Clinical Ethics Issues and Discussion
Emerging Ethical Issues form the Scenario
1. Surrogate decision-making
2. Advance directives
3. Provider-patient communications: disclosing medical error
Discussion of Ethical Issues
Legal/Ethical Issue 1: Surrogate decision-making
This is an ethical issue because it raises the question of what ought to be done given the predicament of the patient. Legally, the stakeholders in the scenario are required to express values of what ought to be done based on existing social rules. Surrogate decision-making involves another person deciding on behalf of the patient due to an incapacitating mental condition. Substantial evidence can be drawn from the scenario in support of this legal and ethical issue. Severe brain damage suffered by the 72-year old woman put them in a permanent unconscious condition (coma), rendering them incompetent in decision making, thus dependent on a surrogate decision maker. Determination of the woman as incompetent to provide informed consent was judicially made by the healthcare provider, hence legally binding (Brock & Anna, 2013). The decision to be made was on whether to relieve the woman in coma of life support, or not. However, disagreement between the supposed surrogate (husband and adult children) on the course of action complicates the situation. This is a common occurrence in medical cases involving euthanasia. Therefore, it is imperative for potential surrogates to seek legal redress to determine if the husband, as a legal aid and surrogate decision maker to the woman, violated the living will of the patient, and should be stripped of surrogate decision-making.
Legal/Ethical Issue 2: Advance directives
Advance directive is more of a legal issue because it rubberstamps the ethical issue of surrogate decision-making. Brock and Anna (2013) define advance directive as different types of legal documents that may be used by a patient while competent to record future wishes in the event the patient lacks decision-making capacity. Such a case is clearly defined in the scenario. One year before the woman was diagnosed to be permanently unconscious; they drew “living wills’ together with their husband. The contents of the patient’s specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition. However, there were no advance directives for durable power of attorney for health care or health care proxy , advance health care directive or health care directive, or Physician Orders for Life Sustaining Treatment ( POLST) form that specify surrogate decision makers and medical decisions to be made. The husband exploited the loophole to argue that the woman’s living will was not intended for situations like the present one. One can argue that by specifying the patient desires, advance directives are important in shielding incapacitated patients from family tussles. However, the scenario highlights situations when the legal and ethical binding nature of such directives is questioned. According to Brock and Anna (2013), the conflicts implicate the interwoven nature of ethics, law, and risk management in healthcare.
Delegate your assignment to our experts and they will do the rest.
Legal/Ethical Issue 3: Provider-patient communications: disclosing medical error
It is common for family members of patients to reject professional diagnosis of their beloved. In the scenario, the husband indicated that they did not consider their wife to be in a permanent unconscious condition , and was even supported in their grief to appreciate the gravity of the wife’s situation. The situation raises the important ethical issue of communication between the healthcare provider and the patient (surrogate decision-maker in this case). According to Brock and Anna (2013), “excellent communication eliminates or reduces the likelihood of misunderstandings and conflict in the health care setting, and also may affect the likelihood that a patient will sue.” The scenario clearly indicates the husband to be in disagreement with the provider’s diagnosis. Their refusal to implement the wife’s living will may not be in violation of the law, even though it may be ethically questioned because they are the wife’s legal next of keen and surrogate decision-making authority. Therefore, they are legally placed to sue for any decisions made in handling the patient that have not been sanctioned by them. The onus lies with the health care provider to convince the husband to recognize and understand the gravity of the situation. However, the woman’s adult children can also seek legal interpretation of the law on living will in an attempt to enforce their mother’s advance directive.
A Framework for Thinking Ethically
Handling of Legal/Ethical Issue #1
The issue of surrogate decision-making can be handled by seeking a court order stripping the husband of the authority as the decision maker. From the scenario, it is evident that the husband is emotionally overwhelmed and in denial of the factual situation. Adult children of the patient can seek legal advice on how to take over the role of surrogate decision-making from the husband. This will facilitate implementation of the patient’s living will.
The issue of surrogate decision making can be examined from the virtue approach perspective that advocates for full advancement of humanity. According to Velasquez et al. (2015), the virtues entail dispositions and habits that enable individuals to act in accordance to the highest potential of their character and on behalf of values such as fidelity, self-control, tolerance, generosity, courage, compassion, integrity, fairness, love, prudence, and others. Therefore, as a surrogate decision maker, the husband’s refusal to grant the patient their wish should lead to self-reflection. The question that the husband must answer is, “What kind of person will I become if I do this?" or "Is this action consistent with my acting at my best?”
Handling of Legal/Ethical Issue #2
Handling the issue advance directive, based on the scenario, will involve enforcing the living will of the permanently unconscious patient. The approach is informed by evidence showing that the husband may be in shock about the condition of the wife, thus is extremely subjective about the decision to implement their wife’s living will. Considering the legal implications of enforcing the living will, it is important to navigate any potential lawsuit by seeking legal interpretation about the validity of the stance of the husband. In addition, the argument can be advance ethically from the social and economic perspective of the family members. In addition, it is important to seek interpretation of when the living will is considered binding or not, and if assertions raised by the husband about it not being applicable to the current situation are admissible.
Velasquez et al. (2015) posited that ethics is not about feelings. Therefore, the husband decisions against the living will of the patient are questionable. In employing the rights approach philosophy, which advances the need for ethical actions that best protect and respect the moral rights of affected individuals, it can be argued that the permanently unconscious patient still has right. Therefore, the right to implement their wishes of not putting them in life support in the event of a permanent unconscious condition or terminal condition cannot be denied. The patient drafted their living will based on understanding that their human nature allows them to choose freely what they do with their life (Velasquez et al. , 2015).
Handling of Legal/Ethical Issue #3
Communication between the provider and the patient or their surrogate decision maker should entail a detailed discussion of the medical condition. The provider needs to be accommodative, but authoritative in passing of their judicial decision on diagnosis. One can argue that the husband may have been suppliant with insufficient information about their permanent unconscious state. It is important to take the husband through emotional support before revisiting the issue of withdrawing life support for the patient.
The issue of communication between the provider and the patient can be handled based on the common good approach. The philosophy, advanced by Greeks, posits that life in a community is as good as the action of its members and their contributions towards it (Velasquez et al. , 2015). The philosophy interprets ethical reasoning as an outcome of the interlocking relationships of the society that generate respect and compassion for all members, especially the vulnerable. Common conditions that are geared towards the welfare of everyone are advocated by the philosophy. In this light, it can be argued that the husband is in an emotionally vulnerable situation and should be handled with compassion, especially when convincing them that their wife’s condition, which they are in denial of, is permanent, hence the need to exercise the concept of utilitarianism in withdrawing life support.
References
Brock, L. & Anna, M. (2013). Clinical ethics and law. University of Washington, School of Medicine. Retrieved 28/2/2018 from: http://depts.washington.edu/bioethx/topics/law.html
Velasquez, V., Dennis, M., Michael, M., Thomas, S., Margaret, M., David, D., Claire, A., & Kirk, H. (2015). A framework for ethical decision-making. Santa Clara University – Markkula Center for Applied Ethics. Retrieved 28/2/2018 from: https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/.
