Vulnerable patients are no exception. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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. 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. 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). 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. Removed to place of safety for up to 72 hours for further assessment. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. 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 . This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. 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). 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. C. Follow to your local protocols and contact medical direction if unsure how to proceed. In other words, paramedics need to adopt the principle of confidentiality and credence. Like the abuse of children, the abuse of older people is a significant community concern. 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. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Elder abuse can encompass neglect, financial duress, psychological threats and violence. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005). While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Aircraft Accidents and Emergency Management, Live 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. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. 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). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Using a reflective format, the article explored 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 complex situations. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Practice in a manner consistent with a code of ethics for registered nurses. There were no obvious physical causes for John's behaviour at this stage. 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). Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). 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. 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. Specifically, the working lives of paramedics are unique and the distinguishing feature is not the medical scope of practice per se, but rather where it is practised (13,14). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if 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. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. 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. 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. 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. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Mental illness can be a challenging vulnerability for clinicians to navigate. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. B. EMTs are not liable for any actions that are accurately documented. The question of justice is another part of the paramedical performance. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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. 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 He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. @article{6040c026e1e34bd9b7239761b13480e7. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Paramedicine occurs in the social fabric of society. This principle refers to both physical and mental damage, which can be done to the clients. MA Healthcare Ltd A significant ethical consideration for clinicians when treating older patients is their capacity. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. 40: . 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. 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. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Consequently, the crew had to consider alternative management plans for John. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. There are particular ethical challenges when multiple vulnerable groups are involved, such as when a mental health patient is also a parent or is caring for an older person. 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. It can be used by . Decision making in this environment is intended to provide care and treatment in the best interests of the patient. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. 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. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. 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. This principle refers to both physical and mental damage, which can be done to the clients. Samantha May Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. abstract = "Decision-making is central to the everyday practice of paramedicine. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Decision-making is central to the everyday practice of paramedicine. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. 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. 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). Therefore, consideration of these effects is part of how they treat patients and make decisions. 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? | 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). Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 2011). 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. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The Notify the family that once CPR has been initiated, you are required to transport the patient. | This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). 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.

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