ethical issues in paramedic practice

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Introduction. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. B. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. 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 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). 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 . Professional practice framework, professional rights and responsibilities, record keeping, governance. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . 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. Their vulnerability may impede their autonomy, which can then affect . The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. abstract = "Decision-making is central to the everyday practice of paramedicine. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). http://dx.doi.org/10.1136/pmj.79.929.151 This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. Another ethical principle in paramedicine is beneficence. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. 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. 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? 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. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Copyright 2023 In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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). Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Although provider judgment plays a large role in the . 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 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. It is diffcult tp prove actions were performed if they are not included on the report. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Mental illness can be a challenging vulnerability for clinicians to navigate. 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). At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Psychiatric admission for assessment and subsequent treatment if required. Paramedic Practice Test. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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]). Paramedics' decisions on patients' treatment will often impact others. 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. 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. By continuing you agree to the use of cookies. 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. care passports). Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. This principle refers to both physical and mental damage, which can be done to the clients. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Our fitness to practise process is designed to protect the public from those who are not fit to practise. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Journal of Paramedic Practice is the leading monthly journal for paramedics. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Wednesday, December 2, 2020. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. 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. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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. This principle refers to both physical and mental damage, which can be done to the clients. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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. 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). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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. They must also deliver care that is consistent with ethical. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. B. EMTs are not liable for any actions that are accurately documented. Although, hallucinations, delusions etc. Copyright 2023 Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. 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. Ethics part 1: what do paramedics owe patients? 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). Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Paramedics interact with these patients every day, often during times of such vulnerability. 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). Vulnerable patients are no exception. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. By utilising a reflective format, the article explores 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 these situations. 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. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. Paramedic practice must consider all of these factors to ensure ethically good care. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Download Free PDF View PDF MA Healthcare Ltd 136: 11 The future for paramedic research. 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). After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. C. Follow to your local protocols and contact medical direction if unsure how to proceed. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). 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. 40: . 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. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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 article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. 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 However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. 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. Despite this, there remain multiple barriers to their fully effective provision of such care. 4 Conducting ethical research in paramedic practice. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. The principles of non-maleficence and beneficence form an area of special interest for the paramedics since these ethical issues are of paramount importance to them. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. 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). 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. 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. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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). The provider must be always stalwart in the face of challenges to. Ethics, bioethics and legal issues in paramedic practice. Due to this misconception, the crew then considered the MHA (1983). The first concern for an EMT must be: A. patient safety. 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). Major incident clinical . 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 . are more commonly known symptoms of psychosis, the symptoms demonstrated by John fall within the six hallmark features of psychosis as described by Kleiger and Khadivi (2015).

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