ethical issues in paramedic practice

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). 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. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. You will see the questions are broken down into the 5 different categories you will be tested on. Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. 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. 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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. Consequently, the crew had to consider alternative management plans for John. Our paramedic test questions are listed below. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 4 Conducting ethical research in paramedic practice. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). C. vehicle safety. 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. 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). Practical decision-making strategies are provided and illustrated by brief examples. Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 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). As with any patient, capacity can fluctuate, although this is more likely with older patients. Such a position will help improve the system and lead to effective and fruitful results. Summary. 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. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. 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. @article{6040c026e1e34bd9b7239761b13480e7. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Practice in a manner consistent with a code of ethics for registered nurses. Paramedic Practice Test. Methods The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. As such, making John secure was a priority. 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. 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. 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. 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). 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. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. NHS Research and Development Permissions were sought and granted. 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 . They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. 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. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Download Free PDF View PDF There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. The provider must be always stalwart in the face of challenges to. 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. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. Paramedics interact with these patients every day, often during times of such vulnerability. A significant ethical consideration for clinicians when treating older patients is their capacity. 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 this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. 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). Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. This is not the case. Paramedics have professional duties toward vulnerable persons. The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. 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. 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. 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. 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. 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. 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. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. 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 must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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. 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. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Vulnerable patients are no exception. 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. . This was because of current UK law and a lack of access to a GP respectively. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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? 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 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. 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. 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. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. Utilizing a priority dispatch system allows dispatchers to send response . Although, hallucinations, delusions etc. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 136: 11 The future for paramedic research. John had arrived at a friend's house during the night, behaving in a strange, confused manner. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. The crew's assessments and thought processes surrounding the management of John will be discussed. The ethics in paramedicine has become a field of interest for many scientists and researchers. This principle refers to both physical and mental damage, which can be done to the clients. It is diffcult tp prove actions were performed if they are not included on the report. 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. 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.

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