Paramedics Law and Ethics in Australia - Case Study Example

Paramedics Law and Ethics Student’s Name Institutional Affiliation Paramedics Law and Ethics Paramedics provide the necessary emergency and urgent medical care that involves assessment and treatment in the pre-hospital set up including transportation for further care (Paramedics Australasia, 2012). Paramedics practice in Australia just like Nursing and medical practice is governed by laws and bioethical principle except in the states of Western Australia and Northern Territory (Eburn & Bendall, 2012). Ethical principles have been accepted and incorporated into everyday practice and are been frequently cited as a basis for undertaking moral initiatives in nursing and emergency medical care (EMC) (Johnstone, 2009). Nevertheless, in the course of practicing paramedicine, paramedics may encounter situations that are not very straight forward in terms of the course of action to take regarding the patient as it may be limited by two conflicting ethical principles. Similarly, there exists various Acts that restrict and guide paramedics practice in any given State or jurisdiction with some Acts been specific for certain medical conditions such as Acts governing handling of mentally ill patients. In this essay, the autonomy and beneficence principles of bioethics and the Victoria’s Ambulance Service Act 1986 (ASA 1986) and Medical Treatment Act 1988 (MTA 1988) shall be discussed in regard to the paramedics practice. Ethical Principles There are four primary ethical principles that include beneficence, autonomy, justice and maleficence. Each principle has its significance and implications and they are usually assessed and applied independently at first sight or prima facie in accordance with the situational context (Townsend & Luck, 2013; Brooker & Waugh, 2013). Autonomy Autonomy is an ethical principle that allows rationale patients to make self-determined decisions regarding whether to accept or reject a given form of treatment regardless of whether the decisions made by the patient are in accordance with the suggestions of the paramedic (Azetsop & Rennie, 2010). However, the autonomy conferred to the patient by virtue of this principle should not impinge or result in disrespect of other persons’ moral interests (Beauchamp & Childress, 2009). The patient’s lawful surrogates are also in a position to makes autonomous decisions on behalf of the patient if the latter is unable to do so for any recognizable reason (Beauchamp & Childress, 2009; Chang & Daly, 2012). For the patient to decide knowledgeably regarding to a choice of care, the paramedic is expected to have exhaustively revealed information that the patient has the right to know which include knowledge of the diagnosis and treatment or management measures. Autonomy also requires that the paramedic gets informed consent concerning any form of treatment to be administered before proceeding to administer it, ensuring privacy and confidentiality as it is deserved by the patient, enabling and supporting the patient's choices and accepting patient choices that are against the paramedic's suggestion (Butt & Rich, 2013). Granting a patient autonomy requires that the patient be sentient and of sound mind at the time of decision making and the choice made should be unambiguously competent, valid without having been coerced by someone else (Willmott, 2007; Beauchamp & Childress, 2009). These elements are significant when patients make decisions regarding “Not For Resuscitation [NFR]” orders and other advanced directives that are significant and binding legal tools in informing resuscitation decisions in EMS (Yuen, Reid & Fetters, 2011). In such cases, even if the paramedic deems it helpful and possibly life-saving to resuscitate a patient, if a DNR order exist it is preferable to respect the patient’s autonomy and not to do so to avoid the legal consequences as stipulated in the Common Law (Willmott, 2007). Most States in Australia have modified the requirements for validity or applicability of advanced directives adding more restrictive limitations compared to those in the Common Law. This is out of the State’s will to support life through their respective health ministries. For instance, Victoria has an additional limitation to advanced directives that a patient must be already suffering from a given condition before completing a certificate directing refusal of s specific form of treatment (Willmott, 2007). This unlike in common law that only requires patients to be competent, and be under no undue influence. Therefore, paramedics should be aware of the specific requirements of admissibility of an advanced directive for the particular state they offer EMS services Beneficence This is a principle that obligates the paramedic to act or omit to act for the sole purpose of sustaining the well-being or benefit the recipient of EMS care (Chang & Daly, 2012). Paramedics should, therefore, perform their duties in the best interest of the patient and contribute to achievement if these interests. Beneficence necessitates the exercise of virtuous acts such as compassion, empathy, sympathy, kindness, care, mercy, love, charity, altruism and friendship (Johnstone, 2009). In exercising this principle, the paramedic may encounter situations where prioritizing the principle comes at the expense of the benefactor or the patient. Other moral aspects may, therefore, limit the applicability of this principle. For instance, if the moral interests of the benefactor might be in potential danger or risk been harmed in implementing virtuous acts of beneficence, the paramedic would not be required to proceed with the acts (Beauchamp & Childress, 2009). Beneficence is deemed to be applicable when there is an ‘obligation of beneficence’ (Beauchamp & Childress, 2009). Although the latter’s applicability has been critiqued, it is said to exist with the satisfaction of the following requirements: (1) if the patient is at risk of considerable damage to health or life, (2) the paramedics’ action is necessary to hinder the damage, (3) the paramedic’s action have a high probability of forestalling the damage, (4) the paramedics’ action would not magnify the burden, risks and cost facing the patient, and (5) that the anticipated benefits to the patient from the action are more than the demerits the paramedics may incur (Beauchamp & Childress, 2009). In emergency situations, beneficence guides most actions of paramedics. However, it is paramount also to consider the patient's autonomy. In a case of a cardiac arrest patient who may benefit from resuscitation, CPR may be instituted if the paramedic confirms the non-existence of a DNR from the immediate guardians of the patient (Willmott, 2007). Legal Principles Paramedics practicing in various jurisdictions in Australia are required to practice in accordance with the various Acts or regulations governing or affiliated with their practice. The ambulance service Acts include ASA of Queensland, Tasmania and Victoria, NSW's Health Services Act 1997, South Australia’s Health Care Act 2008, and ACT’s Emergencies Act 2004 (Eburn & Bendall, 2012). Victoria’s ASA 1986 and MTA 1988 will be discussed as examples of legislations paramedics should understand. Ambulance Services Act 1986 (Vic) Provision of emergency pre-hospital medical services is done by units defined as ambulance service. This Act aims to restructure, provide ambulance service related education and training, and to make ambulance service related general provision (Ambulance Services Act 1986, s. 1). According to Section 15 of the Act, paramedics, who are defined as ‘operational staff members’ in the Act, are expected to exhibit rapid response when requested to attend to medical emergency, to provide specialized medical and transport services to sustain life and curtail injuries, and to promote first aid education among the public. In the Act, the secretary who is defined as the head of the health department has major administrative and managerial responsibilities. According to Section 9, the Secretary may advise the minister on how the Act operates, establish ambulance service policies and plans, fund, monitor, review and evaluate the services, facilitate education and training of ambulance staff, enhance safety and quality in the provision of ambulance services. The Secretary may determine the specific roles of paramedics including what to do and avoid doing in the course of their service provision (Ambulance Services Act 1986, s. 10). The number of paramedics to be employed, and the conditions of their employment may also be directed by the Secretary. Even though the type of patients paramedics are expected to attend to are known courtesy of their education and training, the Secretary may specify this category and number of patients to receive ambulance services. Paramedics are also expected to facilitate transport and referral to appropriate hospitals and health centers in the communities and other health service established as per the Health Services Act 1988 (Ambulance Services Act 1986, s. 10). The ambulance services may charge some fee as may be directed by the Secretary. It is a requirement that a paramedic serving in Victoria's ambulance service abide by the directions of the Secretary. An ambulance service shall be directed by a board of director that will facilitate the achievement of ambulance service objectives, develop priorities for an ambulance service, establish financial plans and ensure accountability of ambulance service, monitor and evaluate the latter’s performance, provide a code of conduct for the ambulance service staff, to establish the structure of the service, facilitate education and research affiliated with the service, and to act as a link between the service and the secretary (Ambulance Service Act 1986, s. 18). This Section is important to paramedics as it implies that by working in Victoria as a paramedic, one has to be a staff of an ambulance service directed by a board. The various ambulance service that a paramedic may be part of while practicing in Australia are highlighted in the Act's Schedule 1 and include over 15 ambulance service. In the course of service of provision, a paramedic may request a police officer to remove individuals who may be or are likely to interfere with the provision of emergency service by their presence (Ambulance Service Act 1986, s. 39AB). The ASA of most States are substantially similar although differences may exist such as the NSW Ambulance Service Acts 1990 that has more details such as in Section 26 where ambulance service employees are excluded from certain liabilities such as any harm or injury caused when carrying out their specified responsibilities in good faith. Therefore, understanding of specific State ASA is paramount for paramedics practicing in a given jurisdiction. Medical Treatment Act 1988 This is a salient Act for paramedics practicing in Victoria in relation to patients refusing treatment including the issuance of a “‘refusal of treatment certificate [RTC]” and the admissibility of a decision made by a patient's representative for a patient not competent to make such a decision (Medical Treatment Act 1988, s. 1). The right to refuse treatment conferred by this Act to patients is in support of the ethical principle of autonomy and the requirement before allowing a patient to make such an autonomous decision. Patients must be knowledgeable regarding what a given treatment entails and the consequences of both receiving and refusing the treatment to allow their decision be informed. The refusal is documented in writing by the paramedic and one other witness. With a documented refusal, the paramedic cannot provide any medical treatment services as the power of patient autonomy and its protection under this Act prohibits and limits the paramedic (Steer, 2012). The provisions of this Act regarding refusal of treatment are sometimes preceded by some provisions of the Mental Health Act 1986 that allows the paramedic to ignore the refusal and out of beneficence, proceed to manage the patient. This applies in cases where the mentally ill patient is assessed and confirmed to be significantly distorted in thought, mood, memory, and perception, and may harm self or others (Steer, 2012; Townsend & Luck, 2012). Another instance where the MTA may not be applied is where a parent or guardian refuse emergency management of a minor since the parent would be acting against the best interest of the child as provided for in Law (Steer, 2012). Conclusion Paramedics should always practice in accordance with the Acts and regulations guiding and related to their practice and also in accordance with bioethical principles. The various States have laws governing paramedicine practice that should be respected to facilitate a successful practice. Actions taken when in their course of practice should be informed by their training, bioethical principles and the relevant Statutes. References Ambulance Service Act 1986. Retrieved from http://www.austlii.edu.au/au/legis/vic/consol_act/asa1986176/ Azetsop, J. & Rennie, S. (2010). Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health. Ethics and Humanities in Medicine, 5(1), 1-10. Beauchamp, T.L. & Childress, J.F. (2009). Principles of biomedical ethics (6th ed.). New York, NY: Oxford University Press. Brooker, C. & Waugh, A. (2013). Foundations of nursing practice: Fundamentals of holistic care (2nd ed.). Maryland Heights, MO: Mosby Elsevier. Butts, J.B. & Rich, K.L. (2013). Nursing Ethics: Across the curriculum and into practice. Burlington, MA: Jones & Barlett Learning. Chang, E. & Faly, J. (2012). Transitions in nursing: Preparing for professional practice. Chatswood, NSW: Jones & Barlett Learning. Eburn, M. & Bendall, J. (2012). The provision of ambulance services in Australia: A legal argument for the national registration of paramedics. Australasian Journal of Paramedicine, 8(4), 1-9. Johnstone, M. (2009). Bioethics: A nursing perspective (5th ed.). Chatswood, NSW: Churchill Livingstone. Willmott, L. (2007). Advance directives to withhold life-sustaining medical treatment: eroding autonomy through statutory reform. Flinders Journal of Law Reform, 10(2), 287-314. Medical Treatment Act 1980. Retrieved from http://www.austlii.edu.au/au/legis/vic/consol_act/mta1988168/ Paramedics Australasia. (2012). Paramedics role descrption. Retrieved from http://www.paramedics.org/content/2009/07/PRD_211212_WEBONLY.pdf Steer, B. (2012). Paramedics, consent and refusal- are we competent? Australasian Journal of Paramedicine, 5(1), 1-9. Townsend, R. & Luck, M. (2012). Protective jurisdiction, patient autonomy and paramedics: the challenges of applying the NSW Mental Health Act. Australian Journal of Paramedicine, 7(4), 1-11. Townsend, R. & Luck, M. (2013). Applied paramedic law and ethics. Chatswood, NSW: Churchill Livingstone. Yuen, J.K., Reid, M.C. & Fetters, M.D. (2011). Hospital Do-Not-Resuscitate orders: Why they have failed and how to fix them. Journal of General Internal Medicine, 26(7), 791-797. Read More