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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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). 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. 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. 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 ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. It is diffcult tp prove actions were performed if they are not included on the report. Powered by Pure, Scopus & Elsevier Fingerprint Engine 2023 Elsevier B.V. We use cookies to help provide and enhance our service and tailor content. 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. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. The question of justice is another part of the paramedical performance. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. The use of the other sections of the MHA can require much more time (Hawley et al. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Our paramedic test questions are listed below. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. 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? Due to this misconception, the crew then considered the MHA (1983). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Paramedicine occurs in the social fabric of society. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). 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. 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). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. This third and final article in the series starts by describing the relationships between the legal principle of capacity and the ethical principles of autonomy and beneficence. A consensus among paramedic supervisors B. Although, hallucinations, delusions etc. 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). Inform client/staff members of ethical issues affecting client care. 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. 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. 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). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Consumer rights in advocacy and health care. 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. 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 . Despite this, there remain multiple barriers to their fully effective provision of such care. Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. The crew's assessments and thought processes surrounding the management of John will be discussed. 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. 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). 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. 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. 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. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? journal = "Journal of Paramedic Practice: the clinical monthly for emergency care professionals", Charles Sturt University Research Output Home, Ethics and law in paramedic practice: Boundaries of capacity and interests, Nursing, Paramedicine and Healthcare Sciences, Journal of Paramedic Practice: the clinical monthly for emergency care professionals, https://doi.org/10.12968/jpar.2020.12.10.CPD1. Copyright 2023 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. He was also unable to effectively communicate his decision making process. Ethics part 1: what do paramedics owe patients? 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). From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under 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. 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. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. 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). The Bachelor of Paramedic Practice (Conversion) is a fully online program, designed to help currently practicing paramedics and advanced medics in the Australian Defence Force upgrade their existing qualifications. 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. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. 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. 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. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. 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 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.

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