Currently, few published research or evidence-based texts exist, specifically in relation to prehospital 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. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. 153: 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. This principle refers to both physical and mental damage, which can be done to the clients. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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). PARAMEDIC2 study: Ethical issues | Medicina Intensiva 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). BSc (Hons) Paramedic Science | Buckinghamshire New University Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 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. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This will also help you learn important concepts for the exam. 4 Conducting ethical research in paramedic practice. Ethics and law in paramedic practice: boundaries of capacity and Our fitness to practise process is designed to protect the public from those who are not fit to practise. 40: . 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. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. Consequently, the crew had to consider alternative management plans for John. 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. 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. Paramedic Practice Test | Answers & Explanations | Test-Guide 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. The term psychosis can be used as an umbrella term for a number of different psychotic disorders (NICE, 2014) and so will be utilised here due to the lack of specific diagnosis present for John. Integrated health care including mental health. 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. In this case, both ethical and legal principles are important. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Paramedicine occurs in the social fabric of society. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. 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). From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Ethical Issues in Critical Care | Clinical Gate @article{6040c026e1e34bd9b7239761b13480e7. This is not the case. Psychiatric admission for assessment and subsequent treatment if required. 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). A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). Confidentiality, capacity and consent. Inform client/staff members of ethical issues affecting client care. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Paramedics - Health and Care Professions Council A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Ethics in EMS: 10 things you need to know to save lives Chapter 4 Medical, Legal and Ethical Issues Flashcards | Quizlet 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. EMS Chapter 3 Medical, Legal, and Ethical Issues Quiz Analyse Legal and Ethical Issues Facing Paramedics Summary. 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. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. Sample Essay on Law and Ethics in Paramedical Science 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. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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. 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. 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. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. 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. 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 Ethical Challenges in Emergency Medical Services: Controversies and For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. This exploratory case study utilized semi-structured interviews of thirteen North. 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Continuing Professional Development: Ethical issues in paramedic practice More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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. Ethical problems in clinical practice | Postgraduate Medical Journal 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. 105: 9 Using quantitative research methods in paramedic practice. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Should paramedics ever accept patients' refusal - BMC Medical Ethics 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. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. Monday, January 2, 2017. 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. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment.
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