedics - ResearchGate 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Continuing Professional Development: Ethical issues in paramedic practice 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. 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. Although, hallucinations, delusions etc. 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. As such, making John secure was a priority. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. 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. C. Patient care cannot be discredited based on poor documentation. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. PARAMEDIC2 study: Ethical issues | Medicina Intensiva In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. There were no obvious physical causes for John's behaviour at this stage. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 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. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 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. 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. Major incident clinical . Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Paramedic: Legislation And And Guidance That Govern The - Edubirdie They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. C. Follow to your local protocols and contact medical direction if unsure how to proceed. http://dx.doi.org/10.1136/pmj.79.929.151 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. 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). 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? AB - Decision-making is central to the everyday practice of paramedicine. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). 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. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). Medical Ethics: Beneficence - The Medic Portal Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . 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. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Consequently, the crew began to assess for a psychological cause. Consumer rights in advocacy and health care. 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. B. crew control. Journal of Paramedic Practice is the leading monthly journal for paramedics. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Legal & Ethical issues associated with paramedic practice during COVID19. Copyright 2023 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). 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. 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. Ethics, bioethics and legal issues in paramedic practice. Reflective practice is undertaken for a variety of reasons. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. Paramedic attitudes and experiences of enrolling patients into the 2 The HCPC standards of conduct, performance and ethics. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. Paramedicine occurs in the social fabric of society. . While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. This will also help you learn important concepts for the exam. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com 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. Such a position will help improve the system and lead to effective and fruitful results. Journal of Paramedic Practice: Vol 3, No 8 Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). 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. 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. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. The ethics in paramedicine has become a field of interest for many scientists and researchers. Paramedic ethics, capacity and the treatment of vulnerable patients
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