ethical issues in paramedic practice

EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz 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). 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). Should paramedics ever accept patients' refusal - BMC Medical Ethics It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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). While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. This is a part of and more. 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. 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. 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. 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. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. You will see the questions are broken down into the 5 different categories you will be tested on. (PDF) Reflective Practice for Paramedics - ResearchGate 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. 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. 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. This exploratory case study utilized semi-structured interviews of thirteen North. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of 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 . 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). 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 EMT Chapter 1 Flashcards | Quizlet 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. (PDF) Law and Ethics for Paramedics: An Essential Guide 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). 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. 4 Conducting ethical research in paramedic practice. Ethical Challenges in Emergency Medical Services: Controversies and 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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. Ethical Practice: NCLEX-RN - Registered nursing 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. He was also unable to effectively communicate his decision making process. keywords = "Ethics, Decision making, paramedic, complexity". Gillick competence empowers children to exercise autonomy over their own medical decisions. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. | Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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.. This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). 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 The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 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. Copyright 2023 It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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. Pre Hospital Ethics and Legal Issues - LawTeacher.net The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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. 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). B. EMTs are not liable for any actions that are accurately documented. 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. 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. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. Another ethical principle in paramedicine is beneficence. This principle refers to both physical and mental damage, which can be done to the clients. 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). These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Reflective practice is undertaken for a variety of reasons. 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 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. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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. 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. 2011). Wednesday, December 2, 2020. Confidentiality, capacity and consent. N2 - Decision-making is central to the everyday practice of paramedicine. Principlism in paramedicine: An examination of applied healthcare ethics Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Continuing Professional Development: Ethical aspects of consent, duty This research aims to highlight and explore underlying values present within practice-based decisions. 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. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). As with any patient, capacity can fluctuate, although this is more likely with older patients. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs 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). 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. 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). 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. 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. 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness Legal | Journal Of Paramedic Practice This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. By continuing you agree to the use of cookies. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. Fitness to practise - Health and Care Professions Council In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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. 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. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Ethics, bioethics and legal issues in paramedic practice. Bachelor of Paramedic Practice (ADF Conversion) (53D) 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. 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). 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). 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). Paramedic practice must consider all of these factors to ensure ethically good care. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Ethical Issues in Critical Care | Clinical Gate The Australasian College of Paramedicine Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Sample Essay on Law and Ethics in Paramedical Science 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). 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. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. 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). 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. It is diffcult tp prove actions were performed if they are not included on the report. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Ethical issues in medical malpractice - PubMed Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Professional practice framework, professional rights and responsibilities, record keeping, governance. The provider must be always stalwart in the face of challenges to. Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). Paramedics interact with these patients every day, often during times of such vulnerability. Samantha May Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Ethics and law in paramedic practice: Boundaries of capacity and 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). Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. Inform client/staff members of ethical issues affecting client care. Paramedicine presupposes direct interaction with individuals. 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. In conclusion, ethical and legal principles are of great importance in paramedical practices. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Psychiatric admission for assessment and subsequent treatment if required. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. 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. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Foundations for paramedic practice: a theoretical perspective - Amazon Ethical considerations in prehospital ambulance based research Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. 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. It affirms the supremacy of law and appreciation of human rights and freedom. 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.