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. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. At these times, police are frequently involved in the prehospital management of patients where there is a potential risk of physical harm to either the patient or paramedics. Elder abuse can encompass neglect, financial duress, psychological threats and violence. 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. 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. The primary task of paramedics is to provide opportune and unprejudiced services, correlating them with legal regulations. A policy set by an EMS Medical Director that allows EMTs to administer glucose to patients in certain circumstances without speaking to the physician is an example of a (n): A. direct order. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. From this point of view, paramedicine has to develop a distinct set of ethical standards and rules to cover their sphere of professional activities. 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]). Chat. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. 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. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. Due to this misconception, the crew then considered the MHA (1983). You note that at 10 years old, he has already had life experiences that many adults would dread.Is it reasonable for a paramedic to be concerned about infringing Terry's autonomy and, if so, how might a paramedic address this problem? On the one hand, the paramedics should not neglect the interests and intentions of the patients. 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. Clinicians must, therefore, consider the least restrictive means of achieving patient care (Department of Health and Social Care, 2015). 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. 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. However, what should paramedics do when their intended, evidence based course of treatment is different from the patient{\textquoteright}s own wishes? C. vehicle safety. A person's capacity depends upon the nature of their disability. Our fitness to practise process is designed to protect the public from those who are not fit to practise. They identify and direct the work of the paramedical practices as well as determine all possible ways of interacting and communicating with patients (Bledsoe et al., 2006). 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. Removed to place of safety for up to 72 hours for further assessment. Discussing Beneficence At Interview When you're talking about ethical issues, you need to consider beneficence. http://dx.doi.org/10.1136/pmj.79.929.151 Principles of consent, autonomy, beneficence, malfeasance 4 Current UK law that relates to . After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. 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. Those two principles form the structure and responsibility of paramedicine and determine its credibility and prominence in contemporary society. This principle refers to both physical and mental damage, which can be done to the clients. In this case, the MCA can be applied in the normal way, to provide treatment, even if for mental health disorders, should the person lack capacity (Department of Constituational Affairs, 2007). 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. And even though the legal issues may have been covered, the ethical implications of the lack of healthcare provided are undoubtedly contrary to good clinical practice given it represents the deliberate concealment of a therapy (or lack of it) used in a given person. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. In the second article, potential conflicts between autonomy and beneficence in relation to end-of-life care were explored (Carver et al, 2020). Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. 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. 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 . Additionally, the measures taken by paramedics during the medical procedures should not contradict the existing laws and rules. Having considered the probability of causes for John's symptoms, the crew suspected John may have been suffering from psychosis. 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. Like the abuse of children, the abuse of older people is a significant community concern. 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. However, the crew were able to identify some typical symptoms of psychosis in Johns' behaviour. Some people's mental illness will not prevent them from exercising their autonomy and their mental illness will not affect their decision-making capacity. Paramedics interact with these patients every day, often during times of such vulnerability. 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). Consequently, the crew began to assess for a psychological cause. 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. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. He was also unable to effectively communicate his decision making process. 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). 2 The HCPC standards of conduct, performance and ethics. This seems like a confusing area and it is unsurprising that paramedics report feeling unsure of exactly how to assess and utilise the capacity act (Amblum, 2014). Practitioners must manage care that is least restrictive of the patient's rights (Mental Capacity Act 2005, section 1). Additionally, according to the current laws, all patients have the right to control their lives without any external interventions, control, and management. Principlism in paramedicine: an examination of applied healthcare ethics Phillip Ebbs, Hamish Carver, Dominique Moritz Sunday, August 2, 2020 Principlism is arguably the dominant recognised ethical framework used within medicine and other Western health professions today, including the UK paramedic profession. Capacity can fluctuate over time or as a health condition changes. Reflective practice is undertaken for a variety of reasons. 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. Non-maleficence is the sister to beneficence and is often considered as an inseparable pillar of ethics. 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. Healthcare practices include many ethical dilemmas, and their solution influences both the personnel and patients. 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). Ethical practice forms a fundamental aspect of paramedic care, and not only is the of model 2 paramedic expected to meet standards of ethics as laid down by the HPC, but more importantly paramedics Following attendance to a call, a reflective account was completed using model 2. are required to treat patients in a way that is humane The All rights reserved, Continuing Professional Development: Ethical issues in paramedic practice. D. personal safety. This guidance helps you to explore and understand the issues of trust in the doctor-patient relationship and looks at factors affecting patients' vulnerability. For example, paramedics have a statutory requirement to safeguard and promote the welfare of children in their care under section 11(2) of the Children Act 2004. Practical decision-making strategies are provided and illustrated by brief examples. 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 There were no obvious physical causes for John's behaviour at this stage. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. The first concern for an EMT must be: A. patient safety. The code of practice for the MCA (Department of Constitutional Affairs, 2007) doesn't clearly set out which specific treatments may or not be provided under the MCA; however, it does seek to explain the relationship between the MHA and MCA. Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. 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. 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. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to: Recognize ethical dilemmas and take appropriate action. 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. 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). Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review.