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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. MA Healthcare Ltd
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. http://dx.doi.org/10.1136/pmj.79.929.151 Vulnerable patients are no exception. |
While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. keywords = "Ethics, Decision making, paramedic, complexity". 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. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). Paramedics have professional duties toward vulnerable persons. Another ethical principle in paramedicine is beneficence. Utilizing a priority dispatch system allows dispatchers to send response . Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. 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. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. John had arrived at a friend's house during the night, behaving in a strange, confused manner. If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). Although, hallucinations, delusions etc. 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). Consumer rights in advocacy and health care. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . A person must be presumed to have capacity unless it is established that he lacks capacity. That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. 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. 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. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. Elder abuse can encompass neglect, financial duress, psychological threats and violence. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. 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). A significant ethical consideration for clinicians when treating older patients is their capacity. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. A person's capacity depends upon the nature of their disability. care passports). In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Professional practice framework, professional rights and responsibilities, record keeping, governance. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Summary. 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. 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 are explored. 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. Capacity can fluctuate over time or as a health condition changes. 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. Reflective practice is undertaken for a variety of reasons. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Copyright 2023
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). It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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. It affirms the supremacy of law and appreciation of human rights and freedom. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . 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). This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Psychiatric admission for assessment and subsequent treatment if required. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. 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. @article{6040c026e1e34bd9b7239761b13480e7. 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. The legal principle of capacity is closely aligned with the ethical principle of autonomy as both relate to the independence and freedom that a person can exercise over their own actions and decisions. 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 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). A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . 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.