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Legal And Ethical Issuesin Healthcare

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Question:

Discuss about the Australin Medical Association Code of Ethics ?

 

Answer :

Introduction

The healthcare professionals are required to be registered and exercise good medical practice in Australia. The Australian medical Association Code of Ethics provides a guideline for the medical practitioners and the other healthcare professionals to maintain ethical and professional conduct in the field of medicine (Mason, Laurie & Smith, 2013). This essay discusses the standard of care the healthcare team is expected to exercise towards the patients. It also entails about the significance of a valid consent and the legal consequence that may arise in case of committing breach of a valid consent. The medical practitioners must inform the patients about the treatment to be undertaken and must obtain valid consent prior to the commencement of the treatment depending on the decision making capacity of the patient. In case, a patient lacks decision making capacity, decision may be made by the family or carer or any person authorised by the patient or tribunal for the same. Under section 32 N of the Guardianship and Management of Property Act 1991, a healthcare professional may provide urgent medical treatment to a patient under the Common law. The ethical principle of autonomy which states that a patient has the right to give consent or refuse to medical treatment and the healthcare professionals must respect the same. The courts have also recognised the principle that an adult patient has a right to inform the healthcare professional that they would wish to refuse the medical treatment in case he or she becomes incapable to give consent or make any decision regarding their medical treatment. In Contemporary ethics, the principle of autonomy has also been recognised (Laurie, Harmon & Porter, 2016).

Legal issues

According to the Medical Board of Australia, no treatment shall be undertaken without obtaining a valid consent of the patient (Gough, 2014). As per the NSW Health Patient Charter every patient must be well explained about the treatment options applicable for him or her and consent must be obtained from the patient except under emergency circumstances where the law states that the patient must be treated without his or her consent (Foy, 2015). Moreover, a competent patient has a right to refuse to undergo any medical treatment and the healthcare professionals must respect their decisions. The High Court of Australia has introduced this principle in the Marion’s case where a competent person may refuse to medical treatment irrespective of the fact whether such decision is rational or irrational (Drazen, Solomon & Greene, 2013). If such patient is treated, it would amount to battery or assault. Such refusal must be specific and given freely, however, if there is a change in the circumstances of the patient, such refusal shall not continue to be valid and may require confirmation. In the mentioned case, Edward did not specifically refuse medical treatment and moreover, there was a change in his medical condition which invalidates his refusal. Therefore, the paramedics are legally authorised to treat Edward for his Diabetic coma.

 


In order to obtain a valid consent, the healthcare professionals must ensure that the criteria for a valid consent is fulfilled as stipulated by the Medical Board of Australia under the Code of Good Ethical Conduct for Doctors. Firstly, the person giving consent must be competent to give such consent that is the person must be competent to understand the consequence of undergoing the treatment. Secondly, such consent must be given voluntarily and not under any coercion, fraud or misrepresentation. Thirdly, it must be specific and must be given after detailed information about the treatment options is provided to the patient. Lastly, the patient must be given adequate time for deliberation. If any patient is treated without obtaining his or her valid consent, such treatment shall amount to battery or an assault that is an offence of trespass for which the patient may initiate criminal or civil proceedings against the medical practitioner committing such offence (Browning, Bigby & Douglas, 2014).  

According to section 33(2) of the Guardianship Act, a patient is incapable of giving a valid consent if such patient is incompetent to understand the information and the implications of the treatment. Under such circumstances the Act stipulates that treatment may be provided to the patient if the medical practitioner considers it necessary to prevent the patient from any serious damage or to save his or her life. In the given case, Edward lacked capacity to make decisions and it was a medical emergence, therefore; the healthcare providers may treat him as they considered it necessary to save his life. However, the healthcare providers must ensure that the decision made on his behalf is in the best interest of Edward.

The Guardianship Act 1990 lays down the provisions for making treatment related decisions for people who are incapable of making their own decisions owing to any intellectual disability or brain injury etc. The Act lays down options which enable the healthcare providers to obtain consent for treating the patients who lack decision making capacity (Khoury & Khoury, 2015). The Act allows an enduring guardian to make decision on behalf of Edward. The Act also permits the appointment of substitute decision-makers by the State Administrative Tribunal. Such person appointed by the State Tribunal is called a Guardian (Barry & Sage-Jacobson, 2015). Part 9D and sections 110ZJ and 110ZD of the Act lays down the course of action to be followed by the health professional in order to obtain treatment decision for Edward.

In the given case, the two substitute decision makers are Edward’s wife and his mother in law, Una. However, there is a disagreement between the two of them regarding the withdrawal of the life-sustaining measures of Edward. Under such circumstances, the healthcare professionals must follow the decision which is in the best interest of Edward as the basic concern of the Guardianship Act 1990 to allow the appointment of substitute decision maker is to promote best interest of the patient lacking decision making capacity.

The decision relating to the withdrawal of the life-sustaining measures signifies the stage where it has become evident that a patient is not receiving any benefit from the life sustaining measures that are being proposed to be withdrawn (Mark et al., 2015). In the given case, in order to take the decision regarding withdrawal of the life sustaining measures, the factors that must be taken into consideration are that the medical treatment is no more beneficial for Edward; that the continuation of the treatment shall not be in the best interest of Edward. Further, the wish of the patient, when he had capacity, must also be considered (Johnstone, 2015). In this case, Edward had previously expressed his wish to his wife that he does not want to live in a condition where he is unable to take care of himself and would want her to turn off the life sustaining machines. Furthermore, the interest of other people shall not be taken into consideration; it is only the best interest of the patient must be determined while withdrawing the life sustaining measures (Willmott et al., 2014).

 

Ethical issues

Under the Universal Declaration on Bioethics and Human Rights (UDBHR) two principles that may be applied in the given scenario are the principle of Benefit and Harm stipulated under Article 4 and the principle relating to the lack of capacity to consent of a person laid down under Article 7. Article 4 of the UBDHR entitles every person to be free from intentional harm. This article is based on the principle of beneficence and non-maleficence which implies that the healthcare providers must provide such treatment which maximizes benefit and minimizes the harm (Pieper & Thomson, 2016). In the given scenario, the healthcare team provided Edward with every possible treatment in order to avoid any harm but unfortunately, he suffered hypoxic brain injury.  The healthcare team also stated that Edward was in a condition where the life sustaining measure will not benefit him anymore as there is no chance of him to recover.

Article 7 states that when a person is incapable of making decisions, any medical procedure or treatment must be conducted only in the best interest or for the benefit of the patient (Flannery, Ramjan & Peters, 2016). In the given scenario, Edward was lacked decision-making capacity and Genevieve and Una were his substitute decision makers therefore while making any medical related decision on behalf of Edward, they must ensure that it is in the best interest of Edward.

In the given scenario, conflict may arise between the above-mentioned principles as the principle of benefit and harm states that the healthcare professionals must provide such medical treatment which minimizes the harm and maximizes good of the patient. Now, before applying this principle, the doctors must provide detail information about the treatment procedures to the patient and the decision taken by the patient shall be final as a competent patient is entitled to make his own medical decision whether to consent or refuse the medical treatment (Hattingh, 2015). However, in the given scenario, since Edward lacks decision making capacity, the substitute decision makers are entitled to make medical decision on his behalf. Now, as per the condition of Edward the healthcare team have declared that there is no chance of recovery and that the life sustaining measures are not providing any benefit to him therefore it must be withdrawn to relieve him of the pain. However, una believes that he has a chance of recovery and disagrees with the healthcare team and Genevieve. Under such circumstances, on one hand the healthcare providers are under legal obligation to provide treatment that minimizes harm to the patient while on the other hand they suggested withdrawing the life sustaining measures which may cause death of Edward. Nevertheless, Edward also did not wish to live on the life sustaining measures and the patient’s wish and it is the best interest of the patient that must be considered to withdraw the life sustaining measures and not the interest of any other person.

 


In order to address the ethical conflict arising in the given case study, Kerridge model of resolving ethical dilemma may be applied here.  The healthcare providers must ensure that the patient is prevented from any harm and must respect the decisions taken by the patient and in this case where Edward lacks decision making capacity, the decision of the substitute decision makers. In the mentioned case, the ethical dilemma is between Edwards’s wife and the healthcare team who are of the opinion that since there is no sign of recovery, the life sustaining measures are not providing benefit to him whereas Una disagrees with them against the withdrawal of the life sustaining measures. Now the decision related to extending life by providing life sustaining measures is always not beneficial for the patient. Benefit in terms of health refers to concept like progress, recovery, pain relief etc.  However, these concepts have different degrees of benefits (Doran et al., 2015). Here, the life sustaining measures was not providing any benefit to Edward as there is no chance of him to recover and circumstances that might cause more harm than benefit to patient especially when the patient is under pain, the healthcare team must consider and weigh up carefully all the factors that are related to the patient’s quality of life.

 

Conclusion

From the above discussion it can be concluded that the healthcare providers must treat the patients honestly, compassionately and respect their integrity, culture, values and beliefs. The medical practitioners are under legal and ethical obligation to provide appropriate treatment to the patients in the best interest of the patients (Tilse et al., 2014). In order to determine the best interest of the patients, the healthcare professionals must consider several factors that are relevant to the best interest of the patients and the factors may vary from one patient to another. The medical practitioners must be cautious about their obligations and procedures as they tend to influence the decisions of the patients. Sometimes, the decisions relating to the life-sustaining measures often become subject to ethical conflicts between the society expectations, rights of the patients and the medical obligation of the healthcare professionals. The medical practitioners must put in efforts to ensure that a balance is maintained between the obligations and the duties imposed by the rights and duties and that decisions are made based on reasonable ethical principles and is in the best interest of the patients.

 

 Reference list

Barry, L., & Sage-Jacobson, S. (2015). Human Rights, Older People and Decision Making in Australia.

Browning, M., Bigby, C., & Douglas, J. (2014). Supported decision making: Understanding how its conceptual link to legal capacity is influencing the development of practice. Research and Practice in Intellectual and Developmental Disabilities, 1(1), 34-45.

Doran, E., Fleming, J., Jordens, C., Stewart, C. L., Letts, J., & Kerridge, I. H. (2015). Managing ethical issues in patient care and the need for clinical ethics support. Australian Health Review, 39(1), 44-50.

Drazen, J. M., Solomon, C. G., & Greene, M. F. (2013). Informed consent and SUPPORT.

Flannery, L., Ramjan, L. M., & Peters, K. (2016). End-of-life decisions in the Intensive Care Unit (ICU)–Exploring the experiences of ICU nurses and doctors–A critical literature review. Australian Critical Care, 29(2), 97-103.

Foy, M. A. (2015). Informed consent. Bone Joint J, 97(9), 1159-1161.

Gough, I. R. (2014). The significance of Good Medical Practice: a code of conduct for doctors in Australia. Med J Aust, 200(200), 148-149.

Hattingh, L. (2015). Pharmacy legal: Legal issues involved in patient or client consent. Australian Pharmacist, 34(8), 68.

Johnstone, M. J. (2015). Bioethics: a nursing perspective. Elsevier Health Sciences.

Khoury, B. S., & Khoury, J. N. (2015). Consent: a practical guide. Australian dental journal, 60(2), 138-142.

Laurie, G., Harmon, S., & Porter, G. (2016). Mason and Mccall Smith's Law and Medical Ethics. Oxford University Press.

Mark, N. M., Rayner, S. G., Lee, N. J., & Curtis, J. R. (2015). Global variability in withholding and withdrawal of life-sustaining treatment in the intensive care unit: a systematic review. Intensive care medicine, 41(9), 1572-1585.

Mason, K., Laurie, G., & Smith, A. M. (2013). Mason and McCall Smith's law and medical ethics. Oxford University Press.

Pieper, I., & Thomson, C. J. (2016). Beneficence as a principle in human research. Monash Bioethics Review, 34(2), 117-135.

Tilse, C., Wilson, J., White, B., Willmott, L., & McCawley, A. L. (2014). Enduring Powers of Attorney: Promoting attorneys' accountability as substitute decision makers. Australasian journal on ageing, 33(3), 193-197.

Willmott, L., White, B., Smith, M. K., & Wilkinson, D. (2014). Withholding and withdrawing life-sustaining treatment in a patient’s best interests: Australian judicial deliberations. Med J Aust, 201(9), 545-547.                                                                                                                                                                     

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