There are many ethical issues that are encountered during the prehospital care of children and adults. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. 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. Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. 136: 11 The future for paramedic research. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. Abstract. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 2011). Paramedics interact with these patients every day, often during times of such vulnerability. 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. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. The ethics in paramedicine has become a field of interest for many scientists and researchers. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). It is diffcult tp prove actions were performed if they are not included on the report. Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Aircraft Accidents and Emergency Management, Live A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. Don't hesitate and rely on professionals! 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. C. vehicle safety. Paramedics have professional duties toward vulnerable persons. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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). 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). 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. 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). 105: 9 Using quantitative research methods 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). Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. 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. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. | This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Summary. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Copyright 2023 Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. 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). After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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). 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). In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . keywords = "Ethics, Decision making, paramedic, complexity". Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. By continuing you agree to the use of cookies. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. 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). Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. 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. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Consequently, the crew had to consider alternative management plans for John. 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. Samantha May The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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. 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. 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. 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. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. Such a position will help improve the system and lead to effective and fruitful results. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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. 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 . This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". As such, making John secure was a priority. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. Although provider judgment plays a large role in the . The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. 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. 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 for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. These factors contribute to an ethically complex decision-making environment. 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. Methods There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. 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. | A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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). Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. The first concern for an EMT must be: A. patient safety. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. AB - Decision-making is central to the everyday practice of paramedicine. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. 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. N2 - Decision-making is central to the everyday practice of paramedicine. 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). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment.
March 14, 2023