Although provider judgment plays a large role in the . 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). MA Healthcare Ltd
It can be used by . It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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 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. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. |
Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). Principlism in paramedicine: An examination of applied healthcare ethics This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Don't hesitate and rely on professionals! Community Paramedics | American Nurses Association Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. This is a part of and more. Purpose of the fitness to practise process. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. 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. 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 . Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Legal | Journal Of Paramedic Practice 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. Psychiatric admission for assessment and subsequent treatment if required. AB - Decision-making is central to the everyday practice of paramedicine. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. 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. Download Free PDF View PDF By continuing you agree to the use of cookies. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). PDF Ethical Questions in Emergency Medical Services: Controversies and Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress.
Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. B. EMTs are not liable for any actions that are accurately documented. 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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). Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Principlism in paramedicine: an examination of applied healthcare ethics Removed to place of safety for up to 72 hours for further assessment. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. (PDF) Law and Ethics for Paramedics: An Essential Guide Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Continuing Professional Development: Ethical issues in paramedic practice Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. 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. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. 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. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of N2 - Decision-making is central to the everyday practice of paramedicine. Paramedicine occurs in the social fabric of society. 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. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Ethics and law in paramedic practice : Boundaries of capacity and interests. Legal and Ethical Aspects of Paramedic Practice Article - Studentshare Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Principlism in paramedicine: an examination of applied healthcare ethics 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). Gillick competence empowers children to exercise autonomy over their own medical decisions. 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. 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). 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. Elder abuse can encompass neglect, financial duress, psychological threats and violence. D. personal safety. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. This is not the case. 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. Sample Essay on Law and Ethics in Paramedical Science Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. 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. 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). 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 . Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Due to this misconception, the crew then considered the MHA (1983). 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). Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. 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.
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. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Paramedics' perceptions of the care they provide to people who self It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This exploratory case study utilized semi-structured interviews of thirteen North. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Bachelor of Paramedic Practice (Conversion Pathway) (53C) 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). John had arrived at a friend's house during the night, behaving in a strange, confused manner. Abstract. 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. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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 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). 40: . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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. 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. Medical Ethics: Beneficence - The Medic Portal In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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 Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Despite this, there remain multiple barriers to their fully effective provision of such care. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). Ethical dilemmas in prehospital emergency care - SpringerLink Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. It is not clear though, how professionals (especially those who do not use the MHA) are likely to know in advance if a patient is likely to meet threshold for detention under this act, and so whether the MCA seems appropriate for use or not. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if After completing this module, the paramedic will be able to: If you would like to send feedback, please email [email protected]. 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. Practical decision-making strategies are provided and illustrated by brief examples. 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. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Major incident clinical . The crew's assessments and thought processes surrounding the management of John will be discussed. B. There were no obvious physical causes for John's behaviour at this stage. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. NHS Research and Development Permissions were sought and granted. MA Healthcare Ltd
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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. 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. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. 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. This was because of current UK law and a lack of access to a GP respectively. 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. He is an intelligent and articulate 10-year-old boy, and also has leukaemia.