ethical issues in paramedic practice

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. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). . Confidentiality, capacity and consent. These factors contribute to an ethically complex decision-making environment. The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Reflective practice is undertaken for a variety of reasons. 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. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. 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. 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). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. 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). John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Paramedicine presupposes direct interaction with individuals. 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. For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Aircraft Accidents and Emergency Management, Live 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). 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. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. Notify the family that once CPR has been initiated, you are required to transport the patient. Despite this, there remain multiple barriers to their fully effective provision of such care. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). MA Healthcare Ltd Integrated health care including mental health. A consensus among paramedic supervisors B. 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. 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. Ethics, bioethics and legal issues in paramedic practice. 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. 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. 122: 10 Researching paramedic clinical practice a practical guide. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). 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. 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. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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). The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 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? 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. Decision-making is central to the everyday practice of paramedicine. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). 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. The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. | In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Gillick competence empowers children to exercise autonomy over their own medical decisions. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. They must also deliver care that is consistent with ethical. 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. 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. 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. Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). 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. 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. 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. Don't hesitate and rely on professionals! 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. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. In other words, paramedics need to adopt the principle of confidentiality and credence. The approach to both participation and trial protocol training varied between ambulance services. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. This is not the case. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. At the same time, the task of the paramedics is to improve their patients health conditions and choose the best way of treatment in every particular case. | 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. Copyright 2023 The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. To assist paramedics in navigating these complex issues, the London Ambulance Service NHS Trust (2019) provides guidance on how to refer vulnerable people to services which may investigate the circumstances and ensure the safety and welfare of the patient). In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Elder abuse can encompass neglect, financial duress, psychological threats and violence.

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