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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). care passports). 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. Ethics, bioethics and legal issues in paramedic practice. 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). Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Maintaining a professional boundary between you and your patient (summary) 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). prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Cuts in public health and community services funding have decimated programs, leaving unmet health needs. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Ethical Issues in Paramedic Practice | Free Essay - Essayscreator.com Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. He was also unable to effectively communicate his decision making process. An introduction to reflective practice for paramedics Assessing a person's capacity at every attendance is crucial because capacity is fluid, affected by numerous personal, medical, social and environmental factors. Paramedics play a crucial role to protect vulnerable children using the principles of beneficence and non-maleficence. Paramedics have professional duties toward vulnerable persons. 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. C. vehicle safety. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Continuing Professional Development: Ethical aspects of consent, duty D. Incomplete . Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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 . Jobs that involve the application of the MCA, either to protect the patient or deprive them of their civil liberties, can present a number of challenges to paramedics. Don't hesitate and rely on professionals! 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. 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 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. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). Unlike in countries such as Australia, Canada and the Republic of Ireland where there are mandatory reporting laws, individual health professionals in England are not criminally liable if they fail to report other instances of known or suspected child abuse or neglect (Forster, 2020). All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. 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. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. This will also help you learn important concepts for the exam. Paramedics delivering palliative and end-of-life care in community Ethical Responsibilities of Paramedics | Work - Chron.com Study with Quizlet and memorize flashcards containing terms like As an EMT, the standards of emergency care are often partially based on: Select one: A. During the shared decision-making process between clinician and patient, paramedics must respect these preferences but also be sure that the material risks associated with alternative options for treatment (including non-transport) are clearly explained to the patient (Chan et al, 2017). 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. 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). Our paramedic test questions are listed below. The crew's assessments and thought processes surrounding the management of John will be discussed. Therefore, they should consider the needs and requirements of patients and act correspondingly. Older patients may have fluctuating capacity so may be able to make decisions for themselves in some circumstances and not others. Summary. Paramedic ethics, capacity and the treatment of vulnerable patients Paramedic ethics, capacity and the treatment of vulnerable patients Dominique Moritz, Phillip Ebbs, Hamish Carver Wednesday, December 2, 2020 Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Therefore, they suggest the introduction of ethical education for doctors and staff working in this sphere (Stirrat et al., 2010). Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). Ethics and law in paramedic practice: boundaries of capacity and For specific vulnerable groupssuch as children, older people, those with mental illness and persons with a disabilitythere are some consistent ethical considerations for clinicians. 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. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. Pre Hospital Ethics and Legal Issues - LawTeacher.net Wednesday, December 2, 2020. Ethical Challenges in Emergency Medical Services: Controversies and Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. In contrast, family discordance was reported by nine studies as a significant barrier to paramedic practice of palliative and end-of-life care. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. 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. 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. 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. 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. Journal of Paramedic Practice is the leading monthly journal for paramedics. Paramedic practice must consider all of these factors to ensure ethically good care. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. 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. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. 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). Monday, January 2, 2017. Vulnerable patients are no exception. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. Sample Essay on Law and Ethics in Paramedical Science At the same time, the education should not be subjective, prejudiced, or convincing as the patients have to make their own decisions concerning their lives and health conditions. D. personal safety. 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. On the one hand, the paramedics should not neglect the interests and intentions of the patients. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? 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. (PDF) Reflective Practice for Paramedics - ResearchGate 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). An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. However, the Department of Health (2015) clearly state that it is, so long as the patient hasn't already had their liberties removed under the MHA (1983). Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Ethics and law in paramedic practice : Boundaries of capacity and interests. Challenges UK paramedics currently face in providing fully effective Law and Ethics for Paramedics: An Essential Guide Authors: Georgette Eaton University of Oxford Abstract Providing a clear and concise overview of applied law and ethics to UK paramedic. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Samantha May From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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). 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. Exploring New Zealand Paramedic Attitudes Towards Advance Directives Together they form a unique fingerprint. Paramedics - Health and Care Professions Council Major incident clinical . Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. 2 Function, build and sustain collaborative, professional relationships as a member of a team within multidisciplinary teams and agencies Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. Ethical Issues in Critical Care | Clinical Gate Ethics and law in paramedic practice: Boundaries of capacity and The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. The disawdvantage to the use of the MHA in this case though, is that it required police involvement as opposed to health care professionals (Parsons et al, 2011), which the Department of Health (2014) appear to be attempting to move away from in their review of section 136 of the MHA. The first concern for an EMT must be: A. patient safety. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. 153: Paramedicine presupposes direct interaction with individuals. Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. This can be a common complication in psychosis and is frequently exacerbated by the effects psychosis has on a person's levels of trust, insight and the ability to rationalise, making them reluctant to share information (Kleiger and Khadivi, 2015). By midday, his ability to communicate was largely diminished and his friend, unable to help John, had phoned for emergency services. After completing this module, the paramedic will be able to: If you would like to send feedback, please email jpp@markallengroup.com. Paramedics should be able to find good solutions to these dilemmas, but they have not received much attention . 1 Ethics And Law For The Paramedic Copy - dev.endhomelessness 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. This principle refers to both physical and mental damage, which can be done to the clients. D. personal safety. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. A legal concept important in understanding the extent to which children have autonomy in making their own healthcare decisions is Gillick competence, named after a landmark UK case (Gillick v West Norfolk and Wisbech Area Health Authority [1985]). A consensus among paramedic supervisors B. 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. 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). It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability. 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). Ethical problems in clinical practice | Postgraduate Medical Journal Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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. They may need to consider whether community rapid response services or home GP visits are appropriate, whether additional support services should be organised or if they may need to ensure family members or friends visit the patient in a timely manner. Like the abuse of children, the abuse of older people is a significant community concern. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. A. Ethics National Health Service (NHS) ethical approval was deemed unnecessary during proportionate review, as interviews were with existing staff and no changes to their practice were planned, nor was any contact made with patients. 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. 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 . 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.

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