ethical issues in paramedic practice
Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). Legal and ethical practice in care. 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. Principlism in paramedicine: an examination of applied healthcare ethics Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. 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. Despite this, there remain multiple barriers to their fully effective provision of such care. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). (PDF) Reflective Practice for Paramedics - Academia.edu All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Summary. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Methods Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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. | After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . Although, hallucinations, delusions etc. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) 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). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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.. 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. 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. PDF Ethical Questions in Emergency Medical Services: Controversies and 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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). In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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. 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). NHS Research and Development Permissions were sought and granted. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. Paramedics' decisions on patients' treatment will often impact others. 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. Paramedic ethics, capacity and the treatment of vulnerable patients It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). 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. This research aims to highlight and explore underlying values present within practice-based decisions. 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. 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. Ethical considerations in prehospital ambulance based research Challenges UK paramedics currently face in providing fully effective The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 105: 9 Using quantitative research methods in paramedic practice. 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. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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). Another ethical principle in paramedicine is beneficence. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 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. 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 other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Mental illness can be a challenging vulnerability for clinicians to navigate. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. This is not the case. 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. School of Nursing, Midwifery & Paramedic Practice 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. A significant ethical consideration for clinicians when treating older patients is their capacity. 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. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy There are many ethical issues that are encountered during the prehospital care of children and adults. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 03 What factors affect paramedics' involvement of people with dementia 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. 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. MA Healthcare Ltd 8 Quantitative research in paramedic practice an overview. Community Paramedics | American Nurses Association Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). 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. 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. Dominique Moritz, Phillip Ebbs, Hamish Carver 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. 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. 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. 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. 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 question of justice is another part of the paramedical performance. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. Utilizing a priority dispatch system allows dispatchers to send response . 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Paramedic: Legislation And And Guidance That Govern The - Edubirdie Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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). 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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. 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? Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . 40: . In other words, paramedics need to adopt the principle of confidentiality and credence. Their vulnerability may impede their autonomy, which can then affect . 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. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Copyright 2023 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. 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). 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care.
