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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. 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. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. 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. Such a position will help improve the system and lead to effective and fruitful results. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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 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 person must be presumed to have capacity unless it is established that he lacks capacity. 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). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. 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). 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. 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. 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 153: Download Free PDF View PDF 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. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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. 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. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Despite this, there remain multiple barriers to their fully effective provision of such care. 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Consumer rights in advocacy and health care. Due to this misconception, the crew then considered the MHA (1983). 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). There were no obvious physical causes for John's behaviour at this stage. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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). Legal & Ethical issues associated with paramedic practice during COVID19. Psychiatric admission for assessment and subsequent treatment if required. 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. Consequently, the crew began to assess for a psychological cause. 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). The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. care passports). The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). Professional practice framework, professional rights and responsibilities, record keeping, governance. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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). 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. 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 guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Therefore, it is important to consider those principles more precisely. Confidentiality, capacity and consent. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. 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. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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 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. The approach to both participation and trial protocol training varied between ambulance services. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Gillick competence empowers children to exercise autonomy over their own medical decisions. Decision-making is central to the everyday practice of paramedicine. This will also help you learn important concepts for the exam. 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 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 . Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Paramedic Practice Test. Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Therefore, consideration of these effects is part of how they treat patients and make decisions. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. In this case, both ethical and legal principles are important. This is not the case. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. practice with medical specialists. A sixth theme of ethical complexity was pervasive across these five themes. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. MA Healthcare Ltd 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. 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. 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 . 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). You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) 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. 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. 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. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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). With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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. 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). Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. 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. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. 105: 9 Using quantitative research methods in paramedic practice. 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. 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. 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. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Ethics, bioethics and legal issues in paramedic practice. 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 specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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). | Paramedic practice must consider all of these factors to ensure ethically good care. D. personal safety. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Major incident clinical . Practice in a manner consistent with a code of ethics for registered nurses. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not.