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. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. 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. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if A. Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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 is a part of and more. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). 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). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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). While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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. These factors contribute to an ethically complex decision-making environment. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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 beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Another ethical principle in paramedicine is beneficence. 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. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. 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). It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. A sixth theme of ethical complexity was pervasive across these five themes. A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. C. Follow to your local protocols and contact medical direction if unsure how to proceed. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? The approach to both participation and trial protocol training varied between ambulance services. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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). 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. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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). AB - Decision-making is central to the everyday practice of paramedicine. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. Don't hesitate and rely on professionals! 2011). For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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. 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. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. 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). Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). 136: 11 The future for paramedic research. 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Although, hallucinations, delusions etc. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. 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. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. Integrated health care including mental health. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. This exploratory case study utilized semi-structured interviews of thirteen North. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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. The question of justice is another part of the paramedical performance. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). However, children's life experiences, maturity and understanding differ from one individual to the nextdepending on factors such as their age, culture, health, upbringing, background and environmentsand their ability to process healthcare-related information also varies. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. 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. Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . Despite this, there remain multiple barriers to their fully effective provision of such care. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. practice with medical specialists. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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. 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. Consequently, the crew had to consider alternative management plans for John. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Ethics, bioethics and legal issues in paramedic practice. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. It is diffcult tp prove actions were performed if they are not included on the report. 2 The HCPC standards of conduct, performance and ethics. 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. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention.
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