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 researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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 . As such, making John secure was a priority. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. A person's capacity depends upon the nature of their disability. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. 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. 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. 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 . 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). D. Incomplete . However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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. There were no obvious physical causes for John's behaviour at this stage. D. personal safety. 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. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. 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. Utilizing a priority dispatch system allows dispatchers to send response . doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). 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 Purpose of the fitness to practise process. The first concern for an EMT must be: A. patient 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Due to this misconception, the crew then considered the MHA (1983). A person must be presumed to have capacity unless it is established that he lacks capacity. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. Paramedics have professional duties toward vulnerable persons. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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. 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. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Practice in a manner consistent with a code of ethics for registered nurses. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Therefore, they should consider the needs and requirements of patients and act correspondingly. 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. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. 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. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. 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. It can be used by . C. vehicle safety. 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. 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. http://dx.doi.org/10.1136/pmj.79.929.151 More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Although, hallucinations, delusions etc. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. 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. 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. Copyright 2023
The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Inform client/staff members of ethical issues affecting client care. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. practice with medical specialists. 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. It affirms the supremacy of law and appreciation of human rights and freedom. 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. 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. 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. Introduction. Methods 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). The views of families, carers and others, if appropriate, should be fully considered when taking decisions. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics .