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For example, a patient might have capacity to refuse their temperature being taken or other observations but not to refuse transport to hospital. Modern paramedicine tends to use the ethical standards developed by scientists T. Beauchamp and J. Childress. An EMT or paramedic with integrity adheres to ethical principles despite any pressures or temptations to do otherwise [4]. | People with mental illness may also be vulnerable because their illness may sometimes render them unable to make some decisions or, like older patients, their decision-making ability fluctuates. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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). However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. 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. Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. http://dx.doi.org/10.1136/pmj.79.929.151 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. 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. For example, some people with conditions such as cerebral palsy may appear to have an intellectual disability that precludes decision-making capacity, where in fact they have no cognitive disability, only communication difficulties. 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. keywords = "Ethics, Decision making, paramedic, complexity". D. personal safety. D. personal safety. Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? Professional practice framework, professional rights and responsibilities, record keeping, governance. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Therefore, the personal attitudes and opinions of paramedicine practitioners should not be valued higher than the intentions and desires of patients. 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 . 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. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. Our paramedic test questions are listed below. For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2).It is important that nurses develop a 'moral competence' so that they are able to contribute to discussion and implementation of issues concerning ethics and human rights . Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. 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. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. He was also unable to effectively communicate his decision making process. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. This research aims to highlight and explore underlying values present within practice-based decisions. It is diffcult tp prove actions were performed if they are not included on the report. 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.. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. A progression of learning in terms of acting morally and ethically is necessary when nurses undergo training on both an undergraduate and a specialist level. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. John spent most of his time standing, staring into space during the crew's presence, a further sign associated with psychosis, where patients spend extended periods of time seemingly doing nothing (Turner, 2009). Therefore, consideration of these effects is part of how they treat patients and make decisions. 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. 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. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. 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). The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. This exploratory case study utilized semi-structured interviews of thirteen North. 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. Integrated health care including mental health. 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). The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017 Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. Unfortunately, in this case, it was wrongly thought by the crew that the MCA could not be used to enforce treatment plans for mental health conditions. 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. 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. 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. It means that all actions taken by the practitioners should demonstrate positive effects on the patients and improve their health conditions. John's risk to the public must also be considered, which, in spite of public opinion, is not usually any higher in psychotic patients (Davies, 2009). 22,26,29,31,37,39-42 More than half the participants in one study raised concerns over handling conflict between patients and family members, especially when there were inconsistent expectations of . As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. The tenet of justice presupposes that paramedicine practitioners should treat all patients equally, without showing personal evaluations and attitudes. 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). The researchers have outlined four main ethical principles, which are important for consideration in paramedicine. Dominique Moritz, Phillip Ebbs, Hamish Carver By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. 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. The design of the PARAMEDIC-2 trial required paramedics to independently determine eligibility and randomise patients into the trial by administering the blinded drugs (either adrenaline or a saline placebo) from a trial-specific drug pack. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. 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 MHA already provides the provision for the appropriate clinicians to provide medical treatment for mental health disorders without consent, whether the patient has capacity or not. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Consequently, the crew had to consider alternative management plans for John.