These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Methods Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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). The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. 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. It can be used by . Consequently, the crew had to consider alternative management plans for John. While the moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. Psychiatric admission for assessment and subsequent treatment if required. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. 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. 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. MA Healthcare Ltd In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. 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. 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. You will see the questions are broken down into the 5 different categories you will be tested on. D. personal safety. 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). Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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). MA Healthcare Ltd Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Monday, January 2, 2017. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. 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. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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). Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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. 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 . Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. 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. Although provider judgment plays a large role in the . All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Confidentiality, capacity and consent. This principle refers to both physical and mental damage, which can be done to the clients. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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). 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. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). 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. As such, making John secure was a priority. Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). On the one hand, the paramedics should not neglect the interests and intentions of the patients. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. This situation will hopefully alter over time, so this module attempts to present the four ethical contexts common in other health disciplines and discuss them in relation to paramedic practice.Learning OutcomesAfter completing this module you will be able: To provide an overview of the four key ethical principles that underpin current clinical practice in the UK To explore these four ethical principles in relation to specific prehospital and clinical issues To encourage the practitioner to reflect on their own ethical practice To begin to develop the ability to share, discuss and debate the four ethical principles with colleagues and friends, in relation to your own clinical practice. A. 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). title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. 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. 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. 122: 10 Researching paramedic clinical practice a practical guide. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards.
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