Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Vulnerable patients are no exception. Journal of Paramedic Practice is the leading monthly journal for paramedics. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Ethics, bioethics and legal issues in paramedic practice. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. 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). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. | Monday, January 2, 2017. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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. 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). 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. 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. 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. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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). There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. Professional practice framework, professional rights and responsibilities, record keeping, governance. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. C. Patient care cannot be discredited based on poor documentation. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. It is diffcult tp prove actions were performed if they are not included on the report. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). 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. 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Legal and ethical practice in care. 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. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. Mental illness can be a challenging vulnerability for clinicians to navigate. Notify the family that once CPR has been initiated, you are required to transport the patient. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). 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. This is a part of and more. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). 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. 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). Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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). Major incident clinical . 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. The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). 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). Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 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). The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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. 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. Removed to place of safety for up to 72 hours for further assessment. Reflective practice is undertaken for a variety of reasons. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Abstract. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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). Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Ethics part 1: what do paramedics owe patients? Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. Consequently, the crew had to consider alternative management plans for John. 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. 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. MA Healthcare Ltd 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.. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. It can be used by . Therefore, they should consider the needs and requirements of patients and act correspondingly. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. 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. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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). Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. MA Healthcare Ltd Wednesday, December 2, 2020. It affirms the supremacy of law and appreciation of human rights and freedom. 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). 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. Consequently, the crew began to assess for a psychological cause. 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. The ethical principle of non-maleficence means that paramedicine practitioners should discuss the probable negative consequences of their decisions and prevent them in order not to harm the patients. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. 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. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 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. The first concern for an EMT must be: A. patient safety. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Therefore, consideration of these effects is part of how they treat patients and make decisions. By utilising a reflective format, the article explores 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 these situations. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. 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 third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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). C. Follow to your local protocols and contact medical direction if unsure how to proceed. As such, making John secure was a priority. 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. 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. 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? 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. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. 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). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Dominique Moritz, Phillip Ebbs, Hamish Carver 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. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. 40: . Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime.