ethical issues in paramedic practice

| Ethics part 1: what do paramedics owe patients? There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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). 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. Psychiatric admission for assessment and subsequent treatment if required. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. @article{6040c026e1e34bd9b7239761b13480e7. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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). For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . MA Healthcare Ltd 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. 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. 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. 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). 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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). John had arrived at a friend's house during the night, behaving in a strange, confused manner. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. Paramedic Practice Test. Practical decision-making strategies are provided and illustrated by brief examples. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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. 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. These factors contribute to an ethically complex decision-making environment. states registered nurses are legally required to report cases of child abuse if there is a "belief on reasonable grounds that a child is in need of protection on a ground referred to in Section 162 (c) or 162 (d), or formed in the course of practicing in . Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). Copyright 2023 Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. 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. 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). Gillick competence empowers children to exercise autonomy over their own medical decisions. It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. 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). Legal & Ethical issues associated with paramedic practice during COVID19. 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. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Professional practice framework, professional rights and responsibilities, record keeping, governance. Paramedics' decisions on patients' treatment will often impact others. 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. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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 CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. 8 Quantitative research in paramedic practice an overview. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. NHS Research and Development Permissions were sought and granted. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. 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). While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). As such, making John secure was a priority. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. D. Incomplete . It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. Consumer rights in advocacy and health care. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. A sixth theme of ethical complexity was pervasive across these five themes. It is not clear though, how professionals (especially those who do not use the MHA) are likely to know in advance if a patient is likely to meet threshold for detention under this act, and so whether the MCA seems appropriate for use or not. Paramedicine occurs in the social fabric of society. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. 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. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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.