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 . Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. 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. Because of older patients' vulnerability, a clinician's role in identifying and reporting elder abuse is crucial. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Dominique Moritz, Phillip Ebbs, Hamish Carver In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. 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). 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. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Copyright 2023 People with a disability may have difficulty advocating for themselves because of communication issues or their disability may affect their understanding of healthcare considerations. With this considered, it appears that in John's case, the MCA would have been an appropriate means with which to act in John's best interests and convey him to a place of safety for further treatment, which would most likely have been the nearest emergency department. Medical Technician-Basic (EMT-B)/ Emergency Medical Technician-Paramedic (EMT-P) team) arrive and assume care. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Professional practice framework, professional rights and responsibilities, record keeping, governance. EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . 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. While clinical information should always be held in confidence, the stigma associated with mental illness means that most patients value their privacy more so in this regard, and paramedics have a duty to ensure they do not share this information, even inadvertently. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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. Using a reflective format, the article explored 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 complex situations. 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). It is particularly important for clinicians to assess patient capacity every time they attend a person rather than relying on past experiences that because the person lacked capacity owing to their mental illness during a previous attendance, they will somehow lack capacity on all future presentations. NHS Research and Development Permissions were sought and granted. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). D. personal safety. 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. 136: 11 The future for paramedic research. Their vulnerability may impede their autonomy, which can then affect . Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). 122: 10 Researching paramedic clinical practice a practical guide. Some patients with a disability are considered vulnerable in a similar way to older patients: they sometimes lack the defences or resources to deal with threats to them. 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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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). This research aims to highlight and explore underlying values present within practice-based decisions. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . Abstract. 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). T1 - Ethics and law in paramedic practice, T2 - Boundaries of capacity and interests. The approach to both participation and trial protocol training varied between ambulance services. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27). 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. @article{6040c026e1e34bd9b7239761b13480e7. Berry (2014) and Roberts and Henderson (2009) found that a large number of paramedics feel that they are undertrained and possibly underequipped to effectively assess and manage mental health conditions. Methods 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). A person's capacity depends upon the nature of their disability. Nevertheless, it is important to understand that many ethical issues presented in health care have little to do with paramedicine as the latter focuses mainly on emergencies. 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). It can be used by . While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. While not criminally liable, registered health professionals (including paramedics) do have a clear professional and ethical duty to act upon instances of known or suspected child abuse or neglect. 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). Paramedic Practice Test. Consequently, the crew had to consider alternative management plans for John. 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. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. Notify the family that once CPR has been initiated, you are required to transport the patient. For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. Paramedics have professional duties toward vulnerable persons. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. As such, making John secure was a priority. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). In other words, paramedics need to adopt the principle of confidentiality and credence. It shall conclude with this student's position on the issue based on the discussions. 1 Demonstrate an adaptive, flexible and self-directed commitment to the promotion, maintenance and restoration of health and to the delivery of primary health care across the lifespan. 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. Have your partner contact the communications center to send law enforcement to the scene, as this is now a legal issue and the officer will make the decision. 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). Aircraft Accidents and Emergency Management, Live 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. Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. It is diffcult tp prove actions were performed if they are not included on the report. 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. 4 Conducting ethical research in paramedic practice. The ethics in paramedicine has become a field of interest for many scientists and researchers. 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. Gillick competence empowers children to exercise autonomy over their own medical decisions. While the moral or ethical side of paramedicine depends on various religious, cultural, and personal beliefs and views, its legal aspect has a strict definition. In addition, due to John's virtually complete lack of speech, it was excessively difficult to ascertain if he was suffering any hallucinations/delusions at that time. The provider must be always stalwart in the face of challenges to. 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). On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. 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. Dive into the research topics of 'Ethics and law in paramedic practice: Boundaries of capacity and interests'. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. 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. C. Patient care cannot be discredited based on poor documentation. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Vulnerable patients are no exception. Utilizing a priority dispatch system allows dispatchers to send response . A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. 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. 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. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . 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. 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. MA Healthcare Ltd Chat. The question of justice is another part of the paramedical performance. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 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). These factors contribute to an ethically complex decision-making environment. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Writing a prescription: the law and good practice Paramedic independent prescribing offers an opportunity to improve patient access to medications. This case report highlights the potential difficulties and complications associated with the management of mental health incidents for ambulance crews (Parsons and O'Brien, 2011) as well as how potentially confusing the ethical and legal aspects are when managing mental health conditions that require some involuntary form of treatment (Townsend and Luck, 2009). Least restrictive option and maximising independence - Where it is possible to treat a patient safely and lawfully without detaining them under the Act, the patient should not be detained. 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. Copyright 2023 Psychiatric admission for assessment and subsequent treatment if required. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Summary. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics interact with these patients every day, often during times of such vulnerability. 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 . 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. There is currently some debate as to whether the police are the most suitable personnel to be detaining patients under the MHA for a variety of reasons, and paramedics are mentioned as a potential alternative group to utilise this law in the future (Department of Health, 2014). Legal & Ethical issues associated with paramedic practice during COVID19. While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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. Download Free PDF View PDF MA Healthcare Ltd Here we provide services and products that are for reference purpose only & are not intended to be put forward as finalised work & are to be used strictly for assistance in writing your own research material papers. All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. Although provider judgment plays a large role in the . Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. For example, in England and Wales under section 74 of the Serious Crimes Act 2015, health professionals have a legal duty to notify the police if they discover female genital mutilation. The ability to do the above forms key elements of an MCA assessment and suggests that John lacked capacity at that time (Department of Constitutional Affairs, 2007). After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. 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. The police, however, do have the power to utilise section 135 and 136 of the MHA (1983). This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. 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. 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). An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. 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). Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. John had arrived at a friend's house during the night, behaving in a strange, confused manner. 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. 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. 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. 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. 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. However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. Introduction. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Specifically, if a child has sufficient intelligence and maturity to understand the nature and consequences of particular treatment, they are able to consent to that treatment independently and without parental input according to the UK's Gillick competence doctrine. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. One of the most important legal principles in paramedicine is the preservation of patients personal information and data. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. For example, a person presenting with suicidal thoughts may score higher on the JRCALC tool, and thus be at high risk of self injury, but at a lower risk of being involved in an accident, a risk which may be higher in a person suffering from psychosis. Up to 28 days, can be extended by subsequent assessments if required, Person must be at significant risk of: harm to self, harm to others, self-neglect, Requires an approved mental health professional (AMHP) and 2 doctors, Up to 6 months then re-assessed (if not already re-assessed), Critical and urgent admission for up to 72 hours, Used in emergencies as only requires one medical opinion so quicker than section 2 or 3, Police may enter a person's property (with a warrant obtained from a magistrate's court) to remove them to a place of safety if they are believed to be suffering from a mental illness and at risk of harm to self or others, Removal to place of safety (can be police station) for further assessment.
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