From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Community Paramedics | American Nurses Association MA Healthcare Ltd Introduction. 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. 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). 40: . 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 136: 11 The future for paramedic research. 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. This was because of current UK law and a lack of access to a GP respectively. Vulnerable patients are no exception. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability. Consumer rights in advocacy and health care. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Sample Essay on Law and Ethics in Paramedical Science Decision making in this environment is intended to provide care and treatment in the best interests of the patient. However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. 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. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Exploring New Zealand Paramedic Attitudes Towards Advance Directives 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 Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. 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. The crew's assessments and thought processes surrounding the management of John will be discussed. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. They must also deliver care that is consistent with ethical. Bachelor of Paramedic Practice (Conversion Pathway) (53C) Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Ethical challenges in Emergency Medical Services - PubMed 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. These factors contribute to an ethically complex decision-making environment. (PDF) Reflective Practice for Paramedics - ResearchGate The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. Although, hallucinations, delusions etc. Decision-making is central to the everyday practice of paramedicine. Methods keywords = "Ethics, Decision making, paramedic, complexity". Paramedicine occurs in the social fabric of society. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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). At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Paramedics' decisions on patients' treatment will often impact others. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Integrated health care including mental health. Utilizing a priority dispatch system allows dispatchers to send response . Paramedics - Health and Care Professions Council A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. 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. 2011b) and it didn't seem that John could have kept himself safe until such a time he could have been detained in this way. 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). 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). 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. A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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. Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet Chat. Summary. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. The approach to both participation and trial protocol training varied between ambulance services. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. 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. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. care passports). Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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). practice with medical specialists. The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). PDF Ethical Questions in Emergency Medical Services: Controversies and 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. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). The use of the other sections of the MHA can require much more time (Hawley et al. Despite this, there remain multiple barriers to their fully effective provision of such care. Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. This principle refers to both physical and mental damage, which can be done to the clients. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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. 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. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). Professional practice framework, professional rights and responsibilities, record keeping, governance. 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. BSc (Hons) Paramedic Science | Buckinghamshire New University 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Ethics in EMS: 10 things you need to know to save lives 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. 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). Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet 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). 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). 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. 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. Ethics part 1: what do paramedics owe patients? C. vehicle safety. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of 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. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). PARAMEDIC2 study: Ethical issues | Medicina Intensiva It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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. Legal & Ethical issues associated with paramedic practice during COVID19. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. B. crew control. 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . You will see the questions are broken down into the 5 different categories you will be tested on. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. 105: 9 Using quantitative research methods in paramedic practice. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. Principlism in paramedicine: an examination of applied healthcare ethics Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. 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. 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). 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. Their vulnerability may impede their autonomy, which can then affect . 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. 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). 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 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. 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). A person is not to be treated as unable to make a decision merely because he makes an unwise decision. It can be used by . Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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 . Paramedic: Legislation And And Guidance That Govern The - Edubirdie 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. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. NHS Research and Development Permissions were sought and granted. 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 . 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 . Paramedic Practice Test | Answers & Explanations | Test-Guide @article{6040c026e1e34bd9b7239761b13480e7. 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.