In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Their vulnerability may impede their autonomy, which can then affect . It shall conclude with this student's position on the issue based on the discussions. 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. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. 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 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. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Major incident clinical . 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]). / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. C. Patient care cannot be discredited based on poor documentation. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. In this case, both ethical and legal principles are important. 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity.
The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. These factors contribute to an ethically complex decision-making environment. 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. Dominique Moritz, Phillip Ebbs, Hamish Carver
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. 153: 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 Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. 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 . A consensus among paramedic supervisors B. 136: 11 The future for paramedic research. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. N2 - Decision-making is central to the everyday practice of paramedicine. 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. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment.
Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). 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. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). D. personal safety. MA Healthcare Ltd
care passports). B. crew control. 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. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. 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. 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). The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. @article{6040c026e1e34bd9b7239761b13480e7. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. http://dx.doi.org/10.1136/pmj.79.929.151 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This research aims to highlight and explore underlying values present within practice-based decisions. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). 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. The ethics in paramedicine has become a field of interest for many scientists and researchers. The first concern for an EMT must be: A. patient safety. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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). Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. As with any patient, capacity can fluctuate, although this is more likely with older patients. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). 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. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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. A significant ethical consideration for clinicians when treating older patients is their capacity. 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. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). It is diffcult tp prove actions were performed if they are not included on the report. 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. 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. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). B. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. A person must be presumed to have capacity unless it is established that he lacks capacity. Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Paramedic practice must consider all of these factors to ensure ethically good care. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. This will also help you learn important concepts for the exam. Reflective practice is undertaken for a variety of reasons.
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. Copyright 2023
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. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests".
Paramedicine presupposes direct interaction with individuals. Mental illness can be a challenging vulnerability for clinicians to navigate. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise.
A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. Like the abuse of children, the abuse of older people is a significant community concern. 40: . 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. AB - Decision-making is central to the everyday practice of paramedicine. In conclusion, ethical and legal principles are of great importance in paramedical practices. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care?
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