PDF Ethical Questions in Emergency Medical Services: Controversies and The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015).
Community Paramedics | American Nurses Association The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. 122: 10 Researching paramedic clinical practice a practical guide. Ethics, bioethics and legal issues in paramedic practice. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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. 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).
Legal, ethical and social aspects of child abuse - NursingAnswers.net C. Follow to your local protocols and contact medical direction if unsure how to proceed. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. 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. 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. 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. 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. 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. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 40: . Preventing children from exercising their autonomy may cause ethical challenges (Box 1).
Ethical Challenges in Emergency Medical Services: Controversies and Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection.
Journal of Paramedic Practice: Vol 3, No 8 C. vehicle safety. Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them.
Paramedics' perceptions of the care they provide to people who self 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. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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. This course is made up of a number of paramedic specific units and additional health care units. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. 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. Within this, confusion and limitations surrounding both the MCA and the MHA will be explored, as well as how these may affect patient care and any key areas that could be developed in the future. Copyright 2023
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 Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy.
Ethical dilemmas in prehospital emergency care - SpringerLink Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism.
Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. |
prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Another ethical principle in paramedicine is beneficence. The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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).
Ethical issues in medical malpractice - PubMed 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. 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. 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. Integrated health care including mental health. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists.
Principlism in paramedicine: An examination of applied healthcare ethics 2 The HCPC standards of conduct, performance and ethics. There are many ethical issues that are encountered during the prehospital care of children and adults. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Notify the family that once CPR has been initiated, you are required to transport the patient. Due to this misconception, the crew then considered the MHA (1983). Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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 frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. MA Healthcare Ltd
Cuts in public health and community services funding have decimated programs, leaving unmet health needs.
Ethical Issues in Sports Medicine - In the United States - studocu.com In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence.
How does a paramedic use chemistry? [FAQ!] Capacity can fluctuate over time or as a health condition changes. Decision-making is central to the everyday practice of paramedicine.
ethics of paramedics - SlideShare The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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. Paramedic practice must consider all of these factors to ensure ethically good care. 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. 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. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 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. Don't hesitate and rely on professionals! 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. In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). 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). Although provider judgment plays a large role in the . Therefore, it is important to consider those principles more precisely. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes?
Should paramedics ever accept patients' refusal - BMC Medical Ethics The use of the other sections of the MHA can require much more time (Hawley et al. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. 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). The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. These factors contribute to an ethically complex decision-making environment.
The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes.
PARAMEDIC2 study: Ethical issues | Medicina Intensiva Vulnerable patients are no exception. 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. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. In the forthcoming sections, these standards, guidelines and ethical principles are used to explore key issues relating to patients who are commonly considered to be vulnerable: children, older people and those with mental illness or disability. practice with medical specialists.
Maintaining a professional boundary between you and your patient (summary) A. He was also unable to effectively communicate his decision making process.
Paramedic Practice Test | Answers & Explanations | Test-Guide You will see the questions are broken down into the 5 different categories you will be tested on. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Monday, January 2, 2017. A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted.
Ethics and law in paramedic practice: Boundaries of capacity and Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. 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 105: 9 Using quantitative research methods in paramedic practice. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. 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. 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. This will also help you learn important concepts for the exam. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. 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. A consensus among paramedic supervisors B. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. It can be used by . Their vulnerability may impede their autonomy, which can then affect . Consequently, the crew had to consider alternative management plans for John. 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.
Challenges UK paramedics currently face in providing fully effective This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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 D. personal safety. keywords = "Ethics, Decision making, paramedic, complexity". 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. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Legal and ethical practice in care. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care?
Pre Hospital Ethics and Legal Issues - LawTeacher.net It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Legal & Ethical issues associated with paramedic practice during COVID19. 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. However, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons.
An introduction to reflective practice for paramedics It shall conclude with this student's position on the issue based on the discussions. The provider must be always stalwart in the face of challenges to. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible.
Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. D. Incomplete . 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).
The Australasian College of Paramedicine For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. 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. 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). Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. MA Healthcare Ltd
A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise.
Paramedics delivering palliative and end-of-life care in community MA Healthcare Ltd
There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. 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. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards.
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