These factors contribute to an ethically complex decision-making environment. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. 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. Copyright 2023 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. The provider must be always stalwart in the face of challenges to. 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. 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. keywords = "Ethics, Decision making, paramedic, complexity". 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. Paramedicine occurs in the social fabric of society. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? A person is not to be treated as unable to make a decision merely because he makes an unwise decision. A sixth theme of ethical complexity was pervasive across these five themes. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. Therefore, consideration of these effects is part of how they treat patients and make decisions. It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). 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). An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Abstract. 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. practice with medical specialists. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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). In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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. 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. 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). Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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. The paramedics and patients views on treatments may vary as well as moral and legal explanations of different procedures are different according to the cultural, religious, and social backgrounds. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. | While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. Paramedics interact with these patients every day, often during times of such vulnerability. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. There are many ethical issues that are encountered during the prehospital care of children and adults. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). Confusions surrounding said laws have been extracted from the case report and discussed in more generic terms in order to be more readily applicable to other similar cases. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. 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. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John. 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 course is made up of a number of paramedic specific units and additional health care units. 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. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. Utilizing a priority dispatch system allows dispatchers to send response . 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). The question of justice is another part of the paramedical performance. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . care passports). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 122: 10 Researching paramedic clinical practice a practical guide. Psychiatric admission for assessment and subsequent treatment if required. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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). Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. 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). Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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 article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. 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). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 4 Conducting ethical research in paramedic practice. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. 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. | 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.
Clinton, Iowa Recycling Schedule,
Priyadarshini Indalkar Height,
Ashkenazi Blood Type A Positive,
Estimate The Heat Of Combustion For One Mole Of Acetylene,
Ken Slang For House,
Articles E