Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. 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. A person is not to be treated as unable to make a decision merely because he makes an unwise decision. This will also help you learn important concepts for the exam. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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). 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). Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". | This can make the balance of patient care and patient autonomy exceedingly difficult to strike, and lead to a number of ethical and legal dilemmas for paramedics (Townsend and Luck, 2009). This exploratory case study utilized semi-structured interviews of thirteen North. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. 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. Our fitness to practise process is designed to protect the public from those who are not fit to practise. 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 . 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). The patient, who will be called John for confidentiality purposes, presented to the ambulance service with an altered mental state. 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. Consumer rights in advocacy and health care. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Paramedics have professional duties toward vulnerable persons. Journal of Paramedic Practice is the leading monthly journal for paramedics. 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. Ethical dilemmas comprise an important non-technical aspect of paramedicine but have not received significant research attention. 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. To get things started, we give a rundown of the most recent research on ethical issues in sports medicine. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Aircraft Accidents and Emergency Management, Live NHS Research and Development Permissions were sought and granted. 2 The HCPC standards of conduct, performance and 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 . Among the main legal principles to be fulfilled in paramedicine, protection of personal data, regulation of drugs consumption, suitability of the medical equipment, and protection and safety of the patients should be considered (AAOS, Elling, & Elling, 2009). The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) Our paramedic test questions are listed below. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. 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. 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). 105: 9 Using quantitative research methods in paramedic practice. He was also unable to effectively communicate his decision making process. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. 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. 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. Examples of harmful actions include the lack of hospital care, utilization of unsuitable medicines, implementation of some procedures and interventions without the agreement of patients as well as the disclosure of confidential information (Aehlert, 2012). It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. MA Healthcare Ltd Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Therefore, a set of laws regulates the requirements of paramedics competence and professional skills that are essential for successful and effective performance (Woollard, 2009). Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. 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. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Ethics part 1: what do paramedics owe patients? The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). John had arrived at a friend's house during the night, behaving in a strange, confused manner. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? 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. Decision-making is central to the everyday practice of paramedicine. This principle refers to both physical and mental damage, which can be done to the clients. The paramedics should consider every individual case and act fairly and objectively in every situation (Beauchamp & Childress, 2008). While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. 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. A person's capacity depends upon the nature of their disability. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. 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. However, incomplete, unclear or incorrectly written prescriptions can cause harm to patients. The ethics in paramedicine has become a field of interest for many scientists and researchers. This was because of current UK law and a lack of access to a GP respectively. 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. 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. 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. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. Similarly, the principle of ethical justice refers to the necessity to provide all patients with equal care and treatment possibilities. A significant ethical consideration for clinicians when treating older patients is their capacity. 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. 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. D. personal safety. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. 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. Nevertheless, paramedicine policies should encourage patients to follow a healthy way of life and apply certain procedures, without intervening in their personal lives and decisions (Sharp, Palmore, & Grady, 2014). Monday, January 2, 2017. The practitioners should have the required level of education and work experience to deal with the patients in the most effective and quality manner. 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). 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. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. John scored low risk on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) self-harm and suicide assessment tool (JRCALC, 2006), but could still be vulnerable to other dangers such as neglect or accidental involvement in incidents such as walking out in front of cars when in a confused state (Azakan and Taylor, 2009). After that, we provide a few recommendations that can assist healthcare professionals in improving their capacity for making ethical decisions. The crew's assessments and thought processes surrounding the management of John will be discussed. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. Utilizing a priority dispatch system allows dispatchers to send response . . Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. 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). This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). Consequently, the crew had to consider alternative management plans for John. 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. 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.

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