Capacity and Consent: Paramedic Reflection

“A decision made by a person (‘P’) after he has reached 18 and when he has capacity to do so, that if – (a) at a later time and in such circumstances as he may specify, a specified treatment is proposed to be carried out or continued by a person providing health care for him, and (b) at that time he lacks capacity to consent to the carrying out or continuation of the treatment, the specified treatment is not to be carried out or

The plaintiff in Ard v. East Jefferson General Hospital, stated on 20 May, she had rang the nurses station to inform the nursing staff that her husband was experiencing symptoms of nausea, pain, and shortness of breathe. After ringing the call button for several times her spouse received his medication. Mrs. Ard noticed that her husband continued to have difficulty breathing and ringing from side to side, the patient spouse rang the nursing station for approximately an hour and twenty-five minutes until the defendant (Ms. Florscheim) enter the room and initiated a code blue, which Mr. Ard didn’t recover. The expert witness testified that the defendant failed to provide the standard of care concerning the decease and should have read the physician’s progress notes stating patient is high risk upon assessment and observation. The defendant testified she checked on the patient but no documentation was noted. The defendant expert witness disagrees with breech of duty, which upon cross-examination the expert witness agrees with the breech of duty. The district judge, upon judgment, the defendant failed to provide the standard of care (Pozgar, 2012, p. 215-216) and award the plaintiff for damages from $50,000 to $150,000 (Pozgar, 2012, p. 242).

Consent means to provide approval for something to happen or an arrangement to do something.

Mental Capacity Act: The Mental Capacity Act 2005 is an Act of the Parliament of the United Kingdom applying to England and Wales. Its primary purpose is to provide a legal framework for acting and making decisions on behalf of adults who lack the capacity to make particular decisions for themselves.

The main aspects of this act are that a person must be assumed to have capacity unless it is established that he lacks capacity, the person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success, a person is not to be treated as unable to make a decision simply because he makes an unwise decision, an act done or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests and before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's

Moreover, through the Mental Capacity Act (2005), it provides a legal framework for making decisions on behalf of the individual who lack the capacity to make decisions for themselves as long as it does not restrict the rights and freedom of action.

Mental Health Act 1983 to ensure that people that have mental disorders get the care and treatment needed.

Legally and ethically under Informed consent a patient has the right to refuse specialty treatment or referral but needs to be informed about the risks involved with delay or lack of the specific treatment recommended. Mostly, if the patient does agree to visit the specialist then, the specialist is responsible for the informed consent for the specific treatment. But is has been contested and help in courts that the primary care physician still is responsible for the patients welfare in all phases of treatment. For a provider in a busy practice it is difficult to keep track of all the referrals and at times, the specialist’s office has a different outlook on the matter.

2. generally right to decide treatment: Patients generally have the right to decide their treatment however; others measures of treatment should be discussed with the patients. Patients should be competent when deciding to refuse treatment and understand what their options are, however; this should not include physician assisted suicide. Patients do not have to suffer or be in pain, there are many medical options to help the patient through palliative care that will keep them comfortable.

It is also clear that while making these decisions, the decisions ought to be made based on informed consent (Werth and Crow 195). Sometime, the patient may be experiencing dementia, clinical depression or delirium for which they may be affecting the patient’s decision making capabilities (Werth and Crow 197, 198). If such a person is allowed to make their right-to-die decision, this may be done without the patient having comprehensive information before consent and thus should not be encouraged (Werth and Crow 198).

The patient went as far to admit that she currently is having a hard time breathing, but has an appointment with her gynecologist on Monday. This writer advised the patient that if she has difficulties breathing she will need to go to the ER immediately and be medically assessed by Nursing. The patient started crying about she does not want to be medically assessed as she needs to return her boyfriend vehicle so that he can work. This writer informed the patient about the seriousness of her health comes first. This writer called Nursing Chrystal, but no response. Then this writer and the patient went to the Nursing Director office to be medically assessed. According to the Nursing Director, she advised the patient to go to the ER first and will not be dosed today unless she provides proof of documentations of her visit. Again, the patient fussed and then says, " I am fine, it's not serious," however, the patient was advised to follow medical

On august 13, 2016 I was assigned to follow one of the ICU Nurse. It was a very calm day. She had two patient one was more critical than the other. Both patients were on the ventilator because they had to be intubated the night before. The lady is obese and had gastric bypass surgery two years ago and suffering from severe sleep apnea, but the patient is non-compliance to the CPAP treatment. That was her second time being intubated. She was admitted for seizure monitoring because she was constantly having seizures the day before while she was at home. Due to the fact that she did not want to wear her CPAP machine while in the hospital, after pain medication was administered she was found unresponsive, that was the reason for her intubation the night before. Patient was on intermittent suctioning, she has sinus tachycardia . I had the opportunity to observe some of her daily care. The patient was on fentanyl but when the Dr. try to wean her out of the ventilator she stop breathing, therefore, the DR. discontinue the fentanyl temporarily in other to retest her later.

The ethical right for individuals to have access to health care already has a form of legal binding within the United States as seen in the Emergency Medical Treatment and Active Labor Act. “In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), which forbids Medicare-participating hospitals from “dumping” patients out of emergency departments” (Pozgar, 2010, p. 221). The act provides that:

Case :- A 17-year-old female presents to her local hospital 's E.R. at 7:45 in the morning on a school day. She appears apprehensive and uncomfortable. She winces and splints her chest to the right side when she coughs. She is examined by the attending resident.

Joanna is an experienced nurse taking care of Mrs. Kelly, who was Joanna’s patient many times in the past for her primary problem which is COPD. This time Mrs. Kelly was admitted with complaints of abdominal pain what was different from her primary diagnoses. Her vital signs were with normal limits and no significant changes from privies results, but for the nurse she looks sick, and Joanna know that something is wrong. She calls the resident doctor, but he tell her to watches and calls back with series changes. Joanna multiple attempts to report that something needs to be done to evaluate the cause of Mrs. Kelly pain was ask to calm down. However nobody took patient symptoms series and the next day patient died.