The doctrine of patient autonomy is very imperative when it comes to the making of decisions regarding the treatment and diagnosis that the patient should have administered to him or her subject to the advice of the doctors. The doctor is only allowed at law to advise the patient and makes him understand the nature of his or her health condition and the available treatment and diagnosis alternatives and not to decide for the patient. This brief responds to a case study involving Ewing who is suffering from a degenerative condition that has made him mentally impaired.
Based on the facts of the case study, it is evident that Emily holds the two important ethical values of honesty and open-mindedness. With regard to honesty, it is evident that Emily does is not feel comfortable with the struggles that the husband is going through by all standards. This is anchored on the fact that she cannot stand to see the husband suffering and at constant pains in the comfort of the home and that is why as a person, he was really not happy with the fact that the husband was struggling at home. To her, it was proper for the husband to be taken to the hospital where he could receive the best attention and care from the professional healthcare officials instead of languishing at home and in the hands of his children who are not professional enough to handle him in the best way. Being honest is an important value that someone should endeavor to have since it helps in always going for real solutions and stating things as they are without concealing any facts. An honest person is always straightforward and as such, he or she cannot be accused of misleading others by lying to them for self-gain. Dean in this scenario is very honest and ready to take the bull by its horns without any compromise whatsoever. Emily demonstrates her honesty by keeping off her husband since she could not pretend to be taking care of her when by all standards there was no hope for survival. In fact, given time and chance, Emily could have proposed assisted suicide for her husband to relieve him from the constant pain and anguish.
The next ethical value that is evident in Emily is that of being open-minded. This is anchored on the fact that Emily does not pretend to support the idea that the husband is doing well at home since after losing hope, she opted to keep off and cater for the children without bothering the suffering man. This is an important development that is important to the scenario given the fact that in as much as she rarely made efforts to visit her husband, she did not at the same time struggle to file for divorce though she had this particular option at her disposal. She is convinced that the death of her husband was imminent and as such, he was better off in the hands of healthcare professionals and not in her hands since she was lacking in the necessary experience to tackle or handle such a person.
The two values of Honesty and open-mindedness have the capacity to influence the decision that Emily may hold concerning the treatment of her husband Ewing to the extent that she may propose measures such as assisted suicide to be performed upon her husband. This is anchored on the fact that she had lost all hope of ever having the health of her husband restored subject to the confirmation of the doctors who had declared the health condition of Ewing to be untreatable by all standards. she could thus decide for her husband to undergo assisted suicide to relieve him from the unnecessary pain and anguish that he was going through since it was more than obvious that he was going to die sooner than later. Such a decision could also have been informed by the fact that there was the need to save the resources that were being used to maintain the husband who instead of getting better, his condition was deteriorating by the day.
As a medical professional with full understanding and commitment to the Kerridge model of ethical decision making, I could have addressed the disagreements among the family members by considering what is in the best interest of the patient. This is based on the fact that given the mental instability of Ewing and his inability to make decisions, I would have convinced the family members to agree on the best way of taking care of the sick person instead of focusing on their personal interests and what they feel (Kogetsu, Ogishima, & Kato, 2018). This could have been the best approach since all that Ewing needed was constant care to the extent that the family members could only be made to agree to hire a professional that could attend to his father while at home instead of leaving him at the health facility where he could continue to accommodate the health bills when it was obvious that there was no much of specialized treatment that Ewing could get from the hospital. As a health professional I could thus solve the disagreements among the family members by inviting their attention to the health condition of the old man Ewing and look into the best possible ways that can be used to give him the best care instead of grumbling and pointing fingers at each other something that could only end up into some form of conflict or violence.
It is on record that at common law, adult persons are often presumed to be competent unless it can be proven that they do not have the necessary competence to make sound decisions regarding treatment and diagnosis. Basically, the law demands that the patient should not only be able to comprehend but also to retain the information regarding treatment, believe and weigh the information before finally making a sound decision and communicate it (Tierney & Perlas, 2018). This is also in line with the doctrine of patient autonomy which puts them at the center of all the decisions touching on their treatment and diagnosis. In Victoria which also practices common law, the functional test for competence is provided for in section 36(2) of the Guardianship and Administrative Act 1986. Before the implementation of the Mental Capacity Act 2005, common law had put in place the best interest principle which is only applied in circumstances where the patient refuses to consent or agree to the treatment and in such circumstances, the doctor who goes on to continue the medical treatment without the consent of the patient can thus be held liable for criminal offense and also a civil suit can be filed against such a medical practitioner in this respect. The consent of the patient should not derive from undue influence. The best interest principle was established in the reported case of Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital where the doctors were only allowed to advise the patient and not to make a decision on his behalf (Bryden, McKnight, & Houston, 2018). The primary function of the doctors is only to tell of the seriousness of the treatment and at the same time give advice to the patient regarding any alternative treatment that can be applied to address the health condition at hand something that was held in the reported case of Malette v Shulman at the Ontario Court where the defendant was held liable in trespass and the right of individual autonomy and the principles of self-determination were further stressed by the courts in this landmark case that involved a Jehovah witness patient who was transfused with blood against his will.
Based on the facts of the case study and the above-discussion, it is proper to state the fact that the paramedics had the authority to transport Ewing to the hospital by all standards. this is based on the fact that in as much as the courts may be very much reluctant to interfere in the decision of the patient who is mentally sound, the situation is however different in circumstances in which the patient does not have the mental capacity to agree to the treatment. Under such circumstances then the courts often provide assistance on the basis of the principle of best interest. Ewing at the point of being taken to the hospital was in the most dangerous situation to the extent that he was at the brink of death and at the same time he did not have such a stable mind to make any sound decision as he did not understand the severity of the condition that he was going through. The Mental Health Act 2005 thus supports the action of the paramedics to forcefully carrying or rather transporting Ewing to the hospital after having been chocked with food since there was the need for urgent medical attention that could not by any standard be performed in the house. At the same time, the patient needed specialized examination so as to have his condition fully addressed and restore his poor health to the condition that it was for him to be able to swallow food without much struggle. Despite the various ethical reasons that supports and vindicates the paramedics from the action of transporting Ewing to the hospital, their greatest defense at law remains to be the deteriorated state of mind of the patient to the extent that he did not have the capacity to fully understand what was going on and as such, patient autonomy principle cannot be called into action under these circumstances. It is thus prudent to underscore that in the principle of best interest as well-laid down under the common law and the Mental Health Act 2005, the paramedics were in order to transport Ewing to the hospital for further treatment despite his resistance and refusal or denial of consent (Blease, Bishop & Kaptchuk, 2017).
As Emily who is the wife of Ewing who is ailing, the common law gives him priority as the first decision maker with the alternative ones being the three children who are all of the sound mind and able to make decisions on behalf of their father though this can only come into play when Emily is not present or in the circumstances in which she may have been incapacitated. Based on the facts of the case study under consideration alongside the consideration of the law, Emily remains to be the lead decision-maker in her capacity as the wife of the ailing husband who lacks the mental capacity to decide for himself in this case (Ashall, Millar, & Hobson-West, 2018). The doctors only come in to make treatment and diagnosis decisions in the event that the other four lack the necessary capacity to carry out such an important function in the healthcare circles. The selected decision maker that could be the alternative for Ewing is Emily who is the spouse and as such allowed to do so under the common law provisions. The principle established in the Guardianship and Administration Act 2000 under section 36 is that of the functional test for competence and it designs the criteria that can be used to establish whether the patient has the right capacity to make a competent decision (Beeker, Schlaepfer, & Coenen, 2017). The outcome that I am seeking for which is to establish that the paramedics were legally right and allowed to transport Ewing to the hospital falls right within the province of this particular principle by all standards.
Conclusion
To sum up, this is a classic case that primarily revolves around the consent of the patient when it comes to treatment and diagnosis especially in circumstances where it has been duly established that the patients have impaired mental capacity to understand the seriousness of their health condition and the various diagnosis and treatment methods available. The case also involves the issue of making decisions on behalf of the patient since family members were in disagreement with each other regarding some of the treatment alternatives. In the final analysis, it is clear in the various pieces of legislation and common law that the impaired mental capacity of the patient ushers in the principle of the best interest which is to be used in guiding the final decision.
References
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