Preventing children from exercising their autonomy may cause ethical challenges (Box 1). 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. MA Healthcare Ltd 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. 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. Although, hallucinations, delusions etc. Elder abuse can encompass neglect, financial duress, psychological threats and violence. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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. This principle refers to both physical and mental damage, which can be done to the clients. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Practical decision-making strategies are provided and illustrated by brief examples. 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. 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? The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . Professional practice framework, professional rights and responsibilities, record keeping, governance. 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. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. 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, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. The provider must be always stalwart in the face of challenges to. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. 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. 105: 9 Using quantitative research methods in paramedic practice. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. C. vehicle safety. Psychiatric admission for assessment and subsequent treatment if required. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. Paramedics interact with these patients every day, often during times of such vulnerability. Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). 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. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). 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 parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. C. Follow to your local protocols and contact medical direction if unsure how to proceed. The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Paramedicine presupposes direct interaction with individuals. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. 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. 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. 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. This is not the case. 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 Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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. Integrated health care including mental health. 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. journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. 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. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. Legal & Ethical issues associated with paramedic practice during COVID19. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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). In the case of paramedicine, both ethics and law should remain unprejudiced and objective. Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). 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). However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. Copyright 2023 Paramedic Practice Test. Together they form a unique fingerprint. 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. 153: Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. They must also deliver care that is consistent with ethical. Abstract. | In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. | 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. 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. This is a part of and more. B. Copyright 2023 They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. A. Paramedics' decisions on patients' treatment will often impact others. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . 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. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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 . Our paramedic test questions are listed below. This principle refers to both physical and mental damage, which can be done to the clients. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Ethics, bioethics and legal issues in paramedic practice. 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.
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