As you may know, the Standards of Practice set out the minimum standards in paramedic services. Each regulated member is required to understand and comply with these Standards, but how does this translate in the day-to-day work of EMRs, PCPs and ACPS?
In an effort to help regulated members understand and apply the Standards to real life situations, we will be sharing scenarios that give context to the Standards and ideas on how to implement this into practice.
The following scenario will attempt to address defining prohibited medical procedures.
1.10 Prohibited Medical Procedures
Paramedic professionals are expected to conduct themselves professionally and ethically while providing the highest quality of care. It is the responsibility of all regulated members to ensure they are performing up to date, legal and ethical medical procedures. A regulated member must not perform or procure illegal medical procedures including, but not limited to, female genital mutilation.
A regulated member has a duty to report as outlined in Standard 1.3 if they believe, on reasonable grounds, that another healthcare provider has performed or procured or is performing or procuring illegal medical procedures including, but not limited to, female genital mutilation.
Scenario:
Bev is an experienced Advanced Care Paramedic (ACP) working in the urban center of Calgary, a city known for its diversity and large immigrant community. Bev has always taken pride in maintaining the highest standards of care and professionalism, and she’s well-respected in the community for her ethical conduct, clinical skills and commitment to patient well-being.
One day, Bev and her partner are called to respond to a home residence. The call comes through as a 20-year-old female patient (named Amina) in acute pain, potentially from a complication following a medical procedure. Upon arriving at the scene, Bev and her partner find Amina in significant pain and distress. Bev’s first priority is to assess the patient’s immediate medical needs. After completing a thorough physical exam, she discovers a healing wound that is highly concerning: it appears to be a recent incision or excision around Amina’s genital area, showing signs of infection and significant swelling. The wound is consistent with a procedure known as female genital mutilation (FGM), a practice that is both illegal and medically dangerous. Amina is now experiencing complications, including severe pain, infection and difficulty urinating, which prompted her to seek medical attention.
Amina is reluctant to speak about the procedure, but with patience and reassurance, she shares a few details with Bev explaining she underwent the procedure a few weeks ago following pressure from someone in her life. The procedure was performed by a family acquaintance who had recently completed medical school. Amina was told the procedure was necessary for her health and well-being and his training in school had prepared him to initiate this surgery.
Bev immediately recognizes the gravity of the situation. Not only is the practice of FGM illegal in many countries, including Canada, but it is also a form of gender-based violence with severe physical and psychological consequences for the patient. As an ACP, Bev is bound by professional ethical standards, and her responsibility is clear: she must ensure Amina receives proper medical care and report this incident to the relevant authorities.
Bev and her partner administer pain relief and initiate appropriate medical treatment for the infection and any immediate threats to Amina’s health. Bev then informs Amina of her options, ensuring she understands that she has the right to seek further legal and medical support. Bev also knows that the next step is a crucial one. According to Standard 1.3 – Duty to Report, she is required by law and ethical standards to report any healthcare provider who has performed or procured an illegal medical procedure, including FGM, if she believes, on reasonable grounds, that it has taken place. This is not just a moral obligation—it’s a legal one.
Bev then initiates immediate action. She contacts the appropriate regulatory body and law enforcement to report the incident. The report is made in strict confidence, and Bev’s primary concern is Amina’s safety and well-being, as well as ensuring that the physician involved is held accountable for their actions. She is careful to document the situation thoroughly, noting Amina’s statement and the medical findings, which she shares with the authorities to support their investigation. While Bev is deeply disturbed by the violation of Amina’s rights and the harm she has suffered, she remains focused on her duty to protect her and others from further harm.
In this example, Bev demonstrates her knowledge and adherence to the Standard 1.8 – Prohibited Medical Procedures, in which paramedic professionals are expected to conduct themselves professionally and ethically while providing the highest quality of care. It is the responsibility of all regulated members to ensure they are performing up to date, legal and ethical medical procedures. A regulated member must not perform or procure illegal medical procedures including, but not limited to, female genital mutilation. In the above case, the acquaintance that performed the illegal procedure of FGM on Amina was in breach of this Standard.
Additionally, the Standard goes on to say that a regulated member has a duty to report as outlined in Standard 1.3 if they believe, on reasonable grounds, that another healthcare provider has performed or procured or is performing or procuring illegal medical procedures including, but not limited to, female genital mutilation. Bev and her partner did a good job of identifying an illegal medical procedure and took the appropriate steps to report their findings while also providing exceptional patient care.