They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Bachelor of Paramedic Practice (ADF Conversion) (53D) Gillick competence empowers children to exercise autonomy over their own medical decisions. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 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.. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Legal, ethical and social aspects of child abuse - NursingAnswers.net (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. 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). He is an intelligent and articulate 10-year-old boy, and also has leukaemia. This exploratory case study utilized semi-structured interviews of thirteen North. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Ethics and law in paramedic practice : Boundaries of capacity and interests. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. PROFESSIONALISM Professionalism in UK paramedic practice Prof Malcolm 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. Paramedic ethics, capacity and the treatment of vulnerable patients 03 What factors affect paramedics' involvement of people with dementia Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Together they form a unique fingerprint. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. 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). The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Fitness to practise - Health and Care Professions Council 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). There were no obvious physical causes for John's behaviour at this stage. 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). Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Decision-making is central to the everyday practice of paramedicine. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Download Free PDF View PDF More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz 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. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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. 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). A person is not to be treated as unable to make a decision merely because he makes an unwise decision. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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. 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 is not the case. A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). 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. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Dominique Moritz, Phillip Ebbs, Hamish Carver 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. 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 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. 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 . Notify the family that once CPR has been initiated, you are required to transport the patient. 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). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 136: 11 The future for paramedic research. 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. Should paramedics ever accept patients' refusal - BMC Medical Ethics 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Cuts in public health and community services funding have decimated programs, leaving unmet health needs. NHS Research and Development Permissions were sought and granted. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Ethical Challenges in Emergency Medical Services: Controversies and The first concern for an EMT must be: A. patient safety. 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. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. 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. journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. practice with medical specialists. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Principlism in paramedicine: an examination of applied healthcare ethics 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). The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 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). As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. 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. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 2 The HCPC standards of conduct, performance and ethics. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Legal | Journal Of Paramedic Practice Due to this misconception, the crew then considered the MHA (1983). 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. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Confidentiality, capacity and consent. Paramedics' perceptions of the care they provide to people who self 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). Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Like the abuse of children, the abuse of older people is a significant community concern. 40: . A sixth theme of ethical complexity was pervasive across these five themes. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. Therefore, consideration of these effects is part of how they treat patients and make decisions. Paramedics interact with these patients every day, often during times of such vulnerability. Maintaining a professional boundary between you and your patient (summary) N2 - Decision-making is central to the everyday practice of paramedicine. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. abstract = "Decision-making is central to the everyday practice of paramedicine. 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 This principle refers to both physical and mental damage, which can be done to the clients. 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.
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