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). The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. / Carver, Hamish; Moritz, Dominique; Ebbs, Phillip. In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. However, again, in much the same way as with other vulnerable people, they may have a sliding scale of autonomy, and paramedics will need to determine each patient's ability to understand, retain and weigh the information being provided to them about their medical condition. 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. Summary of the key detaining sections relevant to paramedic practice (Hawley et al, 2013b). Paramedic Practice Test. 136: 11 The future for paramedic research. 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. care passports). 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. 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. Consumer rights in advocacy and health care. 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. 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). Integrated health care including mental health. In other words, this principle requires minimizing the negative outcomes of treatment and maximizing its positive results. Like the abuse of children, the abuse of older people is a significant community concern. Ethics and law 1 The ethical, legal and professional issues that inform and shape paramedic practice. MA Healthcare Ltd Although provider judgment plays a large role in the . 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. 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. He wasn't known to have sustained a head injury, nor taken any alcohol or drugs. 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. Clinicians and families may become more involved in the decision-making process or take over that decision-making role in the vulnerable person's best interests. Introduction. 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). While parents should be making decisions for infants and very young children, children develop in their maturity as they age and experience life. 2 The HCPC standards of conduct, performance and ethics. It is important to remember that capacity is not a binary state; it exists on a continuum and depends upon the patient's circumstances and the potential consequences of the decision being made. 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). 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. 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, consideration of these effects is part of how they treat patients and make decisions. The ethics in paramedicine has become a field of interest for many scientists and researchers. 105: 9 Using quantitative research methods in paramedic practice. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. Furthermore, the HCPC (2016) standards of conduct place a responsibility on paramedics that they must take reasonable actions to this end. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. | Abstract Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Methods This article addresses these questions by exploring the relationship between healthcare ethics, health law and evidence-based practice in paramedicine. OverviewThis CPD module will focus on some of the key ethical issues in relation to paramedic practice and prehospital care. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. According to Jones et al (2014), the third principle of the MCA (see Table 1) allows patients with capacity to make their own decisions even if they appear unwise or irrational. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. From this standpoint, the paramedics have to follow the same regulations and standards that are mandatory for the whole country. Psychiatric admission for assessment and subsequent treatment if required. This principle refers to both physical and mental damage, which can be done to the clients. Although, hallucinations, delusions etc. 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). 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. Study with Quizlet and memorize flashcards containing terms like The judicial branch at the state level is responsible for, If a paramedic is attacked by a violent patient, When an administrative agency proposes a licensing action in a state that licenses paramedics, the agency must notify the paramedic of the actions that allegedly constituted the infraction. In other words, paramedics need to adopt the principle of confidentiality and credence. 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. Determining the scope of decision-making required is crucial because a person's vulnerability should not automatically equate to a loss of autonomy. 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). Another ethical principle in paramedicine is beneficence. Nevertheless, despite personal values and beliefs, paramedics should provide their patients with essential treatment, medicine, support, and instructions. Consequently, the crew had to consider alternative management plans for John. On closer inspection of the literature, it seems that John could have been treated (or in this case transported for treatment) using the MCA, as he wasn't currently detained under the MHA, nor did it seem likely he was going to be at that time (due mainly to a lack of access to the relevant health care professionals required to perform a MHA assessment) in order to receive the treatment he appeared to require in his best interest. NHS Research and Development Permissions were sought and granted. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. You'll develop your knowledge of the legal, ethical & professional issues in paramedic practice. 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. Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. They must also deliver care that is consistent with ethical. C. vehicle safety. However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? At this time, using police powers seemed to be the last option available to ensure John's safety and treatment. Insufficient competence or lack of basic knowledge can lead to harmful effects and negative consequences of treatment. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. At this point, healthcare professionals (for example paramedics) are likely to question and subsequently assess the person's ability to make this decision. While restraint and sedation may be an option for patient treatment, those options are invasive, contravene autonomy and can perpetuate mental health stigma. A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. kenneth dart daughters,
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