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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. Paramedicine occurs in the social fabric of society. These factors contribute to an ethically complex decision-making environment. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. Abstract. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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. This exploratory case study utilized semi-structured interviews of thirteen North. A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 153: This principle refers to both physical and mental damage, which can be done to the clients. 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 are explored. 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies MA Healthcare Ltd Paramedicine presupposes direct interaction with individuals. 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. 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 term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. 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. This will also help you learn important concepts for the exam. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Consumer rights in advocacy and health care. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Major incident clinical . . The use of the other sections of the MHA can require much more time (Hawley et al. A consensus among paramedic supervisors B. 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. 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. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. 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). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 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 . B. EMTs are not liable for any actions that are accurately documented. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. MA Healthcare Ltd Gillick competence empowers children to exercise autonomy over their own medical decisions. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. @article{6040c026e1e34bd9b7239761b13480e7. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. 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). 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. As such, making John secure was a priority. The approach to both participation and trial protocol training varied between ambulance services. 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 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 . Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Consequently, the crew had to consider alternative management plans for John. 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. 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. Samantha May keywords = "Ethics, Decision making, paramedic, complexity". Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. 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. 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. Utilizing a priority dispatch system allows dispatchers to send response . A person's capacity depends upon the nature of their disability. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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. 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 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. 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. 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 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 is a part of and more. D. personal safety. 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). 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. 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. Inform client/staff members of ethical issues affecting client 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. 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). If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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). | 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. In other words, paramedics need to adopt the principle of confidentiality and credence. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. 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. 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. 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). Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. 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. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). Our fitness to practise process is designed to protect the public from those who are not fit to practise. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? D. personal safety. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). They must also deliver care that is consistent with ethical. 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. AB - Decision-making is central to the everyday practice of paramedicine. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. 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).

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