ethical issues in paramedic practice

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. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. However, it's unclear whether the MCA would have been the best act to utilise to provide treatment without consent in this case. 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. 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 . Together they form a unique fingerprint. This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). It seems important to note that had John been in a private place, this option would have been void, which may have presented an even more complex situation to manage safely and legally. However, while parental responsibility involves exercising legal decision-making authority for children, children do have the ability to make some healthcare decisions for themselves in certain circumstances. 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. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . With the exception of life-threatening situations (where a paramedic will often act in the patient's best interests to protect the patient's wellbeing), the preference is for clinicians to restore capacity or to wait for capacity to resume before intervening in the care of the patient. 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Although provider judgment plays a large role in the . This exploratory case study utilized semi-structured interviews of thirteen North. Like the abuse of children, the abuse of older people is a significant community concern. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. In doing so, the article attempts to provide a clearer format of understanding of the laws and management of these situations, both for the benefit of future patients and the emergency services alike. Due to this misconception, the crew then considered the MHA (1983). 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. Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). This will also help you learn important concepts for the exam. 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. Our paramedic test questions are listed below. 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. 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. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. 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. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. This research aims to highlight and explore underlying values present within practice-based decisions. Another ethical principle in paramedicine is beneficence. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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. By continuing you agree to the use of cookies. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). 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 . 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. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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. 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). Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Copyright 2023 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. The use of the other sections of the MHA can require much more time (Hawley et al. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. 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. 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). It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. Older people are largely understood as vulnerable when they fall within the high-risk groups of frail, isolated or poor (Schrder-Butterfill and Marianti, 2006). Ethics and law in paramedic practice : Boundaries of capacity and interests. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 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. 8 Quantitative research in paramedic practice an overview. Dominique Moritz, Phillip Ebbs, Hamish Carver Legal and ethical practice in care. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). 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). Consequently, the crew began to assess for a psychological cause. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. Aircraft Accidents and Emergency Management, Live One of the most important legal principles in paramedicine is the preservation of patients personal information and data. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. The first concern for an EMT must be: A. patient safety. Paramedics may be the first health professionals to encounter these vulnerable adults and be the link to not only ensuring they receive the clinical care required at the time but also to breaking the cycle of abuse through notifications or referrals to agencies and support services. 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. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. A clinician's role in supporting vulnerable people and reporting abuse and neglect is crucial to protecting patients and allowing them to continue exercising the greatest possible level autonomy over their own healthcare. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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 is a part of and more. The complexity of mental illness means a person's capacity can fluctuate so they may lose or regain capacity at different stages of their illness. 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. Paramedics' decisions on patients' treatment will often impact others. Paramedicine presupposes direct interaction with individuals. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. They must also deliver care that is consistent with ethical. 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. | Neglect or ill treatment of a person who lacks capacity (including older people) is a criminal offence in the UK (Mental Capacity Act 2005, section 44). After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. 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 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.