Legal And Ethical Issues In Healthcare - Essay: Case Analysis.

You do not need to include a detailed account of the facts in the scenario; the markers are aware of the facts and this is an unnecessary use of words.

Using structured sentences and paragraphs, answer the following questions in relation to legal issues raised by the case.

1. As Edward had previously refused medical treatment for his viral infection, do the paramedics have any legal authority to institute treatment for his diabetic coma? What legal authority can you rely upon to support your answer?
2. What elements must be present for this consent to be valid? What legal authority can you rely upon to support your answer? What potential legal consequences may flow if healthcare practitioners provide treatment without first obtaining consent?
3. As Edward is unresponsive he will not have decision-making capacity. Provide a rationale that supports the legal obligation to obtain consent in these circumstances.
4. List the potential options available for the healthcare practitioners to obtain consent for Edward’s ongoing care in these circumstances. What legal authority can you rely upon to support your answer?
5. In circumstances where there are two or more substitute decisions-makers who could potentially provide consent, and they disagree, describe the legal options available to provide a definitive answer as to what course of action the healthcare practitioners should take.
6. What factors will be taken into account when making a decision as to whether Edward’s life-sustaining measures can be withdrawn?

1. Identify two principles that are relevant in this scenario and describe how the selected principles apply to the facts in the scenario.

2. Describe where a conflict between these principles may arise by considering the differentvalues of each of the stakeholders in the scenario.

3. Apply the modified Kerridge et al. (2013) model for ethical problem solving to address the conflict.

Health care is a very challenging sector because it confronts the practitioners with a wide range of ethical and legal dilemmas. However, should this happen, the healthcare providers should use the principles of ethical codes of conduct as well as the legislations governing the profession to resolve them. After a long struggle with illness, it has reached a point when Edward is incapacitated. He is in a coma and cannot make any decision regarding his treatment. The decision should therefore be made by his family members who are authorized to be his surrogates.  In case of refusal, the decision should be respected because it was given by a qualified person.

It is true that the law gives paramedics authority to institute or terminate a treatment for a patient who is in a coma. The paramedics are therefore free to choose whether to continue with or terminate the life support given to Edward who has been in a diabetic coma. However, based on the patient’s condition, it would be inappropriate to continue providing life support to the patient because his condition does not allow. A thorough analysis of the patient’s condition revealed that he is in a vegetative condition and cannot benefit from any intervention (Walsh, Mitchell, Francis, van Driel, 2015).

At the same time, the patient has expressed his views to Genevieve when he told her that he would like to refuse life support when he gets into a coma. Although he is unconscious and cannot give his decision regarding the matter, his earlier wishes should be respected (Hutchinson, et al., 2014). The National Policy Framework for Advanced Care Directives gives a provision for the patients to refuse treatment as long as they are convinced that it is the right thing to do.

The paramedics should withdraw life support because it has been supported by the patient’s family members. The views expressed by Genevieve are a clear proof that the patient should not be subjected to a further treatment because it will not benefit him in any way (Rehnsfeldt,et al., 2014). Genevieve can be used as a witness because he was available when the patient was declaring his refusal intentions.  She can be relied upon to provide substitute decision on behalf of the vegetative Edward. Meaning, she can formally consent on behalf of Edward.

As already hinted Edward is in a coma and cannot give consent for treatment. His unconscious condition cannot allow him to approve or refuse treatment. He is considered incompetent because he is unconscious and cannot understand what is going on or effectively communicate with the paramedics. Therefore, his family members should provide consent on his behalf (Peate, Wild & Nair, 2014). The law allows another party to provide a substitute decision and give consent on behalf of the patient. This is allowed by the Victorian Civil and Administrative Tribunal (VCAT) and the enduring powers of the attorney.

Q1

However, for the consent to be valid, it should meet the following conditions. First, the consent should substitute decision-maker should formally sign a Refusal of Treatment Certificate. Here, the guardian of incompetent person should clearly indicate the kind of treatment that he/she wishes to refuse and the reasons why it has been done. Besides, the guardian should be adequately informed on the conditions of the patients and reasons why the treatment is necessary or not necessary for the patient (Bodenheimer & Berry-Millett, 2012). Moreover, the guardian should express an understanding of the information provided by the medics. The law requires that only an informed guardian should be allowed to give consent on behalf of an incapacitated patient. Last, but not least, the guardian should voluntarily.

However, in case the law is violated, the medic will have to be made to be legally liable. The medic will have to be prosecuted and charged with criminal and civil violations. If the medic proceeds with the treatment after the refusal of the guardian, the medic must face the law. This will be done especially when the patient dies or faces further complications as a result of treatment. In case, the medic will be accused of negligence and infringement of the law even if the complications had nothing to do with negligence.

Since Edward is incapacitated, he cannot be allowed to make decisions regarding the treatment that should be given to him. However, this does not mean that the medics should decide o behalf of the patient. Instead, the decision making process should be left for the patient’s carers. The medics should give mandate to Una and Genevieve to make decisions on behalf of the patient. Substitute decision is required because the law guarantees that an incapacitated patient should be supported to make decisions before any treatment is initiated (Gjerberg, Lillemoen, Pedersen & Førde, 2016). The medics should therefore seek for the opinion of Una and Genevieve because it has reached a point when the patient should be served to help in saving his life, prevent unnecessary sufferings, and fatal damages to his health.

Ordinarily, consent to treatment should be provided by the patient. However, I case the patient is deemed incompetent to do so, the medics only have one option: rely on surrogates to give consent on behalf of the patient. However, in case this fails, the medics can go ahead and treat the matter as an emergency in which they assume the decision-making roles (Hsu, et al., 2012). However, in the case of Edward, the medics have an option of relying on the surrogates to consent on behalf of the patient because he is a coma and cannot do so on his own.

Q2

The law requires the medics should not assume the role of a sole decision maker, but has to collaborate with substitute decision makers to help in coming up with strategies that best serve the interests of the patient. Una and Genevieve are allowed to be decision makers because they are close family members (Oh & Gastmans, 2015). They therefore qualify to equip the medics with the decision to follow. Since Edward is their loved one, it is presumed that they will always serve his interest. When they make decisions, they should formally endorse it and enable the medics to do their work.

Once the medics give authority to the substitute decision makers to decide on behalf f the patient, they should take the challenge and discharge their mandate. The substitute decision makers should deliberate on the matter before coming with a consensus regarding the action to take to save the life of the patient (Kirkman, et al., 2012). However, in case the substitutes fail to come into a consensus, it might not be easy for their decisions to be accepted because it will be conflicting. In this case, the medics should apply the principles of law that govern the choice, powers and privileges of substitute decision makers.

Should this be the case, the medics should only accept the decision made by one of the substitute decision makers. However, the acceptance should be done based on the hierarchy of the decision makers. According to the National Policy Framework for Advance Care Directives, preference should be given to the person who is at the top of the hierarchy based on the scope of the powers held regarding the patient and his life saving decisions. Since Una has disagreed with Genevieve on the next course of action, the medics should accept Genevieve’s decision. She has more powers because she is acting on the wishes of the patient (Mastal, 2014). Besides, he decisions coincide with the medics’ who have grounded their decision on the law as well as ethical and professional convictions.  

The two main factors to be considered when withdrawing Edward’s life support machines are the law and ethics. Legally, the medics are allowed to withdraw or continue providing life support to a patient in a coma. However, this choice can be made based on the consent of the patient or surrogates. In case they decide that the life support measures should be withdrawn, the medics have no choice, but to comply (Heslop, 2015). However, since health care is a profession governed by ethics, the medics are allowed to apply the principles of ethics when making a decision regarding the withdrawal of life support measures.         

Q3

Legal and ethical factors should play a prominent role in the removal of Edward’s life support measures. It is justified to remove the life support measures because of the following reasons: 1) the patient had consented to it, 2) the surrogate or substitute decision makers have consented to it, and 3) it is legally and morally justified because it will not benefit the patient, but will cause him unnecessary sufferings and prolong his death (Cannaerts, Gastmans & Casterlé, 2014).

Universal Declaration on Bioethics and Human Rights is a set of guidelines that were put in place to address all the ethical issues pertaining to life sciences and medicine I regards to environmental, legal, and social dimensions. According to the declaration, human beings should be treated as equal people who should reap the benefits of similar ethical standards in life science and medicine.  Universal Declaration on Bioethics and Human Rights is one of the guidelines that should be applied in the treatment of Edward because of the relevance of the principles of consent, and benefit and harm.

The first principle that should be applied in the case is the principle of benefit and harm.  According to this principle, scientific knowledge in medicine and life science should be based on the concept of utilitarianism. Meaning, it should optimal benefits to the society. Whenever a patient goes to the healthcare facility, deliberate efforts should be made to improve his life and protect him from anything that can cause harm to his life (Ludman & Von Korff, 2012). This is what should be done to Edward. The other principle of consent which stipulates that any medical action done to an individual should be performed after seeking for the informed consent of the patient. Meaning, it should be done voluntarily after a formal consent by a patient or substitute decision makers in case of any incapacitation. Just like any other patient, Edward should be given a benevolent service that can improve his condition as well as eradicate any suffering, pain or harm (Laughlin & Beisel, 2013). This can be achieved by applying these principles.

It is true that a conflict between the principles of consent, harm and no harm can arise as a result of the disagreement between Genevieve and Una. According to the principles of consent, a patient should accept or refuse a treatment based on their moral conviction. This is what Edward had done when he told Genevieve that he would prefer his life support to be withdrawn in case he gets into a coma. So, by disagreeing with Genevieve, it implies that Una does not want the patient to exercise his consent rights. At the same time, by disagreeing on the withdrawal of life support, the two parties are not committed to providing the patient with a holistic, safe, and ham-free care. It is therefore true that the conflict has contravened the application of the principles of the pro-patient Universal Declaration on Bioethics and Human Rights.

Q4

The conflict in the application of the principles of the pro-patient Universal Declaration on Bioethics and Human Rights is unnecessary and should be resolved. To do so, the Modified Kerridge et al. (2013) Model for Ethical Problem Solving         should be applied. According to this model, the ethical and legal challenges faced by the healthcare providers can be resolved if appropriate measures are taken. So, when handling this matter, the disagreement between the surrogates can be addressed by applying the law. The healthcare provider should apply all the relevant legislations and use them in providing a solution to the stalemate. Besides, the healthcare provider should apply the ethical codes of conduct governing health care (Wagner & Dahnke, 2015). Here, a beneficial decision should be made to conform to the standard requirement of beneficence, non-maleficence, justice and autonomy. Ethical decision making is an important activity that should be taken so seriously when attending to patients (Walsh, 2016). It can help in addressing all the ethical and legal challenges that confront healthcare professionals especially when dealing with complex issues such as end-of-life decisions.

Conclusion

In conclusion, Edward is in a coma and is not conscious of what is going on in his immediate surroundings. When attending to him, the healthcare providers should liaise with his substitute decision makers to decide the next course of action. The substitute decisions provided to the medics should be enforced because Edward’s health is an issue of concern to his family as well. No one should dispute or reject their decision because they have powers to decide on behalf of the patient. However, any conflicts that might arise in the application of the principles of Universal Declaration on Bioethics and Human Rights should be ultimately resolved by applying the concepts of the Modified Kerridge et al. (2013) Model for Ethical Problem Solving.

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