References
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.
Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019).
Children are largely understood to be vulnerable and adult patients may also be considered vulnerable. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. Paramedics interact with these patients every day, often during times of such vulnerability.
A major concern in healthcare ethics (including within paramedicine) is the protection of vulnerable persons within the realms of patient-practitioner interactions (Moritz, 2017; Townsend, 2017; Ebbs and Carver, 2019). A patient who is treated by paramedics may be vulnerable because they lack the capacity to consent to treatment or, if they do have the capacity to consent to treatment, they lack the ability (or avenues) to express their worries about that treatment, or to defend themselves in circumstances where their consent has been misinterpreted. This raises the prospect that a patient with legal capacity may still be a vulnerable person, and also that a vulnerable person may be harmed or exploited unintentionally within healthcare settings (Oxford University Hospitals NHS Foundation Trust, 2016; Ebbs and Carver, 2019: 27).
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