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). Ethical Issues in Critical Care | Clinical Gate Professional practice framework, professional rights and responsibilities, record keeping, governance. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Exploring New Zealand Paramedic Attitudes Towards Advance Directives It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. There are many ethical issues that are encountered during the prehospital care of children and adults. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Mental illness can be a challenging vulnerability for clinicians to navigate. 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). Dominique Moritz, Phillip Ebbs, Hamish Carver 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). 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). Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Consequently, the crew began to assess for a psychological cause. AB - Decision-making is central to the everyday practice of paramedicine. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. B. crew control. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. 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. Principlism in paramedicine: an examination of applied healthcare ethics This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). Like the abuse of children, the abuse of older people is a significant community concern. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Copyright 2023 The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. 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. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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). As with any patient, capacity can fluctuate, although this is more likely with older patients. 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. Paramedic Professional Practice | Curtin University Paramedics' decisions on patients' treatment will often impact others. 153: Journal of Paramedic Practice: Vol 3, No 8 They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. On the one hand, the paramedics should not neglect the interests and intentions of the 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). An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Vulnerable patients are no exception. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Ethical problems in clinical practice | Postgraduate Medical Journal An introduction to reflective practice for paramedics Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Ethical challenges in Emergency Medical Services - PubMed Continuing Professional Development: Ethical aspects of consent, duty author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. Copyright 2023 However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). | The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 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. Monday, January 2, 2017. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. 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. How does a paramedic use chemistry? [FAQ!] 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. 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. 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. 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. 40: . 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. 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. Introduction. 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. Ethical Practice: NCLEX-RN - Registered nursing 136: 11 The future for paramedic research. Legal | Journal Of Paramedic Practice Bachelor of Paramedic Practice (ADF Conversion) (53D) 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). These factors contribute to an ethically complex decision-making environment. Paramedics delivering palliative and end-of-life care in community The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. Ethics and law 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 These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. Copyright 2023 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. 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. The Paramedic'S Guide To Research: An Introduction - Google Books Due to this misconception, the crew then considered the MHA (1983). The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. School of Nursing, Midwifery & Paramedic Practice From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 4 Conducting ethical research in paramedic practice. Paramedicine occurs in the social fabric of society. As such, making John secure was a priority. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. John had arrived at a friend's house during the night, behaving in a strange, confused manner. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). 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. 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]). 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. 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. 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. http://dx.doi.org/10.1136/pmj.79.929.151 More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. Reflective practice is undertaken for a variety of reasons. 2011). Legal and Ethical Aspects of Paramedic Practice Article - Studentshare 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. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com Elder abuse can encompass neglect, financial duress, psychological threats and violence. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 122: 10 Researching paramedic clinical practice a practical guide. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Paramedics - Health and Care Professions Council The views of families, carers and others, if appropriate, should be fully considered when taking decisions. It is diffcult tp prove actions were performed if they are not included on the report. Continuing Professional Development: Ethical issues in paramedic practice Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Paramedic ethics, capacity and the treatment of vulnerable patients 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. 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. 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). Summary. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved.