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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . D. personal safety. Ethical issues in medical malpractice - PubMed The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. 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. Paramedic ethics, capacity and the treatment of vulnerable patients 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. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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 police, however, do have the power to utilise section 135 and 136 of the MHA (1983). 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. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. Understanding capacity to consent to research (capacity) The first theme addresses physical and mental capacity and the ability of patients in the ambulance setting to make informed choices. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. PARAMEDIC2 study: Ethical issues | Medicina Intensiva A consensus among paramedic supervisors B. The views of families, carers and others, if appropriate, should be fully considered when taking decisions. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. Pre Hospital Ethics and Legal Issues - LawTeacher.net 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. A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). Moreover, the principle of beneficence involves the necessity to provide sufficient and professional communication and interaction with such patients, without demonstrating their subjective judgments and assessments of the situation. The ethical and legal dilemmas paramedics face when managing a mental This course is made up of a number of paramedic specific units and additional health care units. 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. Although John appeared calm, and wasn't behaving at all aggressively at that time, the acute state of psychosis can be unpredictable, and pose serious risks (Hawley et al, 2011). This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. 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). 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. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies 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. 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). One of the most important legal principles in paramedicine is the preservation of patients personal information and data. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? This exploratory case study utilized semi-structured interviews of thirteen North. 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). 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. 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. Consequently, the crew had to consider alternative management plans for John. The ethical and legal principles of autonomy and capacity help to protect patients and clinicians from abuses of power and exploitation in the healthcare relationship because they establish safeguards for patients. 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). 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). Legal and Ethical Aspects of Paramedic Practice Article - Studentshare Copyright 2023 John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. 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. 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. 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. The Department of Constitutional Affairs (2007) states that a person's ability to make decisions to protect themselves must always be in balance with their civil right to make such decisions. A paramedic should always ensure the confidentiality of not only a patient's medical information but also his or her personal information (Pozgar & Pozgar, 2012). 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. | 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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. He was also unable to effectively communicate his decision making process. 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. 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. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 40: . Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. practice with medical specialists. 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). 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.
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