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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Decision-making is central to the everyday practice of paramedicine. 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). 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 . 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). 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 in paramedic practice : Boundaries of capacity and interests. It is diffcult tp prove actions were performed if they are not included on the report. Utilizing a priority dispatch system allows dispatchers to send response . 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. | title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Mental illness can be a challenging vulnerability for clinicians to navigate. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. The question of justice is another part of the paramedical performance. @article{6040c026e1e34bd9b7239761b13480e7. 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. 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. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Paramedics interact with these patients every day, often during times of such 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. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. Legal and ethical practice in care. Chat. Consequently, the crew began to assess for a psychological cause. 8 Quantitative research in paramedic practice an overview. 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. . Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. 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. 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. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. MA Healthcare Ltd Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Capacity can fluctuate over time or as a health condition changes. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . In conclusion, ethical and legal principles are of great importance in paramedical practices. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). care passports). 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. In the UK, paramedics are currently not able to utilise any part of the MHA, though it is debated whether this would be beneficial (Berry, 2014; DOH, 2014). This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement 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. 136: 11 The future for paramedic research. 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. B. 105: 9 Using quantitative research methods in paramedic practice. Copyright 2023 For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. 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. http://dx.doi.org/10.1136/pmj.79.929.151 The provider must be always stalwart in the face of challenges to. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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 Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 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). 2011). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. Gillick competence empowers children to exercise autonomy over their own medical decisions. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. 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. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. B. crew control. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. 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. 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. It shall conclude with this student's position on the issue based on the discussions. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. keywords = "Ethics, Decision making, paramedic, complexity". John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. You will see the questions are broken down into the 5 different categories you will be tested on. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 2 The HCPC standards of conduct, performance and ethics. 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). Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. C. Follow to your local protocols and contact medical direction if unsure how to proceed. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. | In the case of paramedicine, both ethics and law should remain unprejudiced and objective. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. | 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. 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.
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