However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Integrated health care including mental health. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Paramedicine occurs in the social fabric of society. Practical decision-making strategies are provided and illustrated by brief examples. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. 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. 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? A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Purpose of the fitness to practise process. 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). In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. Paramedics have professional duties toward vulnerable persons. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. It can be used by . At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Decision making in this environment is intended to provide care and treatment in the best interests 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. 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). 4 Conducting ethical research in paramedic practice. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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. 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. Reflective practice is undertaken for a variety of reasons. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. 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). 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. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Although, hallucinations, delusions etc. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. They must also deliver care that is consistent with ethical. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. 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. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. Paramedics interact with these patients every day, often during times of such vulnerability. 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). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. 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. 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). 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). Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). abstract = "Decision-making is central to the everyday practice of paramedicine. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Copyright 2023 Monday, January 2, 2017. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. There are many ethical issues that are encountered during the prehospital care of children and adults. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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. 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. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. The approach to both participation and trial protocol training varied between ambulance services. 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). 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. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. 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). doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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. D. personal safety. John had arrived at a friend's house during the night, behaving in a strange, confused manner. Vulnerable patients are no exception. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. 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. | Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. C. vehicle safety. While carers might have a duty to make decisions that benefit the patient and are least restrictive of the patient's rights, it can be difficult for clinicians to uphold and appropriately consider the patient's wishes when another person is responsible for their decision-making. In conclusion, ethical and legal principles are of great importance in paramedical practices. Using a reflective format, the article explored some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in complex situations. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. 122: 10 Researching paramedic clinical practice a practical guide. 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 Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 2011). Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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). 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. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? A sixth theme of ethical complexity was pervasive across these five themes. Practice in a manner consistent with a code of ethics for registered nurses. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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). 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. It affirms the supremacy of law and appreciation of human rights and freedom. 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 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Our fitness to practise process is designed to protect the public from those who are not fit to practise. This is not the case. 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. A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). 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. 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. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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. Copyright 2023 To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. Our paramedic test questions are listed below. 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. 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. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. A consensus among paramedic supervisors B. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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 . C. Follow to your local protocols and contact medical direction if unsure how to proceed. The first concern for an EMT must be: A. patient safety. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected.