ethical issues in paramedic practice

Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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.. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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). 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. 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 . The views of families, carers and others, if appropriate, should be fully considered when taking decisions. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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. In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). Decision-making is central to the everyday practice of paramedicine. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. Inform client/staff members of ethical issues affecting client care. 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. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Legal and ethical practice in care. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. 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. 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. 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. The provider must be always stalwart in the face of challenges to. Chat. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 136: 11 The future for paramedic research. Together they form a unique fingerprint. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. Methods Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. This 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 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. Their vulnerability may impede their autonomy, which can then affect . Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). It is diffcult tp prove actions were performed if they are not included on the report. 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. 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. Paramedics' decisions on patients' treatment will often impact others. By continuing you agree to the use of cookies. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. B. crew control. 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. Monday, January 2, 2017. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Like the abuse of children, the abuse of older people is a significant community concern. Mental illness can be a challenging vulnerability for clinicians to navigate. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . This was because of current UK law and a lack of access to a GP respectively. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. 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). 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 At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. A significant ethical consideration for clinicians when treating older patients is their capacity. 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 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. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? The use of the other sections of the MHA can require much more time (Hawley et al. The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. It affirms the supremacy of law and appreciation of human rights and freedom. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. 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. 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. 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. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. | Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. A. C. vehicle safety. 2011). This is not the case. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. 40: . keywords = "Ethics, Decision making, paramedic, complexity". This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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.