Paramedic Law and Ethics - Literature review Example

Running head: Paramedic Law and Ethics Paramedic Law and Ethics (school) Paramedic Law and Ethics Reading Report Berglund, C. (2007) Ethics for Healthcare (3rd edition). New York: Oxford University Press In the first chapter of Berglund’s book, she discusses ethics in healthcare and the element of caring which is already innate in the health care professional’s initial expedition into a career in healthcare. The author pointed out that the health care practice is not just about the technical application of skills, but it is also about the care displayed by the health professional to the patients (Berglund, 2007). Ethics essentially goes beyond the rules set forth by a regulating body or organization; instead, it starts with a person’s “internal conviction to behave…” (Kerridge, Lowe & McPhee, 2009, p. 2). In the course of a health professional’s learning, his ethical and moral decision-making processes are also enhanced and enriched. Based on the principles of beneficence, autonomy, non-malfeasance, and justice, ethics guides health care professionals in their practice. It also provides solutions to issues, dilemmas or situations which require choices between “what seem to be two equally desirable alternatives that may arise in health care settings” (Sneesby, 2008, p. 21). The principles of ethics, as mentioned above, are principles which help resolve ethical dilemmas. Berglund (2007) also emphasizes the importance of individual reflection for each professional; a professional in this case is skilled and trained in the proper techniques in order to meet the expectation of expertise in the service to society. The professional code of ethics which are essential to the medical, nursing, and paramedic practice are very much based on the four basic ethical principles. In one way or another, they are covered under beneficence, in terms of the overall “good” that one’s actions can bring; they are covered under justice, in terms of giving a patient and a person his due; under non-malfeasance, in terms of not doing any harm to the patient; and finally under the principle of autonomy, in terms of respecting a person’s right to self-determination (Berglund, 2007). In effect, for doubts which practitioners feel in their practice, mastering these four basic principles may secure balance in the ethical healthcare practice. Kant’s deontological theory also discusses about morality and ethics. According to Kant, freedom is needed in order to allow individuals to develop their own opinions and moral laws (Berglund, 2007). In order to uphold such theory, one must respect himself and others – to benefit others and not to harm them. Consequently, an individual has the autonomy to make his own judgment while also respecting other people’s right to be respected (Berglund, 2007). In this case, the principles of justice and beneficence must be prioritized over and above individual interests. Beauchamp’s theory on ethics is largely based on the above utilitarian ideas laid out by John Stuart Mills and Immanuel Kant. For Childress however, his views are more deontological. In applying this to the practice, a utilitarian would focus more on the result of the behaviour for the most number of people; he would also aim for the happiness of the majority (Berglund, 2007). On the other hand, the deontologist assesses the fundamental rule which should be applied in all scenarios in order to ensure ethical practices (Berglund, 2007). These different theories sometimes apply to patients depending on their circumstances. How each situation is judged is still largely based on the principles of ethics. Reading Report 2: Berglund, C. (2007) Ethics for Healthcare (3rd edition). New York: Oxford University Press In the second chapter of Berglund’s ‘Ethics for Healthcare,’ she discusses about the principle of justice and its application in the healthcare practice. The distribution of resources is one of the crucial issues in the application of the justice principle. For health care providers, the fair distribution of claims is often dependent on the appropriate application of this principle (Berglund, 2007). In many instances, the principle of justice has not always been given much importance, especially when financial considerations have been taken into account. For most people, the point of having a career and of working is to earn money; and when this goal comes into conflict with the concept of justice, the professional is prompted to make a choice between social justice and financial gain (Wuthnow, 1998). In the unequal distribution of resources, a health care professional, as pointed out by Berglund (2007), must try to ‘do good’ at all times. ‘Doing good,’ is the very essence of caring and in ‘doing good,’ the health care professional must apply the principle of beneficence. As a result, the different principles of ethics coordinate with each other. In instances when these different principles come in conflict with each other, the least selfish principle must be chosen by the practitioner. In instances where conflict between patient autonomy and beneficence is seen, beneficence seems to be more important to uphold (Berglund, 2007). Where justice itself conflicts with other people’s entitlement to justice, the concept of comparative need has to be considered (Berglund, 2007). This practice often creates the most controversy for different patients who feel like their need should be given more priority than others. For the practitioner, the burden of considering who among the patients should be prioritized and making such crucial decisions may not always yield the desired outcome (Berglund, 2007). Wuthnow (1993, p. 251). says it best when he points out that justice “focuses less on the happy merging and blending of two individuals, and more on each jealously standing up for the dignity and autonomy of the other”. In any case, regardless of its potentially unpopular effects, hard decisions in relation to justice have to be made, if not for the benefit of all, then for the benefit of those who need it the most. Reading Report 3: Steer, B. (2007) Paramedics, consent and refusal – are we competent? Journal of Primary Emergency Health Care, volume 5, number 1 Paramedics face a major dilemma while caring for their patients. They are in a highly pressured and tense situation with a possibly unconscious or in-pain patient and with relatives who may be too distraught to make the right decisions for their loved ones. The issue of consent is especially crucial and controversial in these cases. More often than not, in the practice, paramedics encounter patients who would refuse care (Steer, 2007). When time is of the essence, the burden of making the right decision for the patient is on the paramedic. However, the paramedic must also consider the fact that the patient indeed has the right to refuse treatment. Even as the purpose of the paramedic is in accordance with his duty to render care to the patient, the ethics of the paramedic practice still dictates that a mentally fit patient is free to make his decision about his care (Steer, 2007). When in doubt, it is also important for paramedics to note that making decisions that are ethically appropriate can sometimes be passed on to the ER doctors and personnel. As medical professionals responding via Ambulance Services, it is still possible to attend to the patient and not violate his autonomy (Steer, 2007). Transporting the patient to the hospital with the patient’s consent may be as far as the ethical coverage may go. The ER doctors can then consult with the patient and try to convince the latter that he needs medical attention (Steer, 2007). In considering the ethical rules, although administering medical care to the patient may indeed be for his benefit and may be in accordance with the principle of justice, paramedics are not in the right position to violate the patient’s autonomy (Steer, 2007). Theirs is a duty of rendering ambulance services – not to force it on patients. Even as patients refuse treatment, it is still possible for ambulance services to assess the patient’s decision-making ability. Through this assessment, a more medical evaluation of the patient’s mental capacity can be used to justify the delivery of care. For coherent and mentally sound patients, their right to autonomy cannot be violated – even if it is justified and beneficial to them. However, for mentally unsound patients, it would be for their benefit and it would be justified to overlook their right to refuse medical attention. In essence, therefore, the delivery of medical care depends largely on sound judgment on the part of the paramedic and on the reliable application of the different ethical principles. Reflective Analysis: Ambulance Services of New South Wales Code of Conduct (Managing Conflicts of Interests In the Code of Conduct, particularly Part 1.2.0, the code specifies about managing conflicts of interests. The code emphasizes that duties must be performed fairly and must not be driven by personal gain (Ambulance Service of NSW Code of Conduct, 2007). Fairness here is very much related to the principle of justice. The principle of justice, as discussed by Beauchamp & Childress (as cited by Masters, 2005) is primarily about distributive justice in the management of scarce resources. In this case, where resources are few, duties must be performed fairly and must rise above self-interest and personal gain. Managing conflicts of interests is also related to the principle of beneficence. The principle of beneficence highlights a person’s duty to do good by others and to maintain the balance between benefits and harms (Daniels, 2004). Once again, by doing good, one’s personal interest and gain cannot be allowed to dominate one’s life. Moreover, situations which give rise to conflicts of interest should also be avoided by the health care practitioner. The principle of non-malfeasance is very much relevant and related to the management of conflicts. Managing conflicts speaks about being unselfish and about setting aside personal gain. Non-malfeasance speaks about avoiding harm or doing no harm to one’s patient (Monagle & Thomasma, 2004). In doing no harm to a patient, the management of conflicts must, at all times, be for the benefit and of the patient. In doing no harm, actual, potential, or perceived conflicts of interest must always be reported to immediate supervisors. The principle of non-malfeasance protects the client from not only current and obvious harm, but also from potential harm (Monagle & Thomasma, 2004). By reporting potential areas of conflict to supervisors, these conflicts can be prevented or resolved immediately as they arise in the healthcare process (Ambulance Service of NSW Code of Conduct, 2007). The code also points out that in case there is a real or potential conflict of interest with another staff member, then such conflict must be reported immediately to the supervisor. In this case, conflicts have to be prevented as much as possible because in the end, the actions and the quality of care of staff members may be affected or compromised by the conflict. Consequently, ‘harm’ may be suffered by the patient as a result of compromised quality of healthcare services (Daniels, 2004). The code also presents details about discrimination, harassment, bullying, and violence (Ambulance Service of NSW Code of Conduct, 2007). The code emphasizes that paramedics should not harass, discriminate, or bully other staff, patients, or members of the public, nor should they encourage staff to harass other people (Ambulance Service of NSW Code of Conduct, 2007). In the basic ethical principle of non-malfeasance, the act of ‘doing no harm,’ supports this portion of the code. Non-malfeasance is about not causing a patient harm and avoiding the risk of harming one’s patient (Heppner, Wampold, & Kivligan, 2007). On further assessing the provisions in relation to harassment and bullying, the beneficence principle also comes out as a supporting principle. Beneficence, as previously mentioned, is about doing good for others and basing one’s actions on what would benefit one’s patient. In this case, harassment and bullying does not benefit one’s patient and the other staff members. It can cause the patient to mistrust the paramedic and the healthcare professionals. It can also cause trauma and can make the patient’s condition worse. In the end, no good or benefit is brought to the patient at all. The principle of justice can also be used to support the code’s prohibition on bullying, harassment, and violence. Justice is about giving people their due (Elkin, 1999). Each person – patients, staff members, and the general public – deserves to be treated with respect, honesty, and care. Bullying and harassing people is not part of justifiable and acceptable behaviour towards patients and the general public; hence is unjustifiable behaviour. Works Cited Ambulance Service of NSW Code of Conduct (2007) Barnes, A. & American Law Institute-American Bar Association Committee on Continuing Profession. (2001) Health care law: desk reference. California: ALI-ABA Berglund, C. (2007) Ethics for Health Care (3rd edition). New York: Oxford University Press. Daniels, R. (2004) Nursing fundamentals: caring & clinical decision making. California: Cengage Learning Elkin, D. (1999) Introduction to clinical psychiatry. New York: McGraw-Hill Publishing Heppner, P., Wampold, B. & Kivligan, D. (2007) Research design in counseling. California: Cengage Learning Kerridge I., Lowe, M., Stewart, C.,(2009) Ethics and law for the health professions. New York: The Federation Press Masters, K. (2005) Role development in professional nursing practice. Pennsylvania: Jones & Bartlett Pennsylvania Monagle, J. & Thomasma, D. (2004) Health Care Ethics: Critical Issues for the 21st Century. Pennsylvania: Jones & Bartlett Sneesby, L. (2008) An Ethical Dilemma: Mine, Yours, or Ours? HNE Handover for Nurses and Midwives. Retrieved 30 August 2010 from http://weblearn.newcastle.edu.au/Resources/Schools/Nursing%20and%20Midwifery/HNE%20Handover/Handover-11-08.pdf#page=23 Steer, B. (2007) Paramedics, consent and refusal – are we competent? Journal of Primary Emergency Health Care, volume 5, number 1 Wuthnow, R. (1998). Poor Richards principle: Recovering the American dream through the moral dimension of work, business, and money. New Jersey: Princeton University Press. Wuthnow, R. (1993). Acts of compassion: Caring for others and helping ourselves. New Jersey: Princeton University Press. Read More