Capacity can fluctuate over time or as a health condition changes. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. 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. 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). 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. Ethics part 1: what do paramedics owe patients? 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. Ethical Challenges in Emergency Medical Services: Controversies and Inform client/staff members of ethical issues affecting client care. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. 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 beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. Such a situation is irresponsible and dangerous in terms of not only morality and ethics but also legislation. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. This will also help you learn important concepts for the exam. Paramedic Professional Practice | Curtin University You will see the questions are broken down into the 5 different categories you will be tested on. 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). Copyright 2023 B. crew control. 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. 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. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. EMT Chapter 3 -- Medical, Legal, and Ethical Issues Quiz prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. By continuing you agree to the use of cookies. Notify the family that once CPR has been initiated, you are required to transport the patient. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. Consumer rights in advocacy and health care. Ethics in EMS: 10 things you need to know to save lives Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. 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). 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. Ethical issues in medical malpractice - PubMed In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. The frequent exposure to physical and verbal abuse is directly associated with the increasing rate of alcohol-related call-outs. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. 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. 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 Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. 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). MA Healthcare Ltd | 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). 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. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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). Like the abuse of children, the abuse of older people is a significant community concern. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs 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 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. 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. A mother (Victoria Gillick) sought to have medical practitioners refuse to provide medical advice to her daughters, aged under 16, in relation to contraception. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. C. Follow to your local protocols and contact medical direction if unsure how to proceed. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Our paramedic test questions are listed below. D. personal safety. 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness 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). Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). PROFESSIONALISM Professionalism in UK paramedic practice Prof Malcolm In the first article of this series on applied ethics in paramedicine, the authors examined the ethical principles of autonomy and beneficence in the context of principlism (Ebbs et al, 2020). 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. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. 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). Paramedic practice must consider all of these factors to ensure ethically good care. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. 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. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . practice with medical specialists. Paramedicine presupposes direct interaction with individuals. 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). 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. Paramedics interact with these patients every day, often during times of such vulnerability. 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. 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). In other words, paramedics need to adopt the principle of confidentiality and credence. Purpose of the fitness to practise process. Paramedic ethics, capacity and the treatment of vulnerable patients The COVID-19 pandemic and the paramedic response to it, has raised a raft of legal, ethical and professionalism questions for paramedic clinicians and managers. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. (PDF) Reflective Practice for Paramedics - Academia.edu For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. In some cases, it may be a confusing task to react properly to the emerged contradictory issues, preserving the legal implications and moral duties at the same time. 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. The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Elder abuse can encompass neglect, financial duress, psychological threats and violence. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Ethical Issues in Sports Medicine - In the United States - studocu.com 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). This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice.