C. Patient care cannot be discredited based on poor documentation. Samantha May Like the abuse of children, the abuse of older people is a significant community concern. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Chat. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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. Paramedic ethics, capacity and the treatment of vulnerable patients The use of the other sections of the MHA can require much more time (Hawley et al. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. Paramedic Professional Practice | Curtin University 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. Paramedic: Legislation And And Guidance That Govern The - Edubirdie All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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. 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. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. 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. 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. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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]). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Ethical considerations in prehospital ambulance based research The first concern for an EMT must be: A. patient safety. 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. 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. Consumer rights in advocacy and health care. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. C. Follow to your local protocols and contact medical direction if unsure how to proceed. 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. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Ethical problems in clinical practice | Postgraduate Medical Journal Consequently, the crew had to consider alternative management plans for John. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. Monday, January 2, 2017. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 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. In other words, paramedics need to adopt the principle of confidentiality and credence. 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. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . A person's capacity depends upon the nature of their disability. 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? This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. Ethics, bioethics and legal issues in paramedic practice. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. 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. BSc (Hons) Paramedic Science | Buckinghamshire New University (PDF) Reflective Practice for Paramedics - Academia.edu 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. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). 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. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. Paramedics have professional duties toward vulnerable persons. 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 . 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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). NHS Research and Development Permissions were sought and granted. In this case, both ethical and legal principles are important. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. 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. 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. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 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. 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). 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. Therefore, consideration of these effects is part of how they treat patients and make decisions. It shall conclude with this student's position on the issue based on the discussions. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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). Abstract. Vulnerable patients are no exception. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. How does a paramedic use chemistry? [FAQ!] There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. The approach to both participation and trial protocol training varied between ambulance services. 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. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. It is diffcult tp prove actions were performed if they are not included on the report. Therefore, they should consider the needs and requirements of patients and act correspondingly. Gillick competence empowers children to exercise autonomy over their own medical decisions. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. 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 dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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 Another ethical principle in paramedicine is beneficence. 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. This principle refers to both physical and mental damage, which can be done to the clients. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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 . Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Principlism in paramedicine: an examination of applied healthcare ethics This is not the case. 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). 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. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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). Paramedics - Health and Care Professions Council 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). This principle refers to both physical and mental damage, which can be done to the clients. Although, hallucinations, delusions etc. Ethical challenges in Emergency Medical Services - PubMed Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. 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. 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. Ethical dilemmas in prehospital emergency care - SpringerLink D. personal safety. 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 Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. 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). 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. Aircraft Accidents and Emergency Management, Live Practical decision-making strategies are provided and illustrated by brief examples. This course is made up of a number of paramedic specific units and additional health care units. In conclusion, ethical and legal principles are of great importance in paramedical practices. 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. A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. 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. 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). EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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. Maintaining a professional boundary between you and your patient (summary) Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. The Paramedic'S Guide To Research: An Introduction - Google Books This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. A consensus among paramedic supervisors B. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. Medical Ethics: Non-Maleficence - The Medic Portal Psychiatric admission for assessment and subsequent treatment if required. Copyright 2023 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. 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. 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. Although provider judgment plays a large role in the . 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. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. Legal & Ethical issues associated with paramedic practice during COVID19. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Despite this, there remain multiple barriers to their fully effective provision of such care. 03 What factors affect paramedics' involvement of people with dementia Capacity can fluctuate over time or as a health condition changes. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible.

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