More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Abstract. A person must be presumed to have capacity unless it is established that he lacks capacity. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Integrated health care including mental health. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. The provider must be always stalwart in the face of challenges to. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. 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. 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. | This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Notify the family that once CPR has been initiated, you are required to transport the patient. These factors contribute to an ethically complex decision-making environment. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. 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). 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. 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. 8 Quantitative research in paramedic practice an overview. 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. 4 Conducting ethical research in paramedic practice. Summary. 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). Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. This was because of current UK law and a lack of access to a GP respectively. 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. It affirms the supremacy of law and appreciation of human rights and freedom. It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. 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. keywords = "Ethics, Decision making, paramedic, complexity". Gillick competence empowers children to exercise autonomy over their own medical decisions. 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). Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. MA Healthcare Ltd doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Another ethical principle in paramedicine is beneficence. B. crew control. 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. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. 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. http://dx.doi.org/10.1136/pmj.79.929.151 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). 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. 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. 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). 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. 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. This course is made up of a number of paramedic specific units and additional health care units. 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. 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. Elder abuse can encompass neglect, financial duress, psychological threats and violence. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. 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. N2 - Decision-making is central to the everyday practice of paramedicine. Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Confidentiality, capacity and consent. Download Free PDF View PDF 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. He was also unable to effectively communicate his decision making process. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. This principle refers to both physical and mental damage, which can be done to the clients. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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 . 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. A. The crew's assessments and thought processes surrounding the management of John will be discussed. This exploratory case study utilized semi-structured interviews of thirteen North. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. There were no obvious physical causes for John's behaviour at this stage. 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. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). 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). This is a part of and more. Legal & Ethical issues associated with paramedic practice during COVID19. 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 . The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. Aircraft Accidents and Emergency Management, Live 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Don't hesitate and rely on professionals! Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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 article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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). 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. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. A person's capacity depends upon the nature of their disability. In conclusion, ethical and legal principles are of great importance in paramedical practices. As such, making John secure was a priority. There are many ethical issues that are encountered during the prehospital care of children and adults. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. Ethics and law in paramedic practice : Boundaries of capacity and interests. Such a position will help improve the system and lead to effective and fruitful results. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). The principles of non-maleficence and beneficence form an area of special interest for the paramedics since these ethical issues are of paramount importance to them. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Methods An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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 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. 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). Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. It is diffcult tp prove actions were performed if they are not included on the report. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. 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. In this case, the MCA can be applied in the normal way, to provide treatment, even if for mental health disorders, should the person lack capacity (Department of Constituational Affairs, 2007). Consequently, the crew began to assess for a psychological cause. 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). 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. A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). By continuing you agree to the use of cookies. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 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. In other words, paramedics need to adopt the principle of confidentiality and credence. 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. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. 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. 136: 11 The future for paramedic research. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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). In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 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.
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