For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. Interestingly, in some Australian states, paramedics have been granted powers under their MHA to detain mentally ill patients who require involuntary treatment (Parsons and O'Brien, 2011). He was also unable to effectively communicate his decision making process. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. http://dx.doi.org/10.1136/pmj.79.929.151 There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Separate to the MCA (2005), the Mental Health Act (1983) (MHA) may also be used to provide treatment without consent in case of a mental health disorder (Department of Constitutional Affairs, 2007). Monday, January 2, 2017. care passports). Chat. These factors contribute to an ethically complex decision-making environment. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). Notify the family that once CPR has been initiated, you are required to transport the patient. 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. abstract = "Decision-making is central to the everyday practice of paramedicine. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. 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. People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Paramedics interact with these patients every day, often during times of such vulnerability. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Another ethical principle in paramedicine is beneficence. Indeed, there is an argument that if we are to expect an improvement in the way emergency services manage mental health presentations and safeguard a vulnerable patient group, emergency services must be provided with the relevant tools and training to do so (Brown, 2014). Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. This course is made up of a number of paramedic specific units and additional health care units. AB - Decision-making is central to the everyday practice of paramedicine. 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). 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. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. 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). 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). Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. A consensus among paramedic supervisors B. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. B. crew control. 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. 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 . In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. Don't hesitate and rely on professionals! Mental illness can be a challenging vulnerability for clinicians to navigate. 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). D. personal safety. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? A person's capacity depends upon the nature of their disability. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. 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). Like the abuse of children, the abuse of older people is a significant community concern. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. The ethics in paramedicine has become a field of interest for many scientists and researchers. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. In the case of paramedicine, both ethics and law should remain unprejudiced and objective. The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 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. 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. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. In this case, both ethical and legal principles are important. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. 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. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Consumer rights in advocacy and health care. Capacity can fluctuate over time or as a health condition changes. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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). 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. 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. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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). Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. 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). 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 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. Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). They must also deliver care that is consistent with ethical. 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). The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Integrated health care including mental health. This is a part of and more. However, children's life experiences, maturity and understanding differ from one individual to the nextdepending on factors such as their age, culture, health, upbringing, background and environmentsand their ability to process healthcare-related information also varies. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. 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. This will also help you learn important concepts for the exam. 8 Quantitative research in paramedic practice an overview. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. 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). Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The scientists regard those ethical principles as principles of respect, non-maleficence, beneficence, and justice (Beauchamp & Childress, 2008). Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. Paramedics have professional duties toward vulnerable persons. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients.