While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. http://dx.doi.org/10.1136/pmj.79.929.151 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. 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. 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 course is made up of a number of paramedic specific units and additional health care units. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. 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. 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. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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. 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. 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. 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). This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. In this case, both ethical and legal principles are important. B. 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). From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. Paramedicine presupposes direct interaction with individuals. 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Summary. 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. 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. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 Legal and ethical practice in care. 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. 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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 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. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. This is a part of and more. Paramedics interact with these patients every day, often during times of such vulnerability. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Ethical challenges in Emergency Medical Services - PubMed This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. The approach to both participation and trial protocol training varied between ambulance services. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Decision-making is central to the everyday practice of paramedicine. Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. 03 What factors affect paramedics' involvement of people with dementia A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Continuing Professional Development: Ethical aspects of consent, duty Removed to place of safety for up to 72 hours for further assessment. 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. Ethical Practice: NCLEX-RN - Registered nursing 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. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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). 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). Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Vulnerable patients are no exception. 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 . Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. Paramedic attitudes and experiences of enrolling patients into the The ethical responsibilities of a paramedic also include acting fairly and helping any patient who needs it, regardless of their race, age, gender, religion or another personal characteristic.. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 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 . 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. Practical decision-making strategies are provided and illustrated by brief examples. Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). 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. The question of justice is another part of the paramedical performance. Pre Hospital Ethics and Legal Issues - LawTeacher.net A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. 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. Ethical considerations in prehospital ambulance based research There are many ethical issues that are encountered during the prehospital care of children and adults. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. PARAMEDIC2 study: Ethical issues | Medicina Intensiva Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Medical Ethics: Non-Maleficence - The Medic Portal Despite this, there remain multiple barriers to their fully effective provision of such care. Principlism in paramedicine: an examination of applied healthcare ethics Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. Aircraft Accidents and Emergency Management, Live Challenges UK paramedics currently face in providing fully effective Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. 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). However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. 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). It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. MA Healthcare Ltd 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 . The first concern for an EMT must be: A. patient safety. 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). Principlism in paramedicine: an examination of applied healthcare ethics 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). 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 It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Decision making in this environment is intended to provide care and treatment in the best interests of the patient.
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