PARA707 Intermediate Life Support – Written Assignment

Semester 1, 2023

[Legal and Ethical Values Underpinning Prehospital Care]

[Joseph Lee 21143414]
[Word Count 1153]

This assessment has been produced by me (or our group) and represents my own (or our own) work.
Any work of another person is appropriately acknowledged and/or referenced.
This work did not involve any unauthorised collaboration.
This work has not previously been submitted by me or any other person/author, unless authorised.
I did not use any other unfair means to complete this work.
I/we understand that the above obligations form a part of the University’s regulations and that breaching them may
result in disciplinary action.

Signature Joseph Lee……………………………… Date 02/05/2024……………………

Enduring Power of Attorney (EPOA):

The son claims to be the Enduring Power of Attorney (EPOA) for the patient. In New
Zealand, an EPOA is a legal document that allows a person to appoint someone to make
decisions on their behalf, including medical decisions, if they become incapacitated. The
EPOA's authority is typically activated when the person is unable to make decisions
themselves.

Older people can become increasingly vulnerable to abuse as they age and lose their
capacity to make decisions. There are no statutory definitions of capacity in regards to the
consent of treatments, the underlying definitions come from case law (Diesfeld & McIntosh,
2014). The inability to give informed consent exists when a person is unable to understand,
comprehend, and articulate the potential treatment and consequences (Re M B (Medical
Treatment)[1997]). The Protection of Personal and Property Rights Act 1988 [PPPRA] was
formed to allow adults who may have or potentially will have incapacity guardians to make
healthcare decisions. To protect a person when the potential for incapacity increases, an
Enduring Power of Attorney [EPOA] can be appointed to those the person trusts most (Office
for Seniors, n.d.). There is often confusion around the EPOA, it is common for those granted
EPOA to think they have control straight away or when the person becomes immediately
incapacitated (Human Rights Commission, 2018). However, an EPOA only comes into effect
when a person is deemed incapable by the Courts or a health practitioner (Diesfeld &
McIntosh, 2014). Until incompetence is determined under PPPRA s 98 (3), the EPOA has no
authority regarding the person's healthcare. The AI’s claims, concerning legislation, are all
correct. Although in this case, it is undeterminable if the son’s EPOA has been activated or if
the patient is normally incapable. In cases where an unconscious patient needs a healthcare
decision made in emergent situations, Right 7(4) of the Code of Health and Disability
Services Consumers’ Rights describes reasonable steps to ascertain the views of the patient.
The son cannot give consent, but information provided via him can determine what is in the
best interest of the patient.
Best interest of the patient:

The legal framework in New Zealand emphasizes decisions that are in the best interests of
the patient. Healthcare providers must carefully consider the patient's medical history,
prognosis, and the likelihood of successful resuscitation.

The “best interests” of a patient are not adequately described within New Zealand (NZ)
legislation and common law. The PPPRA and CHDSCR do provide areas for health
practitioners to navigate decisions around best interest (The Law Foundation, n.d.). There
are often concerns about stopping life-prolonging treatment among healthcare
professionals. Under the Crimes Act 1961, s 151 identifies a legal duty of care, s 160(2)(b)
establishes that a homicide will be culpable when that legal duty of care is neglected
without a lawful excuse to do so. As outlined in s 150A(2), criminal responsibility requires
evidence of poor medical practices. The courts summarised in Shortland v Northland Ltd
[1998] that good medical practice relies on a decision being in good faith and conforming to
current prevailing medical standards. The courts can decide that an action may have been in
the patient's best interest, but practitioners are safe from responsibility if they have a good
faith belief (Diesfeld & McIntosh, 2014). The PPPRA has no clear concept of what “best
interests” are, but when an EPOA is appointed the best interests of a person become the
ultimate consideration in making healthcare decisions described in s 18(3) of the PPPRA. The
courts use this principle to balance the weight of the intervention required. The legal
justification for giving treatment, where consent for or against is unable to be found, is
provided under Right 7(4) of the CHDSCR. Healthcare providers must take certain steps to
inform themselves of the patient's best interests, even if that means discontinuing
treatment when evidence that goes against the patient's best interest is found (Diesfeld &
McIntosh, 2014. Meaning starting a resuscitation is lawful and it is not unlawful
to discontinue if it is in accord with “good medical practice”. The AI is correct that the legal
framework in NZ emphasises a patient “best interest” with careful considerations for “good
medical practice”, however, there is uncertainty in what best interest means.
Communication and Shared Decision-Making:

Open communication with the patient's representative is crucial. Healthcare providers

should engage in shared decision-making, ensuring that the son is informed about the
prognosis and the reasons behind the assessment of futility.

Terminating a resuscitation is a challenging process for paramedics to navigate. Making

these life-changing decisions requires a paramedic to shift the focus of care from the patient
to those around them as research suggests that family grief can be exacerbated by
experiences with paramedics (Fallat et al., 2018). Initial communication with family is usually
focused on obtaining information optimal for patient care (Risson et al., 2023). Limited
information about a patient's circumstances can be a barrier to confident decision-making
where the needs of the patient are prioritised (Anderson et al., 2021). Managing
a difficult scene and communicating empathetically with those around is cognitively
demanding. To effectively engage in communication during this period is often concise,
direct, and confrontational (Risson et al., 2023). Paramedics are adapted to resuscitation
environments and often forget that this can be a terrifying moment for families and
bystanders. When the resuscitation indicates futility the needs of the family now become
the priority (Risson et al., 2023). Breaking the bad news is difficult and can become highly
emotional for both paramedic and family (Fallat et al., 2018). Clear communication and
honesty can ensure that families do not mistake what is happening around them. Principle
1.4 of the Paramedic Council Code of Conduct (n.d) describes partnership with family.
Including the son in the decision-making process can minimise psychological trauma, by not
diminishing the son’s CPR attempt and explaining the reasoning behind the futility of the
situation. The task of resuscitation decision-making requires a specific set of skills, often not
acquired during education. Student needs to witness conversations to help shape their
communication styles to mitigate emotional damage (Anderson et al., 2021).
Cultural and Family Considerations:

Cultural and family considerations are important ethical factors. Healthcare providers
should be sensitive to the son's perspective and cultural beliefs while still adhering to
medical standards

New Zealand is a diverse multicultural country, and this can be a challenge for paramedics to
ensure adequate care for both patients and families. Due to the variety of cultures, religions,
and beliefs, paramedics are unable to fully comprehend and appreciate what death and the
process of death mean to others (Hartley, 2012). Studies from family experiences show that
paramedics are assumptive and often fail to meet the cultural expectations of the
family (Hartley, 2012). Culturally safe care is a set standard by the Paramedic Council,
being culturally safe is important for family-centred care. Individualising the patient and
family expectations can reduce the harm paramedics have on others. A study found that
families want to option to be present during resuscitations, they found that a family member
wants to support the patient both physically and spiritually (Satchel et al., 2023). Cultural
barriers and the inability to recognise the emotions a family were going through led to the
transportation of patients, even when the resuscitation seemed futile, to avoid facing the
family (Milling et al. 2023). Stefan et al. (2016) found that some family members want to
establish a link during resuscitation so that they can be with them beyond death. By being
culturally aware and allowing families to actively participate and communicate their cultural
wishes, the misunderstanding and ignorance of these beliefs can be reduced (Hartley, 2012).
The consequence of leaving harmful impressions that result in poor paramedic/patient
relationships breaches Principle 8 of the Paramedic Code of Conduct to maintain public trust
and confidence. Healthcare providers should be sensitive when communicating their
perspectives and should facilitate trust that the families around them can do the same.
Reference List

Anderson, N., Slark, J., & Gott, M. (2021). Prehospital Resuscitation Decision Making: A
model of ambulance personnel experiences, preparation and support. Emergency
Medicine Australasia, 33(4), 697–702. https://doi.org/10.1111/1742-6723.13715

Diesfeld, K., & McIntosh, I. (2014). Elder Law in New Zealand. Thomson Reuters New
Zealand Ltd.

Fallat, M. E., Barbee, A. P., Forest, R., McClure, M., Henry, K., & Cunningham, M. R. (2018).
Perceptions by families of emergency medical service interventions during imminent
pediatric Out-of-Hospital death. Prehospital Emergency Care, 23(2), 241–
248. https://doi.org/10.1080/10903127.2018.1495283

Hartley, P. (2012). Paramedic Practice and the Cultural and Religious Needs of Pre‐Hospital
Patients in Victoria. https://vuir.vu.edu.au/21301/1/Peter_Ross_Hartley.pdf

Health and Disability Commissioner (Code of Health and Disability Services Consumers’
Rights) Regulations 1996

Human Rights Commission. (2018, June). This is not my home. APO. Retrieved May 1, 2024,
from https://apo.org.au/sites/default/files/resource-files/2018-08/apo-
nid188336.pdf

Office for Seniors. (n.d.). Creating an Enduring Power of Attorney. Retrieved May 1, 2024,
from https://officeforseniors.govt.nz/our-work/promoting-enduring-power-of-
attorney/how-to-create-an-enduring-power-of-attorney/

Protection of Personal and Property Rights Act 1988

Re M B (Medical Treatment)[1997]

Risson, H., Beovich, B., & Bowles, K. (2023). Paramedic interactions with significant others
during and after resuscitation and death of a patient. Australasian Emergency
Care, 26(2), 113–118. https://doi.org/10.1016/j.auec.2022.08.007
Satchell, E., Carey, M., Dicker, B., Drake, H., Gott, M., Moeke‐Maxwell, T., & Anderson, N.
(2023). Family & bystander experiences of emergency ambulance services care: a
scoping review. BMC Emergency Medicine, 23(1). https://doi.org/10.1186/s12873-
023-00829-3

Shortland v Northalnd Health Ltd [19988] 1 NZLR 433 (CA)

Te Kaunihera Manapou Paramedic Council. (n.d.). Code of Conduct.

https://www.paramediccouncil.org.nz/common/Uploaded%20files/Standards/
220422%20Code%20of%20Conduct%20A5%20Spread%20-%20Website.pdf

The Law Foundation. (n.d.). 5A: Best interest in New Zealand Law. Retrieved May 1, 2024,
from http://www.barristerschambers.co.nz/mcap/5_A.html