The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. John had arrived at a friend's house during the night, behaving in a strange, confused manner. It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. 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. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". 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. They help organize the work activities and solve various contradictions between the legal and moral aspects, professional and personal judgments, and cultural and social norms. 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. C. Patient care cannot be discredited based on poor documentation. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. 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 . 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). What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Background This case report discusses an ethical communication dilemma in prehospital patient interaction, involving a patient who was about to board a plane at a busy airport. Integrated health care including mental health. Continuing Professional Development: Ethical issues in paramedic practice Continuing Professional Development: Ethical issues in paramedic practice Friday, August 5, 2011 OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Ethics part 1: what do paramedics owe patients? Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. This will also help you learn important concepts for the exam. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. 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. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Chat. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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 . In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Besides, their classification sets the right vision for the development of paramedicine and provides it with the required tools and methods of acting and solving various dilemmas. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. Due to this misconception, the crew then considered the MHA (1983). You will see the questions are broken down into the 5 different categories you will be tested on. 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. As such, making John secure was a priority. A person must be presumed to have capacity unless it is established that he lacks capacity. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Psychiatric admission for assessment and subsequent treatment if required. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. B. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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 . People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. 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. B. crew control. 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). 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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. As with any patient, capacity can fluctuate, although this is more likely with older patients. While the moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. Legal & Ethical issues associated with paramedic practice during COVID19. Abstract. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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. 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. This was because of current UK law and a lack of access to a GP respectively. 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. 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. Mental illness can be a challenging vulnerability for clinicians to navigate. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. | In other words, paramedics need to adopt the principle of confidentiality and credence. 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. . Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Although, hallucinations, delusions etc. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. The approach to both participation and trial protocol training varied between ambulance services. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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). 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. 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 This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. C. vehicle safety. Some people with a disability may only be capable of autonomy in choices about low acuity or minor treatment, but not about more serious conditions. 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. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Utilizing a priority dispatch system allows dispatchers to send response . Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. Paramedicine presupposes direct interaction with individuals. Copyright 2023 Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. Decision-making is central to the everyday practice of paramedicine. 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). The provider must be always stalwart in the face of challenges to. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). practice with medical specialists. The use of the other sections of the MHA can require much more time (Hawley et al. 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. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. Inform client/staff members of ethical issues affecting client care. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Paramedics interact with these patients every day, often during times of such vulnerability. 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. Removed to place of safety for up to 72 hours for further assessment. Don't hesitate and rely on professionals! Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Their vulnerability may impede their autonomy, which can then affect . For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. Therefore, they should consider the needs and requirements of patients and act correspondingly. 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.
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