The specialised nature of paramedics’ knowledge and skills, and their unique role, has provided them with the power to not only improve their pay and working conditions509 (as outlined in Chapter 3), but also to organise and lobby to be included in the NRAS and be
506 Australian Qualifications Framework Council, Australian Qualifications Framework (2nd ed, January
2013), pp. 12-13
507 NSW Health, Submission to Senate Legal and Constitutional Affairs Committee, Parliament of
Australia, The Establishment of a National Registration System for Australian Paramedics to Improve and
Ensure Patient and Community Safety, 2016
<https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/P aramedics/Submissions>
508 Ibid 84.
509Transport Workers Union v Department of Justice and Community Safety (unreported Determination,
Fair Work Australia, Commissioner Deegan, 29 March 2010) <http://www.fairgo.com/docs/FWA2010decision.pdf>.
regulated by the National Law510 (see Chapter 4). Being regulated by the National Law is evidence that paramedics have demonstrated via a number of routes that they are a group that do hold moral and technical authority as a result of their specialised knowledge and skills and unique role, and should therefore be granted the power to self-regulate. Freidson noted that the power to self-regulate is awarded to those occupations that can demonstrate that their specialised knowledge and skill is of such special value that it is important for the ‘well-being of individuals or of society at large’.511That technical and moral authority is a power that can and is used by the professions to lobby for their own interests, but can also be a power used for and against their patient’s interests. The practice of professionalism seeks to mitigate against the latter concern.
Paramedics’ specialised knowledge and the nature of paramedic work is such that patients are not able to always understand it or accurately assess it. This, in itself is a power because patients must ‘place naïve trust’ in the paramedics who treat them.512 This issue is particularly acute in paramedic work because they work with extremely vulnerable patients (often unconscious) and with little oversight by others. This position of power requires paramedics to act with professionalism – to not abuse trust, to act with integrity and to put the patient’s interests before others. This is perhaps the best example of the way in which the acquisition of the power to self-regulate by an occupational group on the basis that they have specialised knowledge and skills that are unknowable by others but upon which others are dependent, is only worth something if it is applied responsibly in the interests of those who depend on it. In other words, this is the point at which an occupational group fully professionalises because it represents a synthesis of the process of professionalisation with the exercise of professionalism. Although ‘professionalism’ per se is not prescribed within the National Law, some elements of professionalism are codified within it.
For example, there are provisions within the National Law that ensure that only those practitioners possessing the necessary professional skills to competently and safely practise the profession (technical authority) and who have the necessary character and are deemed
510 AHMAC, Final Report: Options for the Regulation of Paramedics (September 2015)Appendix 8:
Written Submissions to the National Consultation
<http://www.coaghealthcouncil.gov.au/Portals/0/Paramedics%20Decision%20RIS.pdf>.
511Eliot Freidson, Professionalism Reborn: Theory, Prophecy and Policy (Polity Press, 1994). 200-201.
a ‘suitable person’ to hold registration as a health professional (moral authority), are admitted to the profession.513 Who is a ‘suitable person’ is determined by the board. The legislation provides a list of those who are unsuitable for registration as a health professional including a person that has an impairment that may place the public at risk;514 that it is not in the public interest to have a person with a particular criminal history on the register;515 that the prospective registrant is not competent in communicating in English;516 that the qualification of the prospective registrant is not adequate, or that the prospective registrant fails to meet the ‘nature, extent, period and recency of practice requirements’ to an approved standard;517 or the person in the board’s opinion, is ‘not a fit and proper person for general registration’518 or is ‘unable to practise the profession competently and safely’.519
The term ‘fit and proper’ person is largely subjective and has no precise legal meaning. The NSW Supreme Court has determined that the concept of ‘fit and proper’ involves three elements: honesty, knowledge and ability.520 In essence, a practitioner must have the knowledge, skills and character to practise their profession safely and effectively; but it extends further to encompass the way in which an individual practitioner’s behaviour may affect the public’s perception and confidence in the profession. The National Law allows for the ‘conduct of the practitioner, whether occurring in connection with the practice of the health practitioner’s profession or not’,521 to be examined when determining whether or not a practitioner is a fit and proper person to hold registration. This is designed to ensure a maintenance of public trust in the system that those admitted to the register are honest and trustworthy and someone in whom the public and other professionals may therefore have confidence.522 This element of trustworthiness is consistent with the Freidson element of professionalism. Again, it is a matter for the Paramedicine Board to determine whether a practitioner is likely to be a ‘fit and proper person’ to practise as a paramedic and be
513Health Practitioner Regulation National Law Act2009 (Qld)s 52. 514 Ibids 55(a). 515 Ibids 55(b). 516 Ibids 55(d). 517 Ibids 55(f). 518 Ibids 55(h)(i). 519 Ibids 55(h)(ii).
520Hughes & Vale Pty Ltd v New South Wales (No. 2) (1955) 93 CLR 127, CJ Dixon, JJ McTiernan and
Webb decided [at 156].
521Health Practitioner National Law Act2009 (Qld) s 5 (emphasis added). 522Edelsten v Medical Practitioners Board (Vic) [2000] VSC 565, 36.
allowed entry to the profession. The power of the Board to make determinations as to who can and cannot represent the profession is another example of self-regulation.