For example, children (according to the law) have not reached the required age to make their own healthcare decisions, although some have the maturity to do so and will be able to make some autonomous decisions. Terry's condition has been worsening in recent weeks and his parents and clinicians have arranged for Terry to be transported by ambulance to hospital.However, Terry does not want to go to hospital today. For example, the patients who suffer from mental disorders have the same right to apply different procedures as those who do not. It concerns the application of four principles: autonomy, beneficence, non-maleficence and justice. 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. Due to this misconception, the crew then considered the MHA (1983). 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. Section 136 allows a police officer to remove a person from a public place to a place of safety if they believe them to be suffering from a mental health condition and at risk of harm to themselves or others (Hawley et al. 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). The disclosure of confidential information, as well as the announcement of personal data about patients, supposes administrative and even criminal responsibility (Steer, 2007). Integrated health care including mental health. 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. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of . 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. A consensus among paramedic supervisors B. 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. Reflective practice is undertaken for a variety of reasons. It then explores practical issues of capacity, autonomy and beneficence as these apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, persons with a mental illness and those with a disability. author = "Hamish Carver and Dominique Moritz and Phillip Ebbs". Therefore, consideration of these effects is part of how they treat patients and make decisions. @article{6040c026e1e34bd9b7239761b13480e7. Mental illness can be a challenging vulnerability for clinicians to navigate. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? The ambulance crew's concerns for John's welfare prompted them to assess his level of risk to self and others. Another legal principle in paramedicine calls for the demonstration of high competence and professional skills (Nixon, 2013). |
NHS Research and Development Permissions were sought and granted. 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. Ethics and law in paramedic practice : Boundaries of capacity and interests. Gillick competence empowers children to exercise autonomy over their own medical decisions. Commonly, these four principles help the paramedics make the optimal decisions and protect the interests of clients, acting both morally and legally. If a person is then deemed to have capacity and continues to refuse care, paramedics are forced to balance their duty to protect life against the patient's right to make autonomous decisions (Hodgson, 2016). There are a numbers of texts in other areas, such as nursing and medicine, but not exclusively in relation to paramedics. http://dx.doi.org/10.1136/pmj.79.929.151 Hamish Carver, Dominique Moritz, Phillip Ebbs, Research output: Contribution to journal Article peer-review. 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. The Mental Health Act (1983) The MHA can be used to provide treatment for mental health disorders without consent (Department of Constitutional Affairs, 2007). 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. Professional practice framework, professional rights and responsibilities, record keeping, governance. In the theory of principle based ethics a paramedic must practise non-maleficence and beneficence. Sections 182 (1) a-e, 184 and 162 c-d of the Children, Youth and Families Act 2005 (Vic.) 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. 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). Some people with a disability may have mobility issues that do not affect their capacity to consent to treatment and decision-making, while others with a disability may not have decision-making capacity for numerous reasons, including communication difficulties or intellectual disability. All of these ethical issues represent significant dilemmas to consider for the sake of patients health as well as moral and legal justification (Bledsoe, Porter, Cherry, & Armacost, 2006). 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. It is diffcult tp prove actions were performed if they are not included on the report. In respecting older patients' choices, their vulnerability requires clinicians to take additional precautions to protect them. Psychiatric admission for assessment and subsequent treatment if required. Fluctuation of capacity means that a person's ability to understand information, retain that information and make an informed decision can come and go. Respect and dignity - Patients, their families and carers should be treated with respect and dignity and listened to by professionals. 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. practice with medical specialists. 4 Conducting ethical research in paramedic practice. Paramedics must be aware of their own personal biases or preconceived ideas of disability; these are sometimes referred to as unconscious biases. However, paramedics have no powers under the MHA (1983), and can have difficulties accessing further support from mental health services (Hawley et al, 2011). However, in this case the crew on scene were unable to utilise any sections of MHA, nor could they arrange for an MHA assessment by other professionals. Every job a paramedic enters, the risk of getting injured is always prominent; But with the correct approach, that risk is minimised. 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. Inform client/staff members of ethical issues affecting client care. 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. The data for the case report is gathered from personal experience and presented as a piece of academic, reflective practice from which to learn. The question of justice is another part of the paramedical performance. This principle refers to both physical and mental damage, which can be done to the clients. As such, making John secure was a priority. This paper aims to analyze the ethical and legal issues in paramedicine and examine the probable solutions. In any case, the role of paramedics consists in the elimination of harmful aspects of patients ethical decisions as well as protection of their legal freedom and choice. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. 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. This course is made up of a number of paramedic specific units and additional health care units. 105: 9 Using quantitative research methods in paramedic practice. 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 beneficence of paramedical practices includes not only the treatment and medicines but also relative education and information. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. This principle refers to both physical and mental damage, which can be done to the clients. This may entail organising supervision or support, transporting both the patient and their dependants in more than one ambulance if need be or arranging neighbour, support services or family visits. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. The Iserson Model for ethical decision making in emergency medicine was used as the conceptual framework. Removed to place of safety for up to 72 hours for further assessment. Vulnerable patients are no exception. Perceptions and concerns about receiving treatment at hospital may arise for a number of reasons, such as fear of not returning home, an experience of relatives dying in hospital, worry about pets, stoicism and beliefs about not wanting to bother others. 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. Ethical issues are closely intertwined with legal aspects of care and this module will therefore consider the four ethical principles, focusing on the two key principles of autonomy and . Not surprisingly, the paramedics encounter many ethical and legal dilemmas as a part of their professional activities. 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. Therefore, John was detained under this section and transported to the nearest 136 suite for further assessment and treatment. Should the MCA have been used, John would have been transported to an accident and emergency department, which may not be the most suited to deal with his condition (Morrisson-Rees et al, 2015; O'Hara et al, 2015), whereas the use of the MHA allowed him to be transported directly to a mental health unit. 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. The ethical and legal dilemmas paramedics face when managing a mental health patient | Journal Of Paramedic Practice Features The ethical and legal dilemmas paramedics face when managing a mental health patient The ethical and legal dilemmas paramedics face when managing a mental health patient Samantha May Monday, January 2, 2017
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