Law and Ethics - Malette v Shulman, 2 Med LR 162, Donnelly J - Essay Example

[Manager] 27 May LAW AND ETHICS It will inappropriate to leave Jack in his home even if he it is his decision not to be brought to the hospital. Although it is the duty of a doctor to respect the patient’s wishes as to what treatments will be done to his body, it is still the primordial duty of a doctor to protect and preserve the health of his patient. Batten (1996, p. 632) concludes that, “However, the decision to refuse medical treatment can have grave consequences, and our society is driven towards the preservation of life. In the past the need for a higher level of understanding if treatment was refused was justified as refusal questions expert opinion and doctors were expected to act in their patients' best interest”. In the case at bar, Jack is already a 72-year-old man, who is at the time of the incident, intoxicated or under the influence of alcohol. Hence, at that precise moment, he cannot validly give consent of refuse a medical treatment which can put his health at risk. Therefore, although Jack is considered a competent adult, the current situation he is into will endanger his life if he refuses to be given a medical treatment taking into consideration his old age. His present medical condition can lead to further complications which can only be prevented by a timely treatment shall to be administered to him. 2. It is important that doctors shall give an assurance that Jack’s condition is stable. A certification coming from a doctor that Jack is out of any danger will justify Jack’s wishes to be left at home and that he is on his way to recovery. In the case of Malette V Shulman, [1991] 2 Med LR 162, Donnelly J., highlights that “the right to refuse treatment was an inherent component of the supremacy of the patient's right over his own body not premised on the risks of refusal. He further where a competent adult rejects and medical treatment, “the courts cannot be dictated by its view of what would be in the best interests of the patient but must look to the validity of the refusal in terms of the capacity of the patient t o give it to determine whether it must be respected”. It is the duty of the doctor to “promote the health of their patients and the public and the patient’s health their primary concern”. Details of good medical practice and duties of a doctor can be found at the General Medical website, which can be viewed at < http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp>. Although Jack is a competent adult who can decide what to do with his own body, it is important that the first priority is the health of Jack and ensure his speedy recovery. It is the duty and responsibility of the doctor to make the care of his patient the main concern. The best interest and welfare of the patient should come first. 11. Although Jack may demonstrate the capability to carry-out a normal conversation, the fact that he is intoxicated and on warfarin is an indication that his present medical condition is unstable. The doctors cannot rely on the decision of Jack to stay at home and refuse treatment because his right to self-determination is impaired and inaccurate. His irrational decision of choosing to stay at home which can lead to internal hemorrhage or blot clot in his head signifies that he is incompetent to make a sound decision to protect himself. In the case of Re: C (Adult: Refusal of Treatment), [1994], the Supreme Court ruled that he legal test for competence is set out in Justice Thorpe's decision. “First is the ability of the patient to comprehend and retain the information; and Secondly, believing it and Thirdly, weighing it in the balance to arrive at a choice." Here, there is a clear indication that the patient cannot fully understand and comprehend the consequences of his actions and decisions because he is under the influence of drugs (warfarin) and alcohol. Therefore, it is the duty of the doctors and the people surrounding him to make an intelligent decision for Jack, which is to bring him to the hospital. 12. In the case of Jack, he cannot make a competent decision and to fully understand the consequences of his choices because he is presently intoxicated and sedated by warfarin. Hence, it is the ethical and moral duty of the doctor and the people around Jack to persuade him to seek medical treatment because it will be best for his interest and welfare. Due to his old age, the main goal of the doctors should be to prolong and to preserve his life. In my opinion, I believe that he is incompetent to make an intelligent decision for himself because he is under the influence of drugs and alcohol. Hence, his mental ability is impaired, added to the factor the he is already 72 years of age. His physical condition is highly at risk which can lead to further medical complications which can cause serious danger to his life. The fact that he may currently be suffering from internal hemorrhage due to the accident is the justification that he needs to be treated immediately in the hospital despite his refusal of treatment. 13. At this stage, I am unhappy to leave Jack and his wife at home if he persists to refuse to be brought to the hospital. It is the ethical and moral obligation of doctors to preserve the life of their patients and make decisions which will be for the best interests of patients and their welfare should be the primary concern. Although the case of Airedale NHS Trust v Bland [1993] 1 All ER 821, held that under the “principle of autonomy”, a competent adult is completely at liberty to decline to undergo treatment, even if the result of his doing so will result to his death”, I am still saddened by the fact the Jack is making an illogical decision. In his case, the competency of Jack is questionable because he is under the influence of drugs and alcohol, and thus, making him incompetent to make a valid decision. Therefore, any decision made by him can be overruled because he is not capable to fully comprehend and understand the consequences of his choice. References: Airedale NHS Trust v Bland1 [1993] 1 All ER 821 Batten, D. A., 1996, “Informed consent by children and adolescents to psychiatric Treatment”. Australian and New Zealand Journal of Psychiatry, pp. 30, 623-632. Finfer, S. Howell, J. Miller, K. Willett & J. Wilson-MacDonald, "Managing patients who refuse blood transfusions: an ethical dilemma", British Medical Journal, vol. 308, no. 6941, 28 May 1994, 1425 General Medical Council, Good Medical Practice: Duties of a Doctor (2006), viewed on May 13, 2011, from < http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp> Kee, P. T., “Refusal To Consent to Treatment on Religious Grounds”, Murdoch University Electronic Journal Of Law, vol. 2, no. 2, July 1995, viewed on, from Malette V Shulman, [1991] 2 Med LR 162 Re: C (Adult: Refusal of Treatment), [1994] Read More