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. Ethical considerations in prehospital ambulance based research Paramedic attitudes and experiences of enrolling patients into the Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. 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). 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. This course is made up of a number of paramedic specific units and additional health care units. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if Should paramedics ever accept patients' refusal - BMC Medical Ethics Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . keywords = "Ethics, Decision making, paramedic, complexity". PDF Ethical Questions in Emergency Medical Services: Controversies and At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Continuing Professional Development: Ethical issues in paramedic practice 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. MA Healthcare Ltd This principle refers to both physical and mental damage, which can be done to the clients. D. personal safety. 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). This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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). Chat. This is not the case. In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. 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. Introduction. 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. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. Paramedicine presupposes direct interaction with individuals. http://dx.doi.org/10.1136/pmj.79.929.151 Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Ethics and law in paramedic practice : Boundaries of capacity and interests. 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. This principle refers to both physical and mental damage, which can be done to the clients. The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. Legal, ethical and social aspects of child abuse - NursingAnswers.net 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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? Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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. Challenges UK paramedics currently face in providing fully effective You'll develop your knowledge of the legal, ethical & professional issues 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. This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). 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. Inform client/staff members of ethical issues affecting client care. This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). Abstract. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. (PDF) Law and Ethics for Paramedics: An Essential Guide 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). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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). Vulnerable patients are no exception. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. It can be used by . 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. Due to this misconception, the crew then considered the MHA (1983). 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. 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. 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. He was also unable to effectively communicate his decision making process. Capacity can fluctuate over time or as a health condition changes. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 105: 9 Using quantitative research methods in paramedic practice. It shall conclude with this student's position on the issue based on the discussions. Therefore, they should consider the needs and requirements of patients and act correspondingly. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Ethical Responsibilities of Paramedics | Work - Chron.com Ethical challenges in Emergency Medical Services - PubMed It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. N2 - Decision-making is central to the everyday practice of paramedicine. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Paramedics' perceptions of the care they provide to people who self 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). 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). Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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 They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). 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. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 2011). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). 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. 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). Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. 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. Paramedic ethics, capacity and the treatment of vulnerable patients Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. ethics of paramedics - SlideShare Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 153: 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. 03 What factors affect paramedics' involvement of people with dementia In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Although provider judgment plays a large role in the resolution of conflicts at the scene, it is important to establish protocols and policies, when possible, to address these high-risk and complex situations. Ethics and law in paramedic practice: Boundaries of capacity and What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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). Our paramedic test questions are listed below. 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. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). Paramedics - Health and Care Professions Council Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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. 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. In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. 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. A person's capacity depends upon the nature of their disability. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Paramedical ethics during acute emergency medical service referral 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. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). Ethical dilemmas in prehospital emergency care - SpringerLink Psychiatric admission for assessment and subsequent treatment if required. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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 Sports Medicine - In the United States - studocu.com 8 Quantitative research in paramedic practice an overview. 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. Paramedicine occurs in the social fabric of society. 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). 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. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. 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 . It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Such a position will help improve the system and lead to effective and fruitful results. 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. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Principlism in paramedicine: An examination of applied healthcare ethics You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. 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.
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