Law and ethics may not be the first ‘go to’ book your average paramedic would choose to browse through. In fact, I would predict it would be pretty low down the list—there are no helicopters, no trauma, paediatrics or maternity, and no new clinical skills to learn. My first concern prior to reading this text, as someone who has little to no knowledge of law, is that it would be heavy going and potentially delve into areas that are not paramedic-related or of any interest to a prehospital clinician. I could not have been wider from the mark if I tried. This is the first book review I have completed where I genuinely couldn't put the book down. There is so much information packed into this book that you really need to know as a paramedic. It was this that made me eager to keep consuming the knowledge within. If I could have collected every penny that dropped while reading, I would have been considerably richer by the end!
Despite all the authors being from paramedic and academic worlds—not one lawyer or solicitor in sight—the evidence and case studies presented were relevant and accurate. They were focused on what we experience as paramedics and backed by case law, academic references and real-life application.
The format will be immediately recognisable to anyone that has read a class publishing book before: short concise paragraphs which are sub-headed for clarity, bullet points peppered throughout and an opportunity for the reader to pause and reflect. This format works really well, especially when tackling complex subjects, of which there are many. It allows the reader to work through the topics in manageable bite-size chunks as well as relate it, not just to paramedic practice, but to their own personal experiences.
The book begins with our journey on 5th July 1948 when the NHS was conceived with its three core principles:
I wonder how many clinicians could recall these verbatim? Many ambulance trusts spend considerable time coming up with tag lines, values and branding; however, we wouldn't go far wrong keeping these three elements at the foundation of everything we do. The introduction touches upon clinical governance and the many elements that make this up. We are then given a brief rundown of how the book works; this is quite a handy section if you are using this book to research a particular section of law or ethics.
The history lesson continues in chapter 2 where we are informed that as early as 1775, there was something that resembled an ambulance service in Scotland. There is a wealth of history covered with lots of facts and figures thrown in, such as paramedics becoming the 12th allied health profession with compulsory registration. There are some landmark events referred to such as the serious adverse events at the Mid Staffordshire Hospital and the Francis (2013) Report. This leads nicely into a discussion around professionalism, accountability and regulations. This is approached using a number of cases in law which help bring the issues to life.
In the following chapter, we are encouraged to develop our own ethical standing. This is perfectly placed following the previous discussion around professionalism. The author uses ethical dilemmas to encourage us to determine our own standpoint, we must decide if we push a man in front of a speeding tram to save the lives of others! As you work through the chapter, you start to realise the complexity of ethics, finishing with a relevant case study to consider. We swiftly move on to an overview of British Law. I did wonder how this huge topic could be covered in one chapter and yet still be relevant to the paramedic; however, the author does a sterling job of achieving this. I found this to be one of the most interesting chapters within the book, it clarified so many points for me and provided an overall structure of the legal system.
The same author excels yet again in the following chapter and somehow manages to make information governance an interesting read! There are a number of useful case studies used as examples and paramedic practice is referred to throughout. The author tackles some really useful topics around breaching confidentiality, making disclosures, and what the paramedic should do in certain difficult situations, e.g. can or should we inform the DVLA if we have safety concerns for a patient that has suffered a seizure?
When I started the book, I bet myself that social media would not make an appearance as it is surely too thorny an issue to try to clarify and give guidance on; bet lost as I reach chapter 6 by a different author but with the same level of detail and linking to paramedicine. Although this is a relatively short chapter, we are provided with a very eye-opening example of how combining a number of seemingly innocent ‘Tweets’ can be pieced together to reveal a huge amount of information from an incident.
In chapter 7, the author uses case law to demonstrate how consent has developed over the years and provides some useful tips for practice before moving onto four detailed case studies for discussion. The author defines how to clarify some common broad and often inaccurate statements such as ‘the patient lacks capacity’ or ‘the patient is refusing’.
As a practising paramedic, I approach chapter 8—clinical negligence—with a degree of nervousness. I really like that all of the authors are tackling these subjects head on. It is clear that they are written by experienced paramedics as phrases such as ‘if you didn't write it down, it never happened’ appear within the first paragraph along with a calming assurance that the author aims to ease some of the anxiety surrounding litigation. Although many of the examples of case law do not directly involve prehospital care, the message comes across clearly and is transferable to the paramedic. Following my reading of the final section on criminal negligence, I cannot say that the author has relieved my anxiety related to this topic; however, it has further embedded my desire to ensure I always take the time to provide the right care for the patient.
Without doubt, the next chapter on legislation relating to mental health will be bookmarked for me. It is packed full of useful information related to Mental Health Sections, a place of safety and the Human Rights Act 1988, among other useful nuggets of information and a couple of very informative case studies to close the chapter. The book naturally moves onto the Mental Capacity Act and clarifies when and how this should be used. Again, this should be something that all prehospital clinicians are ‘au fait’ with; however, from my experience, I am aware that this topic still causes confusion and creates extended time on scene with patients while crews try to find a resolution.
The treatment of children is next on the list and we are taken through Gillick competency and Fraser guidelines. Having heard a number of well respected clinicians speak about these topics in the past, I was surprised how wrong they actually were about the background of these subjects and how they can and cannot be applied in practice.
We are then presented with more challenging topics such as fetal rights, mental health in children and organ donation. Finally, the book covers end-of-life care, medicines governance and medical research. As with all the chapters, consideration is given to the nuances between the different countries within Great Britain. No stone is left unturned, from euthanasia to the Nuremberg Code (1947), there are some real difficult subjects covered and constantly related to back to practice.
In summary, my initial thoughts around this book were so wrong. If you are a practising paramedic, you should have access to this book. If you are searching for it at the point you think you need it, then you are too late—you should probably just call your solicitor. You need to know the law and how this affects your practice. I have been trying my hardest not to say it, but it just goes to show—you shouldn't judge a book by its cover!