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. 03 What factors affect paramedics' involvement of people with dementia They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Legal | Journal Of Paramedic Practice 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. 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). Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. 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 . Ethical problems in clinical practice | Postgraduate Medical Journal @article{6040c026e1e34bd9b7239761b13480e7. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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). By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Paramedics have professional duties toward vulnerable persons. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). 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). 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). 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of 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). Community Paramedics | American Nurses Association Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. 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. Professional practice framework, professional rights and responsibilities, record keeping, governance. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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. This principle refers to both physical and mental damage, which can be done to the clients. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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). PARAMEDIC2 study: Ethical issues | Medicina Intensiva They must also deliver care that is consistent with ethical. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. Summary. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Legal and Ethical Aspects of Paramedic Practice Article - Studentshare This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Journal of Paramedic Practice: Vol 3, No 8 A significant ethical consideration for clinicians when treating older patients is their capacity. Utilizing a priority dispatch system allows dispatchers to send response . 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. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. Notify the family that once CPR has been initiated, you are required to transport the patient. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. 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). Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Paramedic ethics, capacity and the treatment of vulnerable patients 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). Ethics and law in paramedic practice: Boundaries of capacity and Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Reflective practice is undertaken for a variety of reasons. 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). B. (PDF) Law and Ethics for Paramedics: An Essential Guide 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Ethics and law in paramedic practice: Boundaries of capacity and A. Bachelor of Paramedic Practice (Conversion Pathway) (53C) This research aims to highlight and explore underlying values present within practice-based decisions. 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. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. 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). Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. How does a paramedic use chemistry? [FAQ!] In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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. These factors contribute to an ethically complex decision-making environment. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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. 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. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. BSc (Hons) Paramedic Science | Buckinghamshire New University The crew's assessments and thought processes surrounding the management of John will be discussed. 2011). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. 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. Integrated health care including mental health. 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. 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. 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. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz Pre Hospital Ethics and Legal Issues - LawTeacher.net Mental illness can be a challenging vulnerability for clinicians to navigate. 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. 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. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. You will see the questions are broken down into the 5 different categories you will be tested on. PROFESSIONALISM Professionalism in UK paramedic practice Prof Malcolm While the moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. 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). Consequently, the crew had to consider alternative management plans for John. Legal and ethical practice in care. Ethical dilemmas in prehospital emergency care - SpringerLink The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com 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). 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. 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 . 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. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. A sixth theme of ethical complexity was pervasive across these five themes. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Paramedical ethics during acute emergency medical service referral This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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). The use of the other sections of the MHA can require much more time (Hawley et al. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness 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. There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. MA Healthcare Ltd (PDF) Reflective Practice for Paramedics - Academia.edu All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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). At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. 153: 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. 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). 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. As such, making John secure was a priority. 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 Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 136: 11 The future for paramedic research. 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. 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).

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