In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. 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 . 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. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? Copyright 2023
Many with intellectual or communication disabilities are able to live independently in the community and make autonomous choices about their healthcare. Legal and ethical practice in care. For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. 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). 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. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). 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. Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). 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. 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.
A person's capacity depends upon the nature of their disability. 8 Quantitative research in paramedic practice an overview. 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. D. Incomplete . Preventing children from exercising their autonomy may cause ethical challenges (Box 1). This course is made up of a number of paramedic specific units and additional health care units. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). 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). Although, hallucinations, delusions etc. 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. Methods It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Notify the family that once CPR has been initiated, you are required to transport the patient. Sign up to Journal of Paramedic Practices regular newsletters and keep up-to-date with the very latest clinical research and CPD we publish each month. 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.. 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. Paramedics interact with these patients every day, often during times of such vulnerability. 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. http://dx.doi.org/10.1136/pmj.79.929.151 D. personal safety. abstract = "Decision-making is central to the everyday practice of paramedicine. All rights reserved, The ethical and legal dilemmas paramedics face when managing a mental health patient. Therefore, they should consider the needs and requirements of patients and act correspondingly. Therefore, it is important to consider those principles more precisely. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 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. 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. In this case, both ethical and legal principles are important. Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Ethical deliberation contributes to practitioners' critical thinking skills and helps prepare them for decision-making under uncertainty. Such a position will help improve the system and lead to effective and fruitful results. 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). Such an approach preserves all ethical aspects of the paramedical profession since it shows respect to patients and reveals professional competence and help at once (Blaber, 2012). 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. 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. Copyright 2023
The first concern for an EMT must be: A. patient safety. 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 Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Their vulnerability may impede their autonomy, which can then affect . 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. 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. Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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. 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. Overview Fingerprint Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. 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 . Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. When attending older people in the community, paramedics and other clinicians must be cognisant of the patient's life experiences, values and concerns. Capacity can fluctuate over time or as a health condition changes. Samantha May
Vulnerable patients may not have the capacity to consent to their own healthcare, or their vulnerability may mean their interests need protection. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. This is not the case. 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. 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. 153: Efficiency and equity - Providers commissioners and other relevant organisations should work together to ensure that the quality of commissioning and provision of mental healthcare services are of high quality and are given equal priority to physical health and social care services. You'll examine the relationship of law and medicine together with the interplay of medical ethics, analyse the development of medical negligence and consent to medical treatment as well as international medical ethics issues arising from birth to death. This article "Legal and Ethical Aspects of Paramedic Practice" shall discuss one of these ethical issues. 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). This can explain why paramedics also report feelings of confusion surrounding the MCA and a lack of confidence in utilising it (Amblum 2014). 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). 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. 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. Gillick competence allows clinicians to assess a child's capacity to determine their decision-making ability.
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