Section 1
Based on the subject scenario, the three most important ethical/legal issues present in the case are:-
• Informed consent
• Surrogate decision-making
• Advance Directives
Section 2
Legal/Ethical Issue 1: Informed Consent
Informed consent is both a legal and ethical requirement, as well as a factor of consideration, in the event of decision making concerning a person. In the healthcare sector, practitioners and administrators of care to patients often come across ethical challenges that have legal implications in the event of decision-making. However, the law, as well as certain policies, makes it possible for patients, in a conscious state, to decide their future health-related decisions or plans. Therefore, the medical practitioners, guided by the provisions of the law, execute directives, which may have ethical implications, thus raise ethical/legal issues. Among other ethical/legal issues that may arise in the healthcare sector is that of informed consent, which will be applied in this paper’s report.
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Care providers are charged with the duty and responsibility of ensuring no harm or injury comes to a patient. In the event the care provider fails to do so, they are charged in accordance to the stipulated law or policies on causing injury to a patient for failure to carry out what is stipulated, for instance, informed consent. For a patient to receive any form of care, they are required by both legal and ethical standards to provide informed consent. This means that the patient in full capacity and awareness gives consent to the type of care they receive and how they receive based on their physician’s advice.
Taking into consideration the fact that informed consent is given by a patient when they are fully aware of their decision, the case scenario in such a case causes an ethical/legal dilemma. For instance, the patient in this scenario, in her “living will,” gave specific directives on what she would like to happen in the event of a permanent unconscious condition or a terminal condition. According to the patient, in the event of a permanent unconscious condition or a terminal condition, she would not wish to be put on ventilator support or other artificial life support. This is clear indication that the patient had provided informed consent before the cerebral hemorrhage, which left her with severe brain damage and ventilator dependent.
Having said she would not wish to be kept on ventilator support, care providers are required through the informed consent’s provision, to withdraw support and let the patient die. Letting a patient die is contrary to what a care provider is charged with legally, as well as ethically implications and dilemma, thus the ethical/legal issue presented by the subject scenario. Also, her husband, also a person holding the surrogate decision-making authority argues that the patient did not have the same intentions during her writing of her “living will’, thus there may be the issue of lack of informed consent.
Legal/Ethical Issue 2: Surrogate decision-making
Surrogate decision making refers to an instance in which a certain person is designated as the decision maker in the event a patient is established as temporarily or permanently incompetent to decide for themselves. Health care providers are required by both the stipulated laws and clinical ethics to ensure quality healthcare provision for patients in a bid to preserve or save a life. However, in the event a patient is put on life support, certain measures have to be undertaken by ethical and legal standards. The state statute’s stipulations, as well as a court order, are used towards establishing the designated person with whom to entrust the responsibility of surrogate decision-making once the court has established the patient’s incompetence.
Patients also can choose, while of sound mind and consciousness, the individual who would be charged with surrogate decision-making authority in the event of incompetency.
In this scenario, the ethical/legal dilemma results from the fact that the patient’s husband, and also the person with surrogate decision-making authority, wants to keep the patient on ventilator support. The issue is as a result of the conflict between the patient’s stipulated wish, which is not to be put on be put on ventilator support or other artificial life support, and that of her husband who wants her kept on life-support. According to the patient’s husband, the patient had not intended for the document to be used in a situation like the present one, thus presenting a legal/ethical dilemma to the care provider on which of the directives to follow.
Legal/Ethical Issue 3: Advance Directives
Advance directives refer to various documents that are likely to be used by a patient, while conscious and of sound mind, in the event the patient lacks the capacity of decision-making in the future. Among the documents is a living will, which is a document the is written in the expression of “a person’s desires concerning medical treatment in the event of incapacity due to terminal illness or permanent unconsciousness.” Care providers are required by the law as well as certain clinical policies to carry out directives of such legally binding documents, irrespective of the ethical dilemma/issues about a case. In this scenario, the patient already had a living will, which stipulated her wish not to be put on life support in the event her current condition, permanent unconsciousness occurred. However, there is also the issue of a durable power of attorney for health care or health care proxy, which in this case has seen the husband dispute the patient’s wishes, as he is the healthcare proxy. This presents an ethical/legal issue for the care provider, in the event of execution of directives since two documents have contradicting directives.
Handling of Legal/Ethical Issue #1
To handle the issue of informed consent, basing this consideration on the rights approach of ethics, I would handle this issue by respecting the patient’s right to have her wishes, as stipulated in her living will be fulfilled. This is because while the patient wrote the directive on what to do in the event of permanent unconscious condition, she would not wish to be put on ventilator support or other artificial life support
Handling of Legal/Ethical Issue #2
To handle the issue brought about by surrogate decision-making and basing the decision on the common good approach, I would still go with the patient’s decision not to be put on life support. This is because not only was the patient in support of the idea but also so were the children. Weighing the choices, going with the chosen decision, since it is also voiced by of the larger part of the family is more ethical as it may even cause the family emotional turmoil to see the patient in such a condition if she were to be left on life support.
Handling of Legal/Ethical Issue #3
Regarding the issue of conflicting directives from the advance directives, I would, based on the ethical approach of virtue, uphold her husband wish to let the patient stay on life support, as a medical miracle might happen and enable the patient to attain, eventually, the full development of her humanity. Similarly, the decision of whether a person lives or dies should not also be left at the hands of the majority, hence the decision to let the patient live on life-support if only to uphold surrogate decision-making.
