ethical issues in paramedic practice

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 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 Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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. 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. 2011). 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Legal and ethical practice in care. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. B. This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). The crew's assessments and thought processes surrounding the management of John will be discussed. 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. A person must be presumed to have capacity unless it is established that he lacks capacity. 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 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. 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. 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. 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. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. D. personal safety. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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. MA Healthcare Ltd For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. 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. | More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Consequently, the crew began to assess for a psychological cause. 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 . Psychiatric admission for assessment and subsequent treatment if required. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. A person's capacity depends upon the nature of their disability. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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. It is not clear though, how professionals (especially those who do not use the MHA) are likely to know in advance if a patient is likely to meet threshold for detention under this act, and so whether the MCA seems appropriate for use or not. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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). It is diffcult tp prove actions were performed if they are not included on the report. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). 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. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. 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 first concern for an EMT must be: A. patient safety. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Therefore, it is important to consider those principles more precisely. 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. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. Practical decision-making strategies are provided and illustrated by brief examples. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Another ethical principle in paramedicine is beneficence. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. 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. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. It affirms the supremacy of law and appreciation of human rights and freedom. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 136: 11 The future for paramedic research. Although provider judgment plays a large role in the . A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success. Download Free PDF View PDF 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. 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. 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. 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. keywords = "Ethics, Decision making, paramedic, complexity". 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. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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. Paramedicine occurs in the social fabric of society. Methods Decision making in this environment is intended to provide care and treatment in the best interests of the patient. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Paramedics have professional duties toward vulnerable persons. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. 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. Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. The question of justice is another part of the paramedical performance. 8 Quantitative research in paramedic practice an overview. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. 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. Confidentiality, capacity and consent. Notify the family that once CPR has been initiated, you are required to transport 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Paramedics' decisions on patients' treatment will often impact others. practice with medical specialists. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Beneficence asks us to promote a course of action, but in practice, we also need to de-promote certain courses of action if there are better options available. 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. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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). 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. 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. 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. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. 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. Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. 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. 122: 10 Researching paramedic clinical practice a practical guide. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. A. In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. However, it is also essential to explain their view on the problem and prove the beneficence of their choice to reach an agreement with the patients (Aehlert, 2012). 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. 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions.