ethical issues in paramedic practice

ethical issues in paramedic practice

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). John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Purpose of the fitness to practise process. Legal and ethical practice in care. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. 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. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Removed to place of safety for up to 72 hours for further assessment. 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. C. vehicle safety. 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. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. 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. 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. AB - Decision-making is central to the everyday practice of paramedicine. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. A person may be deprived of their civil liberties in order to be provided with care or treatment that they are unable to consent to due to a lack of capacity, if is in their best interests (Ministry of Justice, 2008; Amblum, 2014). 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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]). 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. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. C. Patient care cannot be discredited based on poor documentation. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Professional practice framework, professional rights and responsibilities, record keeping, governance. Practice in a manner consistent with a code of ethics for registered nurses. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. 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. MA Healthcare Ltd 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. 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. 153: The question of justice is another part of the paramedical performance. For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? Abstract. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). 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). 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. 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 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. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. The first concern for an EMT must be: A. patient safety. 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). Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . 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. The provider must be always stalwart in the face of challenges to. 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. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. | This is not the case. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Vulnerable patients are no exception. Summary. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. C. Follow to your local protocols and contact medical direction if unsure how to proceed. 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. Aircraft Accidents and Emergency Management, Live abstract = "Decision-making is central to the everyday practice of paramedicine. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. B. A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020).

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