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. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. | The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). 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. Bachelor of Paramedic Practice (Conversion Pathway) (53C) Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Gillick competence empowers children to exercise autonomy over their own medical decisions. 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). D. personal safety. Ethics, bioethics and legal issues in paramedic practice. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Chat. Ethical challenges in Emergency Medical Services - PubMed 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. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). @article{6040c026e1e34bd9b7239761b13480e7. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. (PDF) Reflective Practice for Paramedics - Academia.edu Medical Ethics: Beneficence - The Medic Portal The question of justice is another part of the paramedical performance. This was because of current UK law and a lack of access to a GP respectively. This principle refers to both physical and mental damage, which can be done to the clients. NHS Research and Development Permissions were sought and granted. 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. 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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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). 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. 2 The HCPC standards of conduct, performance and ethics. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. 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. Abstract. Aircraft Accidents and Emergency Management, Live 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 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. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Copyright 2023 The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Dominique Moritz, Phillip Ebbs, Hamish Carver However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). 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. Reflective practice is undertaken for a variety of reasons. Integrated health care including mental health. 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. 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. 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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). 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). A sixth theme of ethical complexity was pervasive across these five themes. Furthermore, capacity can fluctuate, so clinicians must favour capacity assessments made at each attendance over capacity assumptions because of vulnerability or previous dealings with the patient. Practical decision-making strategies are provided and illustrated by brief examples. 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). prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. In conclusion, ethical and legal principles are of great importance in paramedical practices. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Summary. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. MA Healthcare Ltd AB - Decision-making is central to the everyday practice of paramedicine. Paramedical ethics during acute emergency medical service referral Ethical Challenges in Emergency Medical Services: Controversies and Foundations for paramedic practice: a theoretical perspective - Amazon The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. 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. Copyright 2023 In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . 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. There were no obvious physical causes for John's behaviour at this stage. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. 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). (PDF) Reflective Practice for Paramedics - ResearchGate It can be used by . This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). This is a part of and more. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). In this case, the MCA can be applied in the normal way, to provide treatment, even if for mental health disorders, should the person lack capacity (Department of Constituational Affairs, 2007). B. EMTs are not liable for any actions that are accurately documented. Our paramedic test questions are listed below. Consumer rights in advocacy and health care. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. 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). Ethics in EMS: 10 things you need to know to save lives 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. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. There are many ethical issues that are encountered during the prehospital care of children and adults. These factors contribute to an ethically complex decision-making environment. This will also help you learn important concepts for the exam. 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 . In other words, paramedics need to adopt the principle of confidentiality and credence. The use of the other sections of the MHA can require much more time (Hawley et al. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). (PDF) Ethics In Paramedic Practice: A Qualitative Case Study of Therefore, consideration of these effects is part of how they treat patients and make decisions. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases.
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