Conclusion The involvement of people with dementia is sometimes limited by medical, social or clinician-dependent factors. The crew's assessments and thought processes surrounding the management of John will be discussed. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. 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. B. crew control. 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. This expanded role builds on the skills and preparation of the Emergency Medical Technician (EMT) and Paramedic, with the intention of fulfilling the health care needs of those populations with limited access to primary care services. Our fitness to practise process is designed to protect the public from those who are not fit to practise. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. These factors contribute to an ethically complex decision-making environment. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others.
While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). 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. 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 . D. personal safety. 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. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. 105: 9 Using quantitative research methods in paramedic practice. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. 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. T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). A consensus among paramedic supervisors B. Chat. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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.
All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. 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. From this standpoint, paramedics play a significant role in consideration of ethical issues and bear responsibility for the preservation of both legal and moral standards in every individual case of interaction with the patients. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. practice with medical specialists. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. This highlights the importance of having a good understanding of the MCA, as this is not limited by the persons whereabouts. 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. It shall conclude with this student's position on the issue based on the discussions. Dominique Moritz, Phillip Ebbs, Hamish Carver
It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. 8 Quantitative research in paramedic practice an overview. 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. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. A Department of Health and Social Security memorandum at the time instructed medical practitioners to provide confidential medical advice to children under the age of 16 without a parent present. 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 paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. Inform client/staff members of ethical issues affecting client care. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. 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. Practice in a manner consistent with a code of ethics for registered nurses. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). 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). The first concern for an EMT must be: A. patient safety. Practitioners must be mindful that, despite the frequent interactions with these patients, their behaviour is often perpetuated by mental illness, and the patient needs care for their chronic illness just the same as they would for any other illness. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. A. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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. title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". MA Healthcare Ltd
Stirrat, Johnston, Gillon, and Boyd (2010) suppose that paramedics should be aware of the ethical rules and follow them at the workplace. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. Their vulnerability may impede their autonomy, which can then affect . For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. It is diffcult tp prove actions were performed if they are not included on the report. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. |
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. 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. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This exploratory case study utilized semi-structured interviews of thirteen North. Practical decision-making strategies are provided and illustrated by brief examples. 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. These preferences can then be communicated to paramedics during attendances and care should be consistent with these preferences whenever practicable. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. In this case, both ethical and legal principles are important. Introduction. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Thompson et al (2011) highlight that frequent callers (also known as frequent users) are known to clinicians because they regularly require paramedic support, usually as a result of a mental illness. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Many people with an intellectual disability or communication difficulties often have written information available, particularly in care facilities, that has been compiled with the assistance of family members, health professionals such as occupational therapists or speech pathologists, psychologists and (of course) the patient (e.g. 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). This is the main reason that explains the prominence of the ethical issues in health care and the necessity to respond to them appropriately. Utilizing a priority dispatch system allows dispatchers to send response . However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. He was also unable to effectively communicate his decision making process. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. The use of the other sections of the MHA can require much more time (Hawley et al. The priorities of the medical director C. The wishes of the general public D. Locally accepted protocols, During your monthly internal quality improvement (QI) meeting, you review several patient care reports .
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