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. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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). 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. 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). 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. 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). All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Other sections of the MHA can be utilised to remove a person from their property but require further input from other professionals ranging from magistrates to psychiatric doctors and approved mental health professionals (see appendix 2). The views of families, carers and others, if appropriate, should be fully considered when taking decisions. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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. Their vulnerability may impede their autonomy, which can then affect . An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Integrated health care including mental health. Therefore, they should consider the needs and requirements of patients and act correspondingly. 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. Purpose of the fitness to practise process. 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. There are many ethical issues that are encountered during the prehospital care of children and adults. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . 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). 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. Utilizing a priority dispatch system allows dispatchers to send response . There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. They must also deliver care that is consistent with ethical. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Inform client/staff members of ethical issues affecting client 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. 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. Professional practice framework, professional rights and responsibilities, record keeping, governance. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Decision-making is central to the everyday practice of paramedicine. Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. For example, if a patient is transported and this leaves an older person or older child at home, will they be sufficiently able to manage activities of daily living including food preparation, medication management and personal care? The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. 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). Reflective practice is undertaken for a variety of reasons. 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). 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. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Another ethical principle in paramedicine is beneficence. Using a reflective format, the article explored some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in complex situations. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. 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). In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). | 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). By utilising a reflective format, the article explores some of the laws surrounding treatment without consent and how these may aid or hinder a paramedics' ability to provide good quality care to patients in these situations. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. 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 . 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. C. Follow to your local protocols and contact medical direction if unsure how to proceed. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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). 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. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. 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. Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. 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). The provider must be always stalwart in the face of challenges to. 136: 11 The future for paramedic research. 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. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. 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. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. As with any patient, capacity can fluctuate, although this is more likely with older patients. Copyright 2023 The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Elder abuse is often perpetuated by family members, friends and care workers (Biggs et al, 2009). Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. The approach to both participation and trial protocol training varied between ambulance services. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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 . Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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 Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. 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. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. http://dx.doi.org/10.1136/pmj.79.929.151 Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Therefore, it is important to consider those principles more precisely. The use of the other sections of the MHA can require much more time (Hawley et al. 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. 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 are explored. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. 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. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules.