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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. NHS Research and Development Permissions were sought and granted. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. B. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. 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). 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. 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. Copyright 2023
Journal of Paramedic Practice is the leading monthly journal for paramedics. Professional practice framework, professional rights and responsibilities, record keeping, governance. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. Such a position will help improve the system and lead to effective and fruitful results. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Dominique Moritz, Phillip Ebbs, Hamish Carver
The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. MA Healthcare Ltd
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. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Gillick competence empowers children to exercise autonomy over their own medical decisions. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. http://dx.doi.org/10.1136/pmj.79.929.151 Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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). For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. 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]). 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. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. The crew's assessments and thought processes surrounding the management of John will be discussed. 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). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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). While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. As with any patient, capacity can fluctuate, although this is more likely with older patients. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). A significant ethical consideration for clinicians when treating older patients is their capacity. 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 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. By continuing you agree to the use of cookies. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 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. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. 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. 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.
Paramedics interact with these patients every day, often during times of such vulnerability. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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.
Together they form a unique fingerprint. Like the abuse of children, the abuse of older people is a significant community concern. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). This course is made up of a number of paramedic specific units and additional health care units. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. Download Free PDF View PDF While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. Psychiatric admission for assessment and subsequent treatment if required. D. Incomplete . Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. In other words, paramedics need to adopt the principle of confidentiality and credence. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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. 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 views of families, carers and others, if appropriate, should be fully considered when taking decisions. 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? Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. 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 . Another ethical principle in paramedicine is beneficence. 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. 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 Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. 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). MA Healthcare Ltd
Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Copyright 2023
For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. 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. 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. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. There are many ethical issues that are encountered during the prehospital care of children and adults. Elder abuse can encompass neglect, financial duress, psychological threats and violence. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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 first concern for an EMT must be: A. patient safety. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Consequently, the crew began to assess for a psychological cause. 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 authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. 4 Conducting ethical research in paramedic practice. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Although, hallucinations, delusions etc. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). 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. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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. 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. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. 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. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan.
Laguna Sports Complex,
Articles E