ethical issues in paramedic practice

This research aims to highlight and explore underlying values present within practice-based decisions. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. 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. Download Free PDF View PDF Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. They must also deliver care that is consistent with ethical. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. 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). 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). The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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). 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Wednesday, December 2, 2020. Practical decision-making strategies are provided and illustrated by brief examples. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. care passports). For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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). The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 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. 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). It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 136: 11 The future for paramedic research. 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). 8 Quantitative research in paramedic practice an overview. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. http://dx.doi.org/10.1136/pmj.79.929.151 D. personal safety. By continuing you agree to the use of cookies. Purpose of the fitness to practise process. 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. D. Incomplete . The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Consumer rights in advocacy and health care. 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. Consequently, the crew had to consider alternative management plans for John. Don't hesitate and rely on professionals! | Paramedicine presupposes direct interaction with individuals. 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). Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? NHS Research and Development Permissions were sought and granted. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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). 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. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). B. crew control. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Another ethical principle in paramedicine is beneficence. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Despite this, there remain multiple barriers to their fully effective provision of such care. A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). 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. 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. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Introduction. The provider must be always stalwart in the face of challenges to. abstract = "Decision-making is central to the everyday practice of paramedicine. This is not the case. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. 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). 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. Ethics, bioethics and legal issues in paramedic practice. AB - Decision-making is central to the everyday practice of paramedicine. Legal and ethical practice in care. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and 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. 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. Decision-making is central to the everyday practice of paramedicine. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. Dominique Moritz, Phillip Ebbs, Hamish Carver With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. B. It is diffcult tp prove actions were performed if they are not included on the report.

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