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). Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. To provide guidance for paramedics in how to meet their obligations in reporting children at risk, the London Ambulance Service NHS Trust (2020) has produced the Safeguarding Children and Young People Policy. 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. 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.". The authors have faced all eight of the clinical scenarios in this paper in their routine clinical practice. 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). title = "Ethics and law in paramedic practice: Boundaries of capacity and interests". The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. 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. 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 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). This CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. Vulnerable patients are no exception. 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. 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. In this case, both ethical and legal principles are important. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). The beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. This principle refers to both physical and mental damage, which can be done to the clients. | 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 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. Ethical dilemmas are in large part situational, and so it may be helpful to briefly describe the occupational nature of paramedic practice. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. In these complex cases with so many variables, it can sometimes be difficult to fit patients in-between the lines of any law, often meaning that when decisions are unclear, paramedics are forced to engage in a risk management strategy without the power or provision of involuntary sectioning (Palmer, 2011). The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. The ethical responsibilities of a paramedic also include acting fairly and helping any patient who needs it, regardless of their race, age, gender, religion or another personal characteristic.. This article looks into the current difficulties many UK paramedics face when trying to manage patients presenting with a mental health condition in a safe and respectful manner; particularly when the patient requires some form of treatment but refuses this against medical advice. Psychiatric admission for assessment and subsequent treatment if required. 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. This was because of current UK law and a lack of access to a GP respectively. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. The question of justice is another part of the paramedical performance. Legal and ethical practice in care. 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). Copyright 2023 MA Healthcare Ltd practice with medical specialists. Paramedicine occurs in the social fabric of society. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). Our paramedic test questions are listed below. 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. 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. What makes them vulnerable is their lack of defences or resources to deal with threats or risk (Schrder-Butterfill and Marianti, 2006). There are many ethical issues that are encountered during the prehospital care of children and adults. Despite this, there remain multiple barriers to their fully effective provision of such care. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. This exploratory case study utilized semi-structured interviews of thirteen North. 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). It shall discuss the legal and ethical aspects of the issue and how these aspects can be resolved. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. MA Healthcare Ltd However, if a person seems likely to be detained under the MHA, decision-makers cannot normally (p.234) rely on the MCA to give treatment for, or make decisions about, a mental health condition. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. D. personal safety. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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 Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. Although provider judgment plays a large role in the . T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. 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. These risks seemed higher in John's case as he appeared somewhat detached from reality, as is true in psychosis (Kleiger and Khadivi, 2015), and so oblivious to the risks around him. 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. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. keywords = "Ethics, Decision making, paramedic, complexity". C. vehicle safety. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Another ethical principle in paramedicine is beneficence. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. B. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. A sixth theme of ethical complexity was pervasive across these five themes. 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. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). Don't hesitate and rely on professionals! 136: 11 The future for paramedic research. B. EMTs are not liable for any actions that are accurately documented. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. The article argues that the situation raised dilemmas about communication, patient autonomy and paternalism. N2 - Decision-making is central to the everyday practice of paramedicine. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. 122: 10 Researching paramedic clinical practice a practical guide. Capacity can fluctuate over time or as a health condition changes. 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. Townsend and Luck (2009) state that these additional legislative powers have actually led to more confusion for paramedics attempting to manage mental health patients, advocating the need for further training in order to grasp a better understanding of the ethics and law involved. Apart from being a paramedic, entails checking for dangers as part of your primary survey, to protect yourself, bystanders and the patient. 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? Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. U2 - https://doi.org/10.12968/jpar.2020.12.10.CPD1, DO - https://doi.org/10.12968/jpar.2020.12.10.CPD1, JO - Journal of Paramedic Practice: the clinical monthly for emergency care professionals, JF - Journal of Paramedic Practice: the clinical monthly for emergency care professionals. All relevant services should work together to facilitate timely, safe and supportive discharge from detention. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Methods Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. 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. 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.