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 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 key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Practice in a manner consistent with a code of ethics for registered nurses. 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.. Fitness to practise - Health and Care Professions Council 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. Although provider judgment plays a large role in the . 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. C. Patient care cannot be discredited based on poor documentation. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. Legal | Journal Of Paramedic Practice Paramedic Professional Practice | Curtin University PDF Ethical Questions in Emergency Medical Services: Controversies and / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. They must also deliver care that is consistent with ethical. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. 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 . Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. This is not the case. Ethical problems in clinical practice | Postgraduate Medical Journal (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of As such, making John secure was a priority. 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. MA Healthcare Ltd This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Therefore, it is important to consider those principles more precisely. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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. It shall conclude with this student's position on the issue based on the discussions. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Paramedics delivering palliative and end-of-life care in community 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). (PDF) Law and Ethics for Paramedics: An Essential Guide Aircraft Accidents and Emergency Management, Live 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. Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. 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). Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). Legal and Ethical Aspects of Paramedic Practice Article - Studentshare MA Healthcare Ltd You will see the questions are broken down into the 5 different categories you will be tested on. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Professional practice framework, professional rights and responsibilities, record keeping, governance. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) A person's capacity depends upon the nature of their disability. Ethics in EMS: 10 things you need to know to save lives Ethical Challenges in Emergency Medical Services: Controversies and Practical decision-making strategies are provided and illustrated by brief examples. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Ethical issues in medical malpractice - PubMed Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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. 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. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Pre Hospital Ethics and Legal Issues - LawTeacher.net 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). This was because of current UK law and a lack of access to a GP respectively. This exploratory case study utilized semi-structured interviews of thirteen North. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. 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). By continuing you agree to the use of cookies. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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). Legal, ethical and social aspects of child abuse - NursingAnswers.net The Australasian College of Paramedicine A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). Monday, January 2, 2017. 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. 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. 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. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. The crew's assessments and thought processes surrounding the management of John will be discussed. These factors contribute to an ethically complex decision-making environment. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Principlism in paramedicine: an examination of applied healthcare ethics From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Paramedic attitudes and experiences of enrolling patients into the Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). Mental illness can be a challenging vulnerability for clinicians to navigate. Major incident clinical . Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . D. Incomplete . ethics of paramedics - SlideShare It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Abstract. 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. Paramedical ethics during acute emergency medical service referral Ethical Issues in Critical Care | Clinical Gate 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. 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. The use of the other sections of the MHA can require much more time (Hawley et al. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). Paramedics' perceptions of the care they provide to people who self Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet This is a part of and more. Ethical challenges in Emergency Medical Services - PubMed 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. There are many ethical issues that are encountered during the prehospital care of children and adults. Psychiatric admission for assessment and subsequent treatment if required. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". A. 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). Another ethical principle in paramedicine is beneficence. There were no obvious physical causes for John's behaviour at this stage. 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. 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. Removed to place of safety for up to 72 hours for further assessment. Paramedic ethics, capacity and the treatment of vulnerable patients People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. Download Free PDF View PDF Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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. 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. 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. 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. Paramedic ethics, capacity and the treatment of vulnerable patients 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. Paramedic Practice Test | Answers & Explanations | Test-Guide In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. care passports). 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. Dominique Moritz, Phillip Ebbs, Hamish Carver Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Copyright 2023 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. 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]). 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. D. personal safety. Challenges UK paramedics currently face in providing fully effective Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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. Ethical Practice: NCLEX-RN - Registered nursing . 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. 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.