Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. 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 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. Therefore, they should consider the needs and requirements of patients and act correspondingly. 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. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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). The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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). Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). This principle refers to both physical and mental damage, which can be done to the clients. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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 . 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. Paramedics interact with these patients every day, often during times of such vulnerability. Consequently, the crew had to consider alternative management plans for John. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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 question of justice is another part of the paramedical performance. Paramedics' decisions on patients' treatment will often impact others. keywords = "Ethics, Decision making, paramedic, complexity". The use of the other sections of the MHA can require much more time (Hawley et al. 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. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. 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). Although, hallucinations, delusions etc. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. 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. 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. 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). . 2011). Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Like the abuse of children, the abuse of older people is a significant community concern. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. The ethics in paramedicine has become a field of interest for many scientists and researchers. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. 136: 11 The future for paramedic research. Paramedicine occurs in the social fabric of society. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. Practical decision-making strategies are provided and illustrated by brief examples. 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.. This exploratory case study utilized semi-structured interviews of thirteen North. 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. Samantha May 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. 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). Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. 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. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. In other words, paramedics need to adopt the principle of confidentiality and credence. 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). Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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. 153: 122: 10 Researching paramedic clinical practice a practical guide. 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. @article{6040c026e1e34bd9b7239761b13480e7. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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). 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. This research aims to highlight and explore underlying values present within practice-based decisions. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Copyright 2023 The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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 For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 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. Another ethical principle in paramedicine is beneficence. Ethics and law in paramedic practice : Boundaries of capacity and interests. 4 Conducting ethical research in paramedic practice. A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). B. EMTs are not liable for any actions that are accurately documented. 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. 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. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. It can be used by . Preventing children from exercising their autonomy may cause ethical challenges (Box 1). prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Ethics, bioethics and legal issues in paramedic practice. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Removed to place of safety for up to 72 hours for further assessment. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Capacity can fluctuate over time or as a health condition changes. 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. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. 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 . This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). 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.

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