ethical issues in paramedic practicewhat happened to mark reilly strong island
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. In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). 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. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Journal of Paramedic Practice: Vol 3, No 8 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 . 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). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. Sample Essay on Law and Ethics in Paramedical Science This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. The Health and Care Professions Council (HCPC) (2016, section 7.3: 8) requires that paramedics must take appropriate action where they have concerns about the safety or well-being of children or vulnerable adults. 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 Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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. 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. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. This exploratory case study utilized semi-structured interviews of thirteen North. 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. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. This is not the case. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. 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). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Ethical Practice: NCLEX-RN - Registered nursing More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Confidentiality, capacity and consent. It can be used by . 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. This article explores 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. Legal & Ethical issues associated with paramedic practice during COVID19. N2 - Decision-making is central to the everyday practice of paramedicine. 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. EMT Chapter 1 Flashcards | Quizlet Paramedics' perceptions of the care they provide to people who self Reflective practice is undertaken for a variety of reasons. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. states registered nurses are legally required to report cases of child abuse if there is a "belief on reasonable grounds that a child is in need of protection on a ground referred to in Section 162 (c) or 162 (d), or formed in the course of practicing in . There were no obvious physical causes for John's behaviour at this stage. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. 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. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Consumer rights in advocacy and health care. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedicine occurs in the social fabric of society. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. Practical decision-making strategies are provided and illustrated by brief examples. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. He is an intelligent and articulate 10-year-old boy, and also has leukaemia. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Principlism in paramedicine: an examination of applied healthcare ethics Principlism in paramedicine: An examination of applied healthcare ethics Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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. Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. Consequently, the crew had to consider alternative management plans for John. 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. Continuing Professional Development: Ethical aspects of consent, duty More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. 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). Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Ethical Issues in Sports Medicine - In the United States - studocu.com To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. AB - Decision-making is central to the everyday practice of paramedicine. These factors contribute to an ethically complex decision-making environment. Bachelor of Paramedic Practice (ADF Conversion) (53D) In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). 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). 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). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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 views of families, carers and others, if appropriate, should be fully considered when taking decisions. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Paramedicine presupposes direct interaction with individuals. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. You will see the questions are broken down into the 5 different categories you will be tested on. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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. 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. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. This study explores the nature of paramedical ethics during the high-stakes referral of emergency ambulance patients, and relates findings to accepted concepts of professionalism. In other words, the paramedicine practitioners should inform the patients about all the probable effects of treatment as well as explain its moral and ethical issues. 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. The ethics in paramedicine has become a field of interest for many scientists and researchers. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. The Australasian College of Paramedicine Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. Ethical Responsibilities of Paramedics | Work - Chron.com 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). 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. Continuing Professional Development: Ethical issues in paramedic practice This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). In other words, paramedics need to adopt the principle of confidentiality and credence. Ethics and law in paramedic practice: Boundaries of capacity and Ethical Challenges in Emergency Medical Services: Controversies and Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Methods 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. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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 doi = "https://doi.org/10.12968/jpar.2020.12.10.CPD1". 8 Quantitative research in paramedic practice an overview. Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. 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. 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. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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 . Notify the family that once CPR has been initiated, you are required to transport the patient. 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). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). The crew's assessments and thought processes surrounding the management of John will be discussed. 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. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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]). 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. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Their vulnerability may impede their autonomy, which can then affect . For example, older patients may experience an acute delirium from an infection that temporarily renders their capacity limited, or may lose capacity permanently because of progressive illnesses such as dementia. Together they form a unique fingerprint. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. A person's capacity depends upon the nature of their disability. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Legal, ethical and social aspects of child abuse - NursingAnswers.net 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. Copyright 2023 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). 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. Paramedic attitudes and experiences of enrolling patients into the However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). Like the abuse of children, the abuse of older people is a significant community concern. 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). It shall conclude with this student's position on the issue based on the discussions. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). 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. 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). He was also unable to effectively communicate his decision making process. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. By continuing you agree to the use of cookies. 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. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. 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. 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). Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. In conclusion, ethical and legal principles are of great importance in paramedical practices. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy
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