Three Legal/ Ethical Issues
In the case scenario in this assignment raises three critical ethical issues that needs a redress. These issues include;
Informed consent
Law as it relates with living will
Surrogate decision-makers.
Discussion of Three Legal/Ethical Issues
Legal/Ethical Issue 1 : Informed Consent
Informed consent refers to the process used to acquire permission from a patient while conducting a healthcare intervention. Informed consent plays an essential role within the healthcare sector since it facilitates the involvement of the patient in decision-making. The patient should be able to describe the proposed intervention in a way that is easily understood by the participating parties. Moreover, informed consent principle emphasizes the importance of a patient involvement in decision-making. Nevertheless, it also creates an opportunity to discuss the possible alternatives on the recommended intervention. Consequently, when a patient lacks the capability to engage in decision-making due to existing medical conditions, it is recommendable that efforts are made to identify any written record on the preferred intervention from the patient. When patients cannot provide informed consent on their preferred interventions, then “a legally authorized surrogate decision-maker may do so” ( Clinical Ethics Issues and Discussion Article ) . In the current scenario, the patient already gave consent about the preferred intervention through her living will when her doctor diagnosed her with a permanent unconscious condition. The ethical issue arising from the current situation is that the patient was diagnosed with cerebral hemorrhage and is life support machine. Hence, her husband refutes that the intervention recommended in the living will is not applicable in the current scenario.
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Legal/ Ethical Issue 2: Law as it relates with a living will
A living will is a written directive that facilitates the patient’s decision-making on the most preferred intervention methods when one gets sick to a point of being incapable of guiding the healthcare practitioners. Moreover, a living will plays an essential role in enabling family members to make a decision when faced with a scenario where the patient is making an end of life decision. The healthcare practitioners uphold the decisions outlined in the directive as they target to retain the autonomy of the patient even when in a state that makes decision-making is a difficult task. In this case scenario, the patient has already left a living will directing the withdrawal of the life support machine after he or she becomes unconscious. However, her husband is adamant that the directive is not useful in this case, and therefore should not be executed.
Legal/ Ethical Issue 3: Surrogate Decision Makers
A patient appoints a surrogate decision-maker who is usually a very close family member who is responsible making choices on behalf of the patient at scenarios where no directives are available. Moreover, a surrogate decision maker also acts when the patient is incapable of making healthcare decisions by themselves. The healthcare providers must act in accordance of the decisions made by the surrogate decision maker since failure to act accordingly will only lead to ethical violations. In this case scenario, the patient has already appointed her husband as the surrogate decision maker and he has refused to have the life support machine withdrawn from the patient. Subsequently, the decision on the interventions will rely on the choices made by her husband.
How I would handle each Issue
Handling of Legal/Ethical Issue #1: Informed Consent
The patient has already left a directive that authorizes what should happen to her when she becomes unconscious. The healthcare providers feels that the measure is applicable in this situation and that the patient has documented on the interventions that should be made during the end of life care. Consequently, it will be okay to withdraw the life support machine from the patient and let her die ( A Framework for Thinking Ethically Article ) . Nevertheless, since her husband is opposed to the execution of this decision, it will be essential to allow him to go through the mourning process until he is ready to let go. In the meantime, the healthcare providers should engage the ethic committee within the organization to discuss about the case as a way of eliminating any ethical implications that might arise in the future. Similarly, when the husband finally agrees that the life support machine should be withdrawn, it will be vital to have him sign consent forms aimed at avoiding ethical implications that might arise from the decision.
Handling of Legal/Ethical Issue #2: The law as it relates with a living will
The law requires that healthcare practitioners should abide with provisions in a living will, which acts as the voice of the patient when he or she is considered unsuitable to decide. In this case, the ethical implications arises based on the varying circumstances that the living will is written. Initially, the patient was diagnosed with a permanent unconscious condition and is currently suffering from cerebral hemorrhage. Nevertheless, the latter condition has equally made the patient unconscious and rely on the life support machine for survival. Therefore, even though the circumstances differ, the illness has made the patient unconscious and also endure suffering. Consequently, since the description in the living will befits the current condition of the patient, it will be essential to allow him or her access the desired intervention. Moreover, abiding with the directive enables the family and the healthcare practitioners to abide with the anonymity of the patient when making decisions. Therefore, upon agreement by all the involved parties, and especially her husband, it is recommendable that the life support machine should be withdrawn from the patient and allow her to die.
Handling of Legal/ Ethical Issue #3: Surrogate Decision makers
A surrogate is an individual bestowed with the authority to decide and talk when dealing with events that are beyond the patient. A surrogate must be a close family who might be child, spouse, and a friend that take up the role of a surrogate decision maker. In this case, the surrogate decision maker is the husband to the patient, who can make decision on behalf of the patient if there is no existing living will or the extremity of the condition demanding intervention. Moreover, the surrogate must also allow the execution of the intervention measures outlined in the living will. In this case, the healthcare practitioners are stack because the surrogate feels that the intervention measure suggested in the living will is not a task. Nevertheless, the choice in this case scenario is to allow the surrogate adequate time to moan and agree to let go the patient. Moreover, healthcare providers should try and explain the importance of the preferred intervention in retaining the dignity of the patient even while on death bed.
