The question of justice is another part of the paramedical performance. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. MA Healthcare Ltd
Paramedic practice must consider all of these factors to ensure ethically good care. 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, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. 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. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. These factors contribute to an ethically complex decision-making environment. 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. The ethics in paramedicine has become a field of interest for many scientists and researchers. This course is made up of a number of paramedic specific units and additional health care units. MA Healthcare Ltd
Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Paramedic attitudes and experiences of enrolling patients into the 40: . An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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. Capacity can fluctuate over time or as a health condition changes. 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. Paramedics delivering palliative and end-of-life care in community For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. abstract = "Decision-making is central to the everyday practice of paramedicine. 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. 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. Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. Foundations for paramedic practice: a theoretical perspective - Amazon A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. The Australasian College of Paramedicine 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. Vulnerable patients are no exception. 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). This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Bachelor of Paramedic Practice (Conversion Pathway) (53C) However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). 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. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. 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). Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. Pre Hospital Ethics and Legal Issues - LawTeacher.net More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? In conclusion, ethical and legal principles are of great importance in paramedical practices. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. 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. Chapter 4: Medical/Legal and Ethical Issues (Post Test) - Quizlet This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Ethics and law in paramedic practice : Boundaries of capacity and interests. Maintaining a professional boundary between you and your patient (summary) 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). Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Wednesday, December 2, 2020. Paramedics have professional duties toward vulnerable persons. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. An introduction to reflective practice for paramedics However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). A person's capacity depends upon the nature of their disability. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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). Continuing Professional Development: Ethical issues in paramedic practice 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 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 Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. The ethical and legal dilemmas paramedics face when managing a mental 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. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 8 Quantitative research in paramedic practice an overview. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 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). 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. 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). (PDF) Reflective Practice for Paramedics - ResearchGate 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. 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). EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. (PDF) Applied paramedic law and ethics . Townsend and Luck (eds)(2013 Ethical problems in clinical practice | Postgraduate Medical Journal As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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. All of these actions may devaluate the positive results of treatment and harm patients health and well-being.