Discuss about the Legal and Ethical issues in Healthcare Patient.
Healthcare is a vital sector because of the role it plays in the community through improving the life of individuals. The beauty of life experienced when every member of a family is well and has no health problems. Diseases among other health issues might disrupt the peace of a family, mostly in cases where provider suffers. Also, children are important to their parents and the extended family because they are future of the society and parents invest in them to help them enjoy life. Therefore, when they suffer health problems, the true meaning of life is lost and the victims have to find ways to make them get well (Cohen, 2013).
The aim of the health sector is to help the community to fight health issues that are experienced from time to time. Letting a person is never an option because there are ethical and legal guidelines that protect life. Some discussions have been developed about withdrawing intensive care plans for patients who have no chances of recovery. Law and ethical considerations do not support such decisions because they would deny the patients the right to live. This paper will provide legal and ethical views and discussions of a similar case study where a patient was to be removed in an intensive care plan and decision conflicts were experienced between mother and the wife (Unesco.org, 2017).
Edward had been suffering from Type 1 diabetes for a long time and he was managing the condition quite well. Although he had started experiencing some pain on the sore muscles, he was not sure about the kind of health issue that was to come. His remarks to Genevieve about not visiting the doctor was naïve about the possibility of the condition worsening. Since every individual has the right to make personal health decisions, his wife could not force him to have a medical check-up. However, the Healthcare act 2008 administrates for a healthy community and determined to protect the right of the citizens and their welfare (Stirton, 2017). It is also allowed that when a patient is not in a position to make health decision due to severe illness, the next of kin or family members should provide required decisional support. Every individual in the country has the right to quality health care, hence care providers having the right to provide services even in cases where individuals are unable to control their senses (Albuquerque, 2014).
Before Edward’s family realised that his health condition had worsened, he had already been taken to the hospital because he was found unconscious in his room as he went out of town to pursue his musical career. According to the law, an unconscious person should be provided with first aid services before achieving consciousness or the family members available to make health care decisions. Therefore, because any medical plan is implemented for Edward’s case, his mother Una or Genevieve must have been there to support the decision. Also, in any case, if by any chance the first aid care helped him to gain consciousness, he would also make decisions on whether the doctor to implement the suggested treatment plan. If the doctors decide to engage into treatment process without consulting Edward’s family, they would be answerable for any misfortunes that might happen because of the treatment. For instance, if the patient dies in the process, the victim family would be having the right sue the involved doctors or the institution as a whole.
Informed consent is not about letting the patient or the responsible decision maker sign the paper, rather it is about ensuring that all the treatment process and involved risks are well understood. In such situations, the decision maker will be in a position to weigh all the possible options to choose the best for patients’ welfare. Therefore, the medical institution or the doctor should provide sufficient information to ensure that the decision made is not dependent or limited to some special factors. Some of the principle to be followed in the discussions are frankness, two-way communication, well-balanced and being considerate. After the patient of the decision maker has been providing with the information, enough time is provided to the concerned to make consultations and developed the final decision. The decision should always be in favour of the patient’s welfare (Spofford, & Easker, 2015).
The law imposes the right to signing an informed consent on behalf of a patient if there is a legal relationship and the individual is not a minor. Una is Edward’s biological mother and in that case, she has the right to make a decision on behalf of him because of his state. On the other side, Edward is legally married to Genevieve, who also acquires rights under the law to decide health decision on his behalf. Although Edward has two children, they are not in a position make health decision and sign the informed consent because they are minor according to the law. Therefore, since Una, Edwards mother Genevieve have the legal right to decide what kind of treatment should be imposed, they should discuss and make final decisions they sign the informed consent (Unesco.org, 2017).
Decision conflicts are always expected in an occasion where two or more individuals are involved. In Edward’s case, it is important as a medical practitioner to ensure that both the wife and mother agree on one option before acting. There some procedures to handle these type of disagreements in favour of the patient. Firstly, the decision makers to be put in a counselling process and engagement process to understand benefits and risks of every possible option. As a family, they should synthesise what they would wish for they patient. Evaluation should also be conducted by the medical practitioners to select the less risk decision to be implemented (Devettere, 2016). In this case, Una’s decision should be followed because it assumes less risk to Edward’s health. According to her, more time should be provided to watch if he will recover. Afterwards, she can agree to the withdrawal of the medical services after she finds that he will be able to recover. Moreover, providing more time can lead to Edward’s recovery, hence bringing joy to the family (Taylor, 2015).
Several factors should be considered before withdrawing Edward’s intensive care plan. Firstly, the chances of him recovering should be highly relied on, whereby specialist would provide the best advice. It would be against the health care act to withdraw medical support on a patient who has chances of survival or recovery for those in coma and brain defect. Also, the family capability of keeping the patient in the intensive care plan should also be a factor. If they are able to provide the required financial support and they are willing to pay, the patient should be supported until the last moments. In the case of Edward, her mother is willing to do what she can to ensure that the medical support is not withdrawn, just to him a chance of recovery. Therefore, the medical practitioners should offer the best possible medical support to Edward.
Based on the Bioethics and Human Rights declarations have been developed to govern the welfare of people. In concurrence to Edward’s Case, I would base more effort on article 4 and 6, which talks about Benefit & Harm and consent respectively. The benefit and harm principle adjudicates for maximisation of any sort of direct or indirect benefits to the patients. On the other side, it also states that any form of harm should be minimised for the sake of patient’s welfare. Therefore, Edward’s treatment should be conducted in such a manner that it is of best possible benefit. If Edward recovers, he would be very happy, which makes the treatment to be the first priority of the medical procedure. Withdrawing the intensive care plan would be harming the patient, hence being against article 4 of Universal declaration of bioethics.
Article seven states that therapeutic, diagnostic and preventive measures should be offered to patients after a prior consent has been read, understood and signed by the responsible party. According to the domestic law, authorisation should also be obtained and conducted based on the interests of the responsible individual (Alrc.gov.au, 2017). Therefore, since the interest of Edward’s mother is to keep him in the care plan for more months, that decision should be respected by the medical practitioners. Even after deciding to continue providing medical care to Edward, it only through her when the consent can be withdrawn.
There are possible conflicts that might arise between the principles such as disagreement on already signed informed consent. For instance, an unconscious patient might gain consciousness and notice that the health decision are not according to personal will (Battard, 2013). Also, a conflict might arise in cases where the patient might have made remarks that do not concur with the will of the laws. Edward had stated that he would never wish to be in a position where he cannot take care of himself, which leads her wife to decide to opt for the withdrawal of the care plan. On the other side, the principle of benefit and harm states that any medical practice should maximise health benefit of the patient (Yu et.al, 2016). Therefore, withdrawing the services would be causing harm to him, although it could be according to his wish. Such conflict might be challenging to handle, mostly in cases where the patient is not in a position to make the consent.
It would be unethical to let a patient suffer because there is nobody to sign the informed consent. Although the healthcare is supposed to be providing best health care to the patients, some medical procedure might be having a high level of success. Medical practitioners who decide to help the patients might end up being accused of implementing medical procedures without letting the patient’s family make the decision on the same (Petrini, 2016). In sometimes it is ambiguous because conflicts might not arise when a life is saved. Therefore, based on human right and ethical considerations, the best decision should be made by the medical practitioners among other decision makers. In cases of conflict between human rights and bioethics, the concerned should perform a benefit and risk analysis before relying on one side (Pozgar, 2013).
Conflicts, especially in health, should be ethically solved to avoid external issues that might follow. In Edward’s case, the first step in solving the conflict on whether to withdraw medical care or not is to determine if there is an ethical issue or dilemma. The main ethical issue is that the life of Edward will be lost because they decided to pull off the supporting health services. Secondly is to identify the principles and values associated with the issues. As discussed above, any medical practice should be aimed at maximising direct and indirect benefits, hence reducing harm. The involved principles should always be ranked to concentrate on values that are of much importance compared to the others (Kerridge, Lowe, & Stewart, 2013).
In this case, the life of Edward is much important and if there is any practice that can benefit his health, it should be retained or implemented. An action should be developed that considers ethical values and human right principles (Saul, 2013). After every party agrees on the plan, the implementation plan should be commenced immediately. Finally, an evaluation of the consequences of the plan should be conducted. For instance, if Edwards care plan is withdrawn, Genevieve might regret in future thinking that maybe he would have survived. Therefore, before implementing any plan, all the above should be considered to avoid future issues (Fee, & Belland, 2012).
Conclusion
In conclusion, human rights and ethical considerations should be the basis of a decision on whether to withdraw the support or not. It might be hard to weight between Genevieve, Una and Edward previous wishes about his life. Consultations between family members and specialists should be conducted to ensure that the final decision does not hurt either of the parties (Wall, 2014).
References
Albuquerque, A. (2014). Interculturalism, bioethics perspectives, and human rights. Global Bioethics, 25(2), 81-94. https://dx.doi.org/10.1080/11287462.2014.920162
Alrc.gov.au, (2017). Informed consent to medical treatment | ALRC. Alrc.gov.au. Retrieved 23 March 2017, from https://www.alrc.gov.au/publications/10-review-state-and-territory-legislation/informed-consent-medical-treatment
Battard, J. (2013). Informed Consent. Jona?s Healthcare Law, Ethics, and Regulation, 15(4), 145-146. https://dx.doi.org/10.1097/nhl.0000000000000019
Cohen, I. (2013). Globalization of Health Care (1st Ed.). Cary: Oxford University Press, USA.
Devettere, R. (2016). Practical decision making in health care ethics (1st Ed.). Georgetown: University Press.
Fee, S., & Belland, B. (2012). The role of criticism in understanding problem solving (1st Ed.). New York, NY: Springer.
Kerridge, I., Lowe, M., & Stewart, C. (2013). Ethics and law for the health professions (4th Ed.). The Federation Press.
Petrini, C. (2016). Organ Allocation Policies 10 Years after UNESCO’s Universal Declaration on Bioethics and Human Rights. Transplantation Proceedings, 48(2), 296-298. https://dx.doi.org/10.1016/j.transproceed.2015.10.059
Pozgar, G. (2013). Legal and ethical issues for health professionals (1st Ed.). Burlington, MA: Jones & Bartlett Learning.
Saul, P. (2013). Neat model for ethical problem solving. The Medical Journal of Australia, 199(7), 511. https://dx.doi.org/10.5694/mja13.10868
Spofford, C., & Easker, D. (2015). Unresponsive Patient in the Post Anesthesia Care Unit. Mededportal Publications. https://dx.doi.org/10.15766/mep_2374-8265.10005
Stirton, R. (2017). The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: A Litany of Fundamental Flaws? The Modern Law Review, 80(2), 299-324. https://dx.doi.org/10.1111/1468-2230.12255
Taylor, H. (2015). Legal and ethical issues in end of life care: implications for primary health care. Primary Health Care, 25(5), 34-41. https://dx.doi.org/10.7748/phc.25.5.34.e1032
Unesco.org, (2017). Universal Declaration on Bioethics and Human Rights | United Nations Educational, Scientific and Cultural Organization. Unesco.org. Retrieved 23 March 2017, from https://www.unesco.org/new/en/social-and-human-sciences/themes/bioethics/bioethics-and-human-rights/
Wall, J. (2014). Human Rights Reasoning and Medical Law: A Sceptical Essay. Bioethics, 29(3), 162-170. https://dx.doi.org/10.1111/bioe.12083
Yu, T., Holbrook, J., Thorne, J., & Puhan, M. (2016). Using a patient-centered approach to benefit-harm assessment in treatment decision-making: a case study in uveitis. Pharmacoepidemiology and Drug Safety, 25(4), 363-371. https://dx.doi.org/10.1002/pds.3959
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