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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. 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? 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. The ethical principle of respect for the patients autonomy presupposes the non-interference in the freedom of their decisions and choices (Steer, 2007). They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. D. personal safety. 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. 4 Conducting ethical research in paramedic practice. NHS Research and Development Permissions were sought and granted. 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. Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). 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. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. Paramedical practice should not neglect the intentions of patients to undergo certain types of treatment but fulfill the required tasks responsibly and credibly (Sharp, Palmore, & Grady, 2014). D. personal safety. 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. The approach to both participation and trial protocol training varied between ambulance services. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine.". Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 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. 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 . This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. Another ethical principle in paramedicine is beneficence. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. 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. 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? MA Healthcare Ltd The question of justice is another part of the paramedical performance. Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 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. 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. 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). Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Psychiatric admission for assessment and subsequent treatment if required. Preventing children from exercising their autonomy may cause ethical challenges (Box 1). Empowerment and involvement - Patients should be fully involved in decisions about care, support and treatment. Often, a person's capacity to consent to care is presumed intact until such a time that the patient refuses treatment, which appears to be in their best interest (Jones et al, 2014). That said, given the earlier acknowledgment of paramedics feeling undertrained to assess mental health patients (Roberts and Henderson, 2009; Berry, 2014) it could be questioned how equipped paramedics would be to utilise this act. 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. Among the most significant and complicated ethical dilemmas in nursing, it is possible to distinguish the problem of euthanasia, abortion, truth-telling as opposed to deliberate deception, and freedom contrary to control. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? 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. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if It seems that deciding which act is most appropriate must be managed on a case-by-case basis factoring in issues such as access to healthcare professionals available to utilise the MHA (as paramedics do not have it), the likely cause of the persons behaviour (physical/psychological), whether the patient seems likely to meet the threshold for detention under the MHA, and equally whether the patient is likely to be assessed as lacking capacity under the MCA. 136: 11 The future for paramedic research. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: A. This paper highlights some of the ethical dilemmas that face practising clinicians in their everyday life and restates how useful the General Medical Council guidance is to make appropriate decisions. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. 1. be able to practise safely and effectively within their scope of practice 2. be able to practise within the legal and ethical boundaries of their profession 3. be able to maintain fitness to practise 4. be able to practise as an autonomous professional, exercising their own professional judgement Dominique Moritz, Phillip Ebbs, Hamish Carver At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. Following the legal side of the treatment is a great step toward establishing qualitative and appropriate services. If a registrant's fitness to practise is impaired (in other words, negatively affected) it means there are concerns about their ability to practise safely and effectively. Consequently, the crew had to consider alternative management plans for John. 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. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . 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. However, ethical issues relating to vulnerability and the treatment of children extend well beyond Gillick competence. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). In such a way, they will not violate personal freedom and demonstrate respect for patients demands and plans (Blaber, 2012). It can be used by . prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? care passports). MA Healthcare Ltd Capacity can fluctuate over time or as a health condition changes. practice with medical specialists. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. 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. Removed to place of safety for up to 72 hours for further assessment. You will see the questions are broken down into the 5 different categories you will be tested on. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Reflective practice is undertaken for a variety of reasons. Speaking about the legal principles of paramedical practices, it is important to mention that legislative acts and rules are common for all individuals and organizations despite the scopes and directions of their activities. Wherever possible a patient's independence should be encouraged and supported with a focus on promoting recovery wherever possible. 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 . It shall conclude with this student's position on the issue based on the discussions. 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). A. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. In this case, John refused to engage with the ambulance crew leading the crew to consider both the MCA and the MHA to protect the patient's wellbeing without his consent. 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. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. abstract = "Decision-making is central to the everyday practice of paramedicine. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). 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. By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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). 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). After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. A person must be presumed to have capacity unless it is established that he lacks capacity. 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. Our paramedic test questions are listed below. A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. 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. While invasive options may be necessary for the safety of the patient, the clinician and the broader community in some circumstances, they should be used only as a last resort and less invasive treatment options should be preferred where possible, such as voluntary transport to hospital or a community referral. There were no obvious physical causes for John's behaviour at this stage. Such a position will help improve the system and lead to effective and fruitful results. At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Capacity is the legal principle, that a person is able to make decisions about their own healthcare where they can demonstrate an ability to understand relevant information given to them about their condition, retain that information and use or weigh that information to make an informed and considered choice (Mental Capacity Act 2005).
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