ethical issues in paramedic practice

care passports). It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. 4 Conducting ethical research in paramedic practice. 122: 10 Researching paramedic clinical practice a practical guide. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. This is a part of and more. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). 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 can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). This is not the case. Utilizing a priority dispatch system allows dispatchers to send response . 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. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. Psychiatric admission for assessment and subsequent treatment if required. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. 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. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. It can be used by . 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. A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. There were no obvious physical causes for John's behaviour at this stage. These factors contribute to an ethically complex decision-making environment. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). 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. Notify the family that once CPR has been initiated, you are required to transport 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. 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. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. . Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. 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. 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. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. AB - Decision-making is central to the everyday practice of paramedicine. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. | In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. 136: 11 The future for paramedic research. You will see the questions are broken down into the 5 different categories you will be tested on. Paramedics interact with these patients every day, often during times of such vulnerability. Professional practice framework, professional rights and responsibilities, record keeping, governance. 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). It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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. 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. The question of justice is another part of the paramedical performance. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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. A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. Capacity can fluctuate over time or as a health condition changes. Although provider judgment plays a large role in the . 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 . Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. Furthermore, those with mental illness may at times experience treatment and management that limits their autonomy, such as during times of severe psychosis where a patient's autonomy is lawfully overridden in their best interests through the use of chemical or even physical restraint. Methods @article{6040c026e1e34bd9b7239761b13480e7. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Copyright 2023 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. 40: . Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. Paramedics have professional duties toward vulnerable persons. Introduction. 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. C. Patient care cannot be discredited based on poor documentation. 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. 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 respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). A sixth theme of ethical complexity was pervasive across these five themes. 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. 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). 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. In other words, paramedics need to adopt the principle of confidentiality and credence. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . Practice in a manner consistent with a code of ethics for registered nurses. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. http://dx.doi.org/10.1136/pmj.79.929.151 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. 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. 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. Therefore, it is important to consider those principles more precisely. MA Healthcare Ltd 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. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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. 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. Consequently, the crew had to consider alternative management plans for John. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 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 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). Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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? By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. The use of the other sections of the MHA can require much more time (Hawley et al. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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. 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). 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. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). The approach to both participation and trial protocol training varied between ambulance services. 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. 8 Quantitative research in paramedic practice an overview. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. N2 - Decision-making is central to the everyday practice of paramedicine. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards.

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