Legal and Ethical Responsibilities

Question 1 

From a legal and ethical perspective, primary responsibility of every clinician is to the patient, then to the family and other third parties (Butts & Rich, 2019). According to section KSA 65-28, 103, (4) B of Kansas statute, the primary patient in the case study is the unborn child, as opposed to the normal scenario where the patient is the mother until birth. Under this approach, clinician should ignore the will of Janet and her parents and focus on the survival of the unborn child. The two approaches create a grey area that is beyond the mandate of clinicians. The clinicians should refer Janet’s parents to the hospital’s administration. The parents should get some legal advice and perhaps some counseling. Until the ethical/legal impasse ends, Janet and her parents have to be on a holding pattern. Conversely, unless otherwise advised the clinician should take steps to preserve the life and health of the fetus.

Question 2: 

Section KSA 65-28, 103, (4) B of Kansas statutes is informed by the value that human life begins at conception. Every human being is an independent entity with a right to be considered as such. The act seeks to preclude a mother from making irrevocable decisions about the unborn child. However, another set of values holds that life begins at birth.

Question 3: Reflection 

I do not agree with the statute, although it is a difficult decision to make. There is no easy way of evaluating the circumstances of the instant case and come up with a substantive opinion regarding Section KSA 65-28, 103, (4) B of Kansas Statutes. On the one part, acquiescence means taking away the rights of a woman to determine her health outcomes. On the other, disagreeing with the act means allowing the death of a child to no benefit of any of the parties as the mother is in a persistent vegetative state. The only plausible way to look the issue is broadly by considering the overall implication of each side of the divide. KSA 65-28, 103, (4) B of Kansas statute goes into the core of the issue of the independence of a fetus and at what point a fetus gains fundamental rights. Another perspective of looking at the issue is that until birth, the fate of the fetus is intertwined with that of the mother. The decisions of the mother should, by extension also be the decisions of the fetus. For example, Janet already knew that she was pregnant and was excited about it. Had she wanted a different outcome in the case of a persistent vegetative state now that she was pregnant, she would have changed her instructions. An act that seeks to differentiate between a mother and a fetus must be wrong.

Question 4: 

As Janet’s parental surrogate, I would fight for the rights and wishes of the child. The issue involves Janet and her unborn child who is inside her body. Janet has a right and full autonomy to make decisions with regard to what happens inside her body. I have to admit that personal rights are subject to legality. In the instant case, the right of Janet to include an unborn child in her definition of personal autonomy has a guarantee in the Supreme Court decision in the case of Roe v. Wade (Barry, 2018). I would start by trying to solve the issue administratively through the hospital’s administration. If that fails, I would move to federal court for a constitutional review. If need be, I would keep going through to the Supreme Court even after it is too late for Janet, for the sake of others facing the same predicament.

Question 5: 

There should not be a surrogate for Janet’s fetus since Janet’s surrogate acts both for Janet and for the fetus. Based on the argument made above, as long as the fetus is inside Janet’s body, its fate is intertwined with that of Janet (Goodwin, 2017). Further, Janet knew that she was pregnant and communicated the same to her parents. She did not proceed to change her instructions about their status as her surrogates. Conversely, appointing a surrogate for the fetus creates a slippery slope where third parties can take control of the bodies and lives of pregnant women.

Summary

Ethical and Legal Aspects

As reflected above the main ethical issue relates to the relationship between the clinician and the patient. The clinician has a duty to act for in the best interest of the patient (Butts & Rich, 2019). The legal issue of the other had related to the letter of the law which in the instant case expressly contradicts the ethical aspect hence creating an ethical dilemma.

Applicable Laws

Two sets of applicable laws apply in the instant case, which in my opinion are also on a collision cause. On the one hand, there is KSA 65-28, 103, (4) B that rules out Janet’s autonomy. On the other hand, there is judicial precedent under Roe v. Wade that supports Janet’s autonomy (Barry, 2018). Normally, federal laws overrule state laws with regard to human rights.

The Ethical Principles that Pertain to this Case

The primary ethical principles of this case relate to the concept of patient autonomy. As per the principle, every adult patient has a right to make decision with regard to the patient’s health and the clinician is ethically bound to respect those decisions (Rodríguez-Prat et al., 2016). For example, under the principle of autonomy, a patient is allowed to decline treatment, leading to eventual death.

The Specific Details that Require Clarification

Whether there is a legal distinction between Janet and her fetus.

Whether Janet’s parents act both as surrogates of Janet and her embryo.

Whether KSA 65-28, 103, (4) B supersedes the position outlined in Roe v. Wade.

Actions by the Hospital or Nurse to Ensure Appropriate Outcome

The hospital and the attending nurse are in a quandary. On the one hand, the principle of autonomy favors following the instructions of the parent and transferring Janet to the hospice. On the other hand, the law dictates that Janet’s decisions are invalid because of her pregnancy. Any decision should have adverse consequences. If the hospital ignores the law, it might be subjected to regulatory consequences, which may include losing its license. On the other hand, if the nurse fails to follow the will of the patient, potential professional ramifications and a potentially debilitating court case may follow. The hospital and its nurse should play the center and seek to appease all parties until the decision is taken over by a court of law.

Dependencies for my Recommendation

The only available facility available as per my recommendation is federal law, through the federal courts (Barry, 2018).

References

Barry, U. (2018). What do we mean by bodily autonomy? And what does bodily autonomy mean for women in particular?. In  D'Arcy, K.(ed.). Autonomy . New Binary Press.

Butts, J. B., & Rich, K. L. (2019).  Nursing ethics . Burlington, Massachusetts: Jones & Bartlett Learning.

Goodwin, M. (2017). How the criminalization of pregnancy robs women of reproductive autonomy.  Hastings Center Report ,  47 , S19-S27.

Rodríguez-Prat, A., Monforte-Royo, C., Porta-Sales, J., Escribano, X., & Balaguer, A. (2016). Patient perspectives of dignity, autonomy and control at the end of life: systematic review and meta-ethnography.  PloS one ,  11 (3), e0151435.