Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). 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). 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. 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. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. Consequently, the crew had to consider alternative management plans for John. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. The Australasian College of Paramedicine In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Legal & Ethical issues associated with paramedic practice during COVID19. 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. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. 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. 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). Medical Ethics: Non-Maleficence - The Medic Portal After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. B. Consequently, the crew began to assess for a psychological cause. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. 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. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. Principlism in paramedicine: An examination of applied healthcare ethics Bachelor of Paramedic Practice (Conversion Pathway) (53C) They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Practice in a manner consistent with a code of ethics for registered nurses. 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. A. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Notify the family that once CPR has been initiated, you are required to transport the patient. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. MA Healthcare Ltd
Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. The ethics in paramedicine has become a field of interest for many scientists and researchers. Paramedic Professional Practice | Curtin University 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. Due to this misconception, the crew then considered the MHA (1983). 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. 2011). 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. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. Wednesday, December 2, 2020. Community Paramedics | American Nurses Association 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). As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. 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. 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. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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). This was because of current UK law and a lack of access to a GP respectively. They must also deliver care that is consistent with ethical.
Like the abuse of children, the abuse of older people is a significant community concern. (PDF) Reflective Practice for Paramedics - ResearchGate While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). 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. It affirms the supremacy of law and appreciation of human rights and freedom. 122: 10 Researching paramedic clinical practice a practical guide. keywords = "Ethics, Decision making, paramedic, complexity". This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). 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. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. abstract = "Decision-making is central to the everyday practice of paramedicine. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. 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. 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. Although provider judgment plays a large role in the . For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. 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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Removed to place of safety for up to 72 hours for further assessment. 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. Ethical Responsibilities of Paramedics | Work - Chron.com However, children's life experiences, maturity and understanding differ from one individual to the nextdepending on factors such as their age, culture, health, upbringing, background and environmentsand their ability to process healthcare-related information also varies. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) The crew's assessments and thought processes surrounding the management of John will be discussed. Despite this, there remain multiple barriers to their fully effective provision of such care. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Methods However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Principlism in paramedicine: an examination of applied healthcare ethics By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Ethics in EMS: 10 things you need to know to save lives prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Fitness to practise - Health and Care Professions Council Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. In this case, both ethical and legal principles are important. Capacity can fluctuate over time or as a health condition changes. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz 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 B. crew control. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of It can be used by . A significant ethical consideration for clinicians when treating older patients is their capacity. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Paramedic Practice Test | Answers & Explanations | Test-Guide Copyright 2023
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. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. Paramedic ethics, capacity and the treatment of vulnerable patients Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". In conclusion, ethical and legal principles are of great importance in paramedical practices. 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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. care passports). Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). Maintaining a professional boundary between you and your patient (summary) The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. Bachelor of Paramedic Practice (ADF Conversion) (53D) This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able: To provide an overview of the four key ethical principles that underpin current clinical practice in the UK To explore these four ethical principles in relation to specific prehospital and clinical issues To encourage the practitioner to reflect on their own ethical practice To begin to develop the ability to share, discuss and debate the four ethical principles with colleagues and friends, in relation to your own clinical practice. 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. 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. 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. Ethics part 1: what do paramedics owe patients? This principle refers to both physical and mental damage, which can be done to the clients. Introduction. Legal | Journal Of Paramedic Practice Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. 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. Utilizing a priority dispatch system allows dispatchers to send response . This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Principlism in paramedicine: an examination of applied healthcare ethics