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The Role of Law in the Professionalisation of Paramedicine

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The Role of Law in the Professionalisation of Paramedicine The Role of Law in the Professionalisation of Paramedicine in Australia Ruth Townsend LLB LLM A thesis submitted for the degree of Doctor of Philosophy of The Australian National University © Copyright by Ruth Townsend December 2017 All Rights Reserved ii Statement of Originality I certify that the thesis entitled, ‘The Role of the Law in the Professionalisation of Paramedicine in Australia,’ submitted for the degree of Doctor of Philosophy at the Australian National University is my own original work. Where reference is made to the work of others, due acknowledgement is given. I also certify that the material in this thesis has not previously been submitted for a degree or diploma at any university. Name: Ruth Townsend Signature: Date: December 2017 iii Acknowledgements I would not have been able to even think about undertaking this project if it wasn’t for the encouragement and support of some very special people. Thank you to my mum for giving me the gift of reading that has led to a lifelong love of learning, fostered my creativity and imagination, and allowed me to feel a sense of success and self-confidence in my abilities. Thanks dad for instilling in my a sense of social justice that has sparked a passion to try and make the world a better place even if it is in just a very small way. Thank you to my supervisors, Professor Tom Faunce, Associate Professor Michael Eburn, with whom I have worked closely on paramedic law matters for many years, and panel member Dr Dominique Dalla Pozza who have all offered me enormous support and shared their very limited and precious time, and great wisdom and intelligence with me so generously. Thank you Adjunct Associate Professor Ray Bange and Professor Peter O’Meara for our discussions on and your critical contributions to the professional development of paramedicine in Australia. This thesis has been edited by Elite Editing in accordance with the Australian standards for editing practice. A PhD project takes years of time and effort for not only the writer, but the support team that feeds, hugs, kisses, encourages and believes in the writer. Sharon Kenna provided me with a room and food and hugs and movies and massages and cups of tea on my many visits to Canberra. I can’t tell you how critical your friendship was in getting me through this. Thank you also to John Gaffey and Helen Masterman-Smith for your great sociological wisdom and ‘surviving-a-PhD advice’; Bruce Arnold, Wendy Bonython and Leigh Haywood for legal insights; and Courtney, John, Rach, Meg, Chris and Bron for the many cups of tea, PhD meltdowns and debriefs, support, encouragement, friendship and laughs. iv I am—literally—neither physically nor mentally the woman I was when I began this project; but with the support of my GP, Dr Jane Lawrence, I was able to survive a year of cancer treatment and then resume and complete this project. The experience made me appreciate all the more the excellent healthcare we have in Australia. Getting through this would have been simply impossible without the love and support of the three most important people in my world: Andrew, Tom and Will. Andrew, without you, this thesis would not exist, and it is not an exaggeration to say that without your support I am not sure that I would exist. Thank you so much for 20 years of friendship and love. To Tom and Will; you little gorgeouseses. You are my world. I am so proud of the boys you are and the men you are becoming. Thank you for all the support you have given to help me complete this project, which has been in the making for what is essentially the length of your entire lives. I am so sorry that this project has taken away precious time that we should have spent together, time that we will never get back. The best part of finishing this project of course is having more time to spend with you but I also wanted to finish—in spite of all that we have been through—so that I can show you that when life knocks you down it is possible to get back up again and keep going. I love you. v Abstract The paramedic discipline has developed over time from its humble beginnings as stretcher bearers and ‘drivers’ to now carrying out high-risk, highly skilled, life-saving interventions. Paramedics in Australia have not traditionally been regulated in the same way as other comparable health practitioners, despite performing similar tasks and playing a unique and essential role in healthcare delivery however they have undertaken a concerted campaign over the past 10 years to change their professional status and have looked to the law to facilitate that transition. This change is now underway. Despite the ambition of the paramedic discipline to be regulated as professionals, there has been relatively little analysis or discussion in the paramedic literature of the effect the discipline believes regulation as a profession will have on shaping the discipline in the future. This study examines how structural and legislative reform of the Australian healthcare workforce has coincided with the Australian paramedic professionalisation project to provide an opportunity for paramedics to gain professional status. It further analyses what the role of law could be in fostering a culture and ethos of professionalism in the discipline. This socio-legal study investigates whether or not paramedics have the characteristics of a profession; how best the law can facilitate their transition to professional status; and why that matters. The analysis utilises a sociological framework informed by the work of sociologist Eliot Freidson in particular to define what a profession is and establish whether paramedicine is a profession according to common criteria. It will map those criteria against the primary piece of Australian legislation that regulates health professionals in Australia, the Health Practitioner Regulation National Law Act 2009 (Qld). The study uses the same analytical framework to compare the Australian legislation to similar legislation in the United Kingdom (UK) where paramedics have been regulated as professionals for over a decade. The study analyses the implications of any significant differences between the two regulatory schemes for the UK and Australian paramedic professionalisation projects. vi Table of Contents Statement of Originality ................................................................................................ iii Acknowledgements ......................................................................................................... iv Abstract ........................................................................................................................... vi Table of Contents .......................................................................................................... vii Table of Abbreviations ................................................................................................... x Preface ........................................................................................................................... xiii Why Should Paramedics be Regulated as Professionals? ........................ 1 1.1 Introduction ............................................................................................................. 1 1.2 The Problem ............................................................................................................ 2 1.3 Aims and Scope of the Research ............................................................................. 6 1.4 Overview of the Study ............................................................................................. 8 Part I—Paramedicine as a Profession ......................................................................... 12 What is a Profession? ................................................................................ 12 2.1 The Role of the Professions ................................................................................... 13 2.2 Theories of Professions ......................................................................................... 21 2.2.1 Flexner and the Typology of a Profession ...................................................... 21 2.2.2 Parsons, the Professions and the Importance of Altruism .............................. 23 2.2.3 The Professional Continuum .......................................................................... 24 2.2.4 The Process of Professionalising .................................................................... 26 2.2.5 Freidson and Self-regulation ........................................................................... 27 2.2.6 Larson, Knowledge and Self-interest ............................................................. 30 2.2.7 Professional Power and the Law ..................................................................... 33 2.2.8 Freidson and Professionalism as Occupational Control ................................. 36 2.3 The Benefits of Professionalism as a Form of Occupational Regulation .............. 37 2.4 The Elements Common to a Profession ................................................................ 39 The Evolution of Paramedicine ................................................................ 44 3.1 The Development of a Unique Role and a Significant Public Service ................. 44 3.1.1 New Technology and Paramedic Role Development ..................................... 47 3.1.2 Recognition of the Need for Professionalism ................................................. 50 3.2 Industrialisation and Professionalisation ..............................................................
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