Paramedic ethics, capacity and the treatment of vulnerable patients

Abstract

Vulnerable patients are at an increased risk of harm or exploitation in healthcare. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability.

A qualitative exploration of the perceptions of professional registration by Australian paramedics during the transition into professional regulation

“…The PBA shares regulatory functions with the Australian Health Practitioner Regulation Agency (AHPRA) and, in some cases, co-regulatory arrangements with state-level agencies. 16 The self-regulatory element makes the profession itself responsible for its conduct and activities (delineating it from other forms of regulation such as licencing). Thus, the profession has a direct stake in its social contract with the community and has control over how it discharges its role within the social contract.…”

An exploration of perceptions and experiences of Australian paramedics following the introduction of professional regulation

“…Regulation is a key mechanism in providing checks on professional power and ensuring the safety of the community. Regulation helps ensure uniform standards of practice and that paramedics meet responsibilities in their social contract with the communities they serve (Irvine, 2016;Moritz, 2019;Reed, 2022). Likewise, self-regulatory frameworks have a role in establishing the community mandate of a profession to control their work and are thus linked to the professionalisation of the discipline (Brydges et al, 2022).…”

“…Likewise, self-regulatory frameworks have a role in establishing the community mandate of a profession to control their work and are thus linked to the professionalisation of the discipline (Brydges et al, 2022). The decision to include paramedics in Australia was made in 2015 by the Council of Australian Governments Health Council following a decade of lobbying by the profession and a significant risk assessment (Moritz, 2019). The risk assessment conducted by the regulator recognised a range of challenges with paramedicine.…”

“…The need for regulation reflects the increased independence and scope of paramedics as health practitioners. From origins as basic first aiders with a mandate to transport the sick and injured to hospital, paramedics have evolved to a well-educated and autonomous group of clinicians (Newton et al ., 2020; Moritz, 2018; Brydges et al ., 2022; McCann, 2022). This highlights the continuous evolution of paramedics to meet the needs of the communities they serve, including the prevalence of complex and chronic health and social conditions (Makrides et al ., 2021; Cockrell et al ., 2019).…”

Undergraduate Ethics Education in Paramedicine in Australia

“…Diversity is not only experienced through their clinical caseload, but also across cultural contexts and in geographically disparate settings, from metropolitan locations through to regional and remote sites (Hartley, 2012 ; O'Meara & Duthie, 2018 ). The cases attended by paramedics can present a range of ethical dilemmas, including but not limited to refusal of service, the protection of vulnerable persons, resuscitation decisions, and challenges involving advance care directives (Adams et al, 1992 ; Heilicser et al, 1996 ; Moore, 2020 ; Moritz et al, 2020 ; Nordby & Nøhr, 2012 ; Shearer et al, 2021 ). In the past, paramedics have articulated the need for improved ethics education to assist them in dealing with the ethical problems faced (Heilicser et al, 1996 , p. 242).…”