Legal And Ethical Implications Paramedicine

Assessment 1 – Written Assignment: Part A
In paramedicine, it is essential to understand the elements of law in order to provide the highest standard of care and assistance. This essay will discuss the concept of consent in paramedicine and the legal and ethical implications that are involved in treating a patient.
As a paramedic, before treating or transporting a patient, informed consent needs to be obtained. The term consent means to give assent, permission, agreement or to approve (Steer, 2007). When deciding on the validity of consent, some key points have to be examined. Firstly, the patient must be competent, meaning they have sufficient decision making capacity. If the patient is competent, full disclosure of all information regarding
the proposed treatment must be made and fully understood by the patient (LawTeacher, 2013). Secondly, consent is only valid if the patient gave consent by their own free will, without coercion, pressure or influence from others, therefore making consent voluntary (LawTeacher, 2013). Finally a paramedic has to gain consent from the patient either verbally, in writing or implied by way of conduct such as extending an arm for cannula insertion (LawTeacher, 2013).
If a paramedic acts against the patient’s wishes and provides treatment or transportation without their consent, they can be liable for assault and battery (LawTeacher, 2013). Under common law, paramedics are covered meaning in certain cases, when consent is deemed unnecessary as long as paramedics are acting in the best interests of a patient (such as providing CPR) they are protected from any legal ramifications.
Looking at Appendix 1 Case 1 consent can be analysed. In this case, the first crew acknowledge the patient’s right to refuse treatment. What can be assessed in this case though is whether the patient could legally withhold consent. The patient saying she did not want to go to hospital proved she verbally gave refusal. In terms of her refusal being voluntary, there is no evidence to suggest she was coerced in her decision, as she refused any further assessment. Lastly, there is no evidence that the ambulance crew checked for competency. As they were provided with the patients history of Type 1 diabetes, this should have been enough to provoke a feeling that the patient may have lacked sufficient decision making capacity.
The ambulance crew should have asked the woman when she had last had an insulin injection and assessed the woman for Type 1 diabetes symptoms.
By assessing for symptom’s they would have realised why the patient was feeling lethargic, kept her eyes closed and was irritable as they all appear as Type 1 diabetes symptom’s. Since the ambulance crew failed to examine the necessary key elements for consent, the patient’s refusal of consent was invalid. As a result in the absence of capacity, the default position by the first ambulance crew should have been one of treatment or transport rather than leaving the patient at her house (Steer, 2007). This may result in the ambulance crew being liable for abandonment for their improper termination of care.
Therefore it is important for paramedics to understand the elements of consent and the legal ramifications that follow, because if the proper steps for consent had been taken, the patient would have received treatment earlier, possibly not ending up in the emergency department and a second ambulance crew would not have been called to deal with a critically ill
patient.

Appendix 1

Case 1
A crew has been called by a relative to an elderly emaciated woman with a history of Type 1 diabetes. She presents as lethargic, too weak to sit up in bed, cool skin and is somewhat irritable. She is resistant to a full vital signs examination and repeatedly says she does not want to go to hospital, has a GCS of 13, though at no time does she open her eyes to respond to questions. The crew decides to leave her at home as she has refused assessment. A short time later a second ambulance crew is called. They are more assertive and find the patient to be significantly hypotensive and with a blood sugar too high to be recorded. They carry her to their stretcher and find she is restless and somewhat oppositional, but quite manageable. In ED she is found to have a pH of 6.9 and a blood sugar of 60 m/mol/L. Soon after she is transferred to intensive care, critically ill with ketoacidosis.
(Steer, 2007)

References
Clarke, V., Harris, G., & Cowland, S.
(2012 ). Ethics and law for the paramedic. In A. Blaber, Foundations for Paramedic Practice (p. 10). Milton Keynes: OPEN UNIVERSITY PRESS.
LawTeacher. (2013, November). Analyse Legal And Ethical Issues Facing Paramedics. Retrieved from Law Teacher : http://www.lawteacher.net/free-law-essays/medical-law/analyse-legal-and-ethical-issues-facing-paramedics-medical-law-essay.php
Levine, R. J. (1980). The Senate's Proposed Statutory Definition of 'Voluntary and Informed Consent'. In IRB: Ethics and Human Research (pp. 8-10). The Hastings Center.
M.Eburn. (2013, April 03). Alcohol and refusing treatment. Retrieved from Australian Emergency Law: https://emergencylaw.wordpress.com/2014/04/03/alcohol-and-refusing-treatment/
Steer, B. (2007). Paramedics, consent and refusal – are we competent? Australasian Journal of Paramedicine , 1.
Townsend, R., & Luck, M. (2013). Applied Paramedic Law and Ethics. Chatswood: Melinda
McEvoy.