What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Psychiatric admission for assessment and subsequent treatment if required. 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, paramedics must be aware that it is a medical event that is occurring and the person is generally not being held for criminal reasons. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. 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). During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Mental illness can be a challenging vulnerability for clinicians to navigate. 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. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . The first concern for an EMT must be: A. patient safety. A sixth theme of ethical complexity was pervasive across these five themes. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical 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). For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. 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. While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). Wednesday, December 2, 2020. 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. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. 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. Aircraft Accidents and Emergency Management, Live In conclusion, ethical and legal principles are of great importance in paramedical practices. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). Consumer rights in advocacy and health care. Despite this, there remain multiple barriers to their fully effective provision of such care. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Integrated health care including mental health. 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. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Capacity can fluctuate over time or as a health condition changes. Dominique Moritz, Phillip Ebbs, Hamish Carver Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). 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 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. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . There are many ethical issues that are encountered during the prehospital care of children and adults. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. care passports). 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. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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. This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. By continuing you agree to the use of cookies. 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. 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. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Notify the family that once CPR has been initiated, you are required to transport the patient. 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. Paramedic Practice Test. Therefore, they should consider the needs and requirements of patients and act correspondingly. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? MA Healthcare Ltd Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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). It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. 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. 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. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Overview This CPD module aims to outline, describe and explain some of the key ethical-legal issues in paramedic practice, and their relation to the concept of consent, a duty of care and negligence. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) John had arrived at a friend's house during the night, behaving in a strange, confused manner. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Professional practice framework, professional rights and responsibilities, record keeping, governance. Legal and ethical practice in care. 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). 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. 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). The views of families, carers and others, if appropriate, should be fully considered when taking decisions. 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 Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). In the case of paramedicine, both ethics and law should remain unprejudiced and objective. It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. 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. Gillick competence addresses children's understanding and provides paramedics and other health professionals with a means to determine the extent of involvement a child should have in decisions that affect their healthcare. 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 The MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. 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. 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. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment. 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. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports . 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. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). A. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 40: . Paramedics have professional duties toward vulnerable persons. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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. 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. | The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. 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. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 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. D. Incomplete . Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. As with any patient, capacity can fluctuate, although this is more likely with older patients. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness.