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. For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. 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. Summary. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. It is diffcult tp prove actions were performed if they are not included on the report. 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. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. It also calls for the appropriate estimation of patients rights and a tolerant attitude to them. 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. Methods 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. 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. Inform client/staff members of ethical issues affecting client care. care passports). Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. A person must be presumed to have capacity unless it is established that he lacks capacity. Mental illness can be a challenging vulnerability for clinicians to navigate. 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 Ethics and law in paramedic practice : Boundaries of capacity and interests. Major incident clinical . 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). 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. In other words, paramedics need to adopt the principle of confidentiality and credence. 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. Wednesday, December 2, 2020. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. 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. This is a part of and more. 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. NHS Research and Development Permissions were sought and granted. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. Paramedicine occurs in the social fabric of society. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 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. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". practice with medical specialists. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. http://dx.doi.org/10.1136/pmj.79.929.151 This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. In this case, both ethical and legal principles are important. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. 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. For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Introduction. After completing this module, the paramedic will be able to: If you would like to send feedback, please email [email protected]. keywords = "Ethics, Decision making, paramedic, complexity". More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 2011). A person's decision-making capacity is subject to change depending on circumstances such as the illness or injury being experienced at the time, the seriousness of the decision and various other factors. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Samantha May Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. B. EMTs are not liable for any actions that are accurately documented. In conclusion, ethical and legal principles are of great importance in paramedical practices. A consensus among paramedic supervisors B. 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. 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. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. It is clear from these assessments that there are consequent physical risks to the patient's wellbeing depending on the mental health condition(s) present. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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). Journal of Paramedic Practice is the leading monthly journal for paramedics. 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). 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. 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. He wants to stay at home with his dog, who he feels safe with.Even though Terry legally lacks the capacity to make a decision against being transported to hospital, he is still a human being with agency and a level of intelligence. He was also unable to effectively communicate his decision making process. Practice in a manner consistent with a code of ethics for registered nurses. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 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. They must also deliver care that is consistent with ethical. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". 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). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained.

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