The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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 . 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. There are many ethical issues that are encountered during the prehospital care of children and adults. Journal of Paramedic Practice is the leading monthly journal for paramedics. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Confidentiality, capacity and consent. 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. For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? @article{6040c026e1e34bd9b7239761b13480e7. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. D. Incomplete . 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. In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). 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. Due to this misconception, the crew then considered the MHA (1983). The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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]). 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. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. 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. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. Copyright 2023 136: 11 The future for paramedic research. In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). 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. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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). AB - Decision-making is central to the everyday practice of paramedicine. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. You will see the questions are broken down into the 5 different categories you will be tested on. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. 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 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. 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. 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. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. In conclusion, ethical and legal principles are of great importance in paramedical practices. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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. 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. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Summary. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. MA Healthcare Ltd 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). To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. In this case, both ethical and legal principles are important. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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). This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). The use of the other sections of the MHA can require much more time (Hawley et al. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Monday, January 2, 2017. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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). All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Vulnerable patients are no exception. Introduction. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. This was because of current UK law and a lack of access to a GP respectively. 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. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. 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. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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. In other words, paramedics need to adopt the principle of confidentiality and credence. 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. 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). Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Paramedics' decisions on patients' treatment will often impact others. keywords = "Ethics, Decision making, paramedic, complexity". In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. 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. 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. 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). 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Despite this, there remain multiple barriers to their fully effective provision of such care. 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. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Our fitness to practise process is designed to protect the public from those who are not fit to practise. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). 2011). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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 . Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. MA Healthcare Ltd Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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. 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. 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). However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. 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 The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Therefore, it is important to consider those principles more precisely. 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. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Consequently, the crew had to consider alternative management plans for John. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. 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. A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. 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. 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Notify the family that once CPR has been initiated, you are required to transport the patient. This research aims to highlight and explore underlying values present within practice-based decisions. On the one hand, the paramedics should not neglect the interests and intentions of the patients. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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. As such, making John secure was a priority. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Copyright 2023 After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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). Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Ethics, bioethics and legal issues in paramedic practice. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies
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