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. 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 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. Paramedicine occurs in the social fabric of society. Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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). Vulnerable patients are no exception. 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. 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. 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). Practical decision-making strategies are provided and illustrated by brief examples. 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. 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. Consequently, the crew had to consider alternative management plans for John. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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. 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. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. C. Follow to your local protocols and contact medical direction if unsure how to proceed. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 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? 2011). 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. This is not the case. This course is made up of a number of paramedic specific units and additional health care units. 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). author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Therefore, consideration of these effects is part of how they treat patients and make decisions. 2 The HCPC standards of conduct, performance and ethics. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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). Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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). 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). B. EMTs are not liable for any actions that are accurately documented. It affirms the supremacy of law and appreciation of human rights and freedom. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 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. Reflective practice is undertaken for a variety of reasons. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. Our paramedic test questions are listed below. It is diffcult tp prove actions were performed if they are not included on the report. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. Decision-making is central to the everyday practice of paramedicine. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. 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). In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. A significant ethical consideration for clinicians when treating older patients is their capacity. 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. It shall conclude with this student's position on the issue based on the discussions. 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. 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). This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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. Aircraft Accidents and Emergency Management, Live More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Consumer rights in advocacy and health care. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. 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. http://dx.doi.org/10.1136/pmj.79.929.151 Integrated health care including mental health. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Samantha May Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). Due to this misconception, the crew then considered the MHA (1983). 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. The crew's assessments and thought processes surrounding the management of John will be discussed. 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. 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. 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. 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 may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). The use of the other sections of the MHA can require much more time (Hawley et al. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. 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. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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). MA Healthcare Ltd Journal of Paramedic Practice is the leading monthly journal for paramedics. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. 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). This will also help you learn important concepts for the exam. 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). 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. | 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. 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). Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. They must also deliver care that is consistent with ethical. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. A. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 40: . He is an intelligent and articulate 10-year-old boy, and also has leukaemia. 136: 11 The future for paramedic research. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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. | 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). A person's capacity depends upon the nature of their disability. 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 . Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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). 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Abstract. 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. 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? Ethics part 1: what do paramedics owe patients? Don't hesitate and rely on professionals! 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 . Major incident clinical . Methods Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. This is a part of and more. Such a position will help improve the system and lead to effective and fruitful results. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. 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. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. 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 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. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. | The provider must be always stalwart in the face of challenges to. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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). Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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). 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. C. vehicle safety. Inform client/staff members of ethical issues affecting client 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). Paramedics have professional duties toward vulnerable persons. These factors contribute to an ethically complex decision-making environment. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. Although provider judgment plays a large role in the . Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. Ethics and law in paramedic practice : Boundaries of capacity and interests. With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. This principle refers to both physical and mental damage, which can be done to the clients. 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 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. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Purpose of the fitness to practise process. 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Paramedic Practice Test. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Professional practice framework, professional rights and responsibilities, record keeping, governance.
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