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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. The first concern for an EMT must be: A. patient safety. Samantha May 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. 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. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. 40: . Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. 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. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Copyright 2023 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. B. crew control. A sixth theme of ethical complexity was pervasive across these five themes. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Mental illness can be a challenging vulnerability for clinicians to navigate. 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. 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. 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. Our paramedic test questions are listed below. 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. 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. D. Incomplete . Such a position will help improve the system and lead to effective and fruitful results. Ethics and law in paramedic practice : Boundaries of capacity and interests. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Don't hesitate and rely on professionals! Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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 frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). MA Healthcare Ltd Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Integrated health care including mental health. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. 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. 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 Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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 will also help you learn important concepts for the exam. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. keywords = "Ethics, Decision making, paramedic, complexity". Although, hallucinations, delusions etc. 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 Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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]). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. MA Healthcare Ltd However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). There are many ethical issues that are encountered during the prehospital care of children and adults. 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. 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. The approach to both participation and trial protocol training varied between ambulance services. 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. 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 diffcult tp prove actions were performed if they are not included on the report. 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. 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. 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. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 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. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). Cuts in public health and community services funding have decimated programs, leaving unmet health needs. There were no obvious physical causes for John's behaviour at this stage. 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). B. EMTs are not liable for any actions that are accurately documented. 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). 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. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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. Introduction. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. 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. 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). practice with medical specialists. 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. You will see the questions are broken down into the 5 different categories you will be tested on. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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. 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Consequently, the crew began to assess for a psychological cause. This principle refers to both physical and mental damage, which can be done to the clients. 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. N2 - Decision-making is central to the everyday practice of paramedicine. 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 are explored. Consumer rights in advocacy and health care. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 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). Vulnerable patients are no exception. 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. In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). 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. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Utilizing a priority dispatch system allows dispatchers to send response . 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. abstract = "Decision-making is central to the everyday practice of paramedicine. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. Paramedicine presupposes direct interaction with individuals. 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. In this case, both ethical and legal principles are important. Although provider judgment plays a large role in the . Our fitness to practise process is designed to protect the public from those who are not fit to practise. A person's capacity depends upon the nature of their disability. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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. Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). Gillick competence empowers children to exercise autonomy over their own medical decisions. 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.