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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Pre Hospital Ethics and Legal Issues - LawTeacher.net 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. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Paramedics' perceptions of the care they provide to people who self 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). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. PARAMEDIC2 study: Ethical issues | Medicina Intensiva The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. 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 moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Reflective practice is undertaken for a variety of reasons. abstract = "Decision-making is central to the everyday practice of paramedicine. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. Paramedics delivering palliative and end-of-life care in community AB - Decision-making is central to the everyday practice of paramedicine. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. | Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Principlism in paramedicine: An examination of applied healthcare ethics The use of the other sections of the MHA can require much more time (Hawley et al. Medical Ethics: Beneficence - The Medic Portal Copyright 2023 It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. 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. 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. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Psychiatric admission for assessment and subsequent treatment if required. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . Legal and ethical practice in care. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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). Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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. Paramedics' decisions on patients' treatment will often impact others. 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. Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Continuing Professional Development: Ethical issues in paramedic practice At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. C. Patient care cannot be discredited based on poor documentation. NHS Research and Development Permissions were sought and granted. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). Maintaining a professional boundary between you and your patient (summary) There are many ethical issues that are encountered during the prehospital care of children and adults. It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. Dominique Moritz, Phillip Ebbs, Hamish Carver Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. ethics of paramedics - SlideShare Vulnerable patients are at an increased risk of harm or exploitation in healthcare. N2 - Decision-making is central to the everyday practice of paramedicine. 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). EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. 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). Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. These factors contribute to an ethically complex decision-making environment. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. This principle refers to both physical and mental damage, which can be done to the clients. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. Therefore, they should consider the needs and requirements of patients and act correspondingly. Bachelor of Paramedic Practice (Conversion Pathway) (53C) prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Ethics, bioethics and legal issues in paramedic practice. 153: 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. 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. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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). From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. 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. Like the abuse of children, the abuse of older people is a significant community concern. Paramedic ethics, capacity and the treatment of vulnerable patients 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. 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). Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. In this case, both ethical and legal principles are important. 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 . Foundations for paramedic practice: a theoretical perspective - Amazon It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. EMT Chapter 1 Flashcards | Quizlet Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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). 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). 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. 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. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 2 The HCPC standards of conduct, performance and ethics. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. You will see the questions are broken down into the 5 different categories you will be tested on. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. Notify the family that once CPR has been initiated, you are required to transport the patient. 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? 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. How does a paramedic use chemistry? [FAQ!] Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. It is diffcult tp prove actions were performed if they are not included on the report. Samantha May MA Healthcare Ltd Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. A. 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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). Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. 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. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Wednesday, December 2, 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. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 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. B. EMTs are not liable for any actions that are accurately documented. 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. This principle refers to both physical and mental damage, which can be done to the clients. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Ethics and law in paramedic practice : Boundaries of capacity and interests. Legal & Ethical issues associated with paramedic practice during COVID19. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 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. BSc (Hons) Paramedic Science | Buckinghamshire New University 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 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. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Their vulnerability may impede their autonomy, which can then affect . They must also deliver care that is consistent with ethical. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. Purpose of the fitness to practise process. 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). The Australasian College of Paramedicine 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
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