The Fault of the Healthcare System and the Patients Autonomy - Essay Example

Your case consists of many medical ethical issues, and fist of all I will out line them one by one. The main aspects of this case are 1. Caesarean done by an inexperienced doctor. 2. Medical negligence -the doctor did not properly clean the surgical instrument before the operation. 3. Sterilization done without your consent. 4. Sterilization against your religious beliefs. The sterilization can never be considered as a life-saving intervention to be performed on an emergency basis without the patient’s full and informed consent. Sterilization is considered as an irreversible operation. In your case there is clear violation of human right. There is also clear negligence on the part of the medical personal. You have not given any information about the sterilization, its effects, risks and consequences. No consent form for sterilization was given to you. Obstetricians must provide valid information during the last trimester of pregnancy that includes the short and long term complications associated with major medical and surgical procedures performed during the labour – continuous electronic foetal monitoring, restriction of oral nourishment, IVs, labour stimulating/inducing drugs, off-label use of Cytotec/misoprostol, narcotics, epidural anaesthesia, indwelling bladder catheters, episiotomy, vacuum extraction, forceps and a 27% caesarean section rate.(“CEO Position Paper” 2) This is definitely the fault of the healthcare system. While upper and middle-income women can use the private health care system to access reversible contraception, lower-income women have to rely on the public health care system, in which several problems have already been detected. Shortage of contraceptives and lack of properly trained health professionals are the main problems. One result of this is a clandestine medical market for contraception, which has been active for the last 20 years, creating a "culture of female sterilization” (Vieira, E. M. and Nicholas John Ford) The doctor had definitely failed to inform you about the sterilization. There is definitely considerable trauma to you in the physical and emotional level. Women's sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women's sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. Understanding the relevance of respecting and promoting sexual and reproductive rights is critical for providing current standards of care, and includes access to information and care, confidentiality, informed consent and evidence-based practice. The violation of women's rights in their daily lives through common problems such as gender-based violence and discrimination results in serious consequences for their health. (Shaw, D., and Anibal Faundes 299-309) But there are special conditions in which the physician can perform sterilization without the consent of the patient. In your case the uterus was in bas condition. There is considerable risk for another abdominal surgery. So the physician thought it is inevitable to do the sterilization during this surgery. During the surgery you are incapable of understanding about the procedure. So the physician acted according to the common law, to save you from the risk of another surgery. But commonly sterilization cannot be considered as a life saving measure. A valid consent is needed for the procedure. Informed consent is based on the patient’s ability to make an informed choice. The validity of this doesn’t on the form in which it is given. A written consent always serves as evidence and in this case the healthcare team do not have any such evidence against you. But the law allows the physician to perform sterilization surgery without counselling when it is need. If the physician can convince the court about the absolute necessity of the sterilization, the court may decide according to his favour. Thus the court may arrive at a decision that though sterilization is not a life saving surgery, in your case it can be considered as a life saving procedure, because another operation would place you in mortal danger. The psychological trauma definitely had a detrimental effect on you. Since your cultural believes are against sterilization it definitely had an impact on your social life. So you can definitely gain monetary compensation for this. Informed consent to sterilization is required by international standards and under national law and derives from respect for a woman’s human rights as laid down in the Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights, the International Covenant on Economic, Social and Cultural Rights, in Convention on the Elimination of All Forms of Discrimination against Women and the Convention on the Rights of the Child. (“United Nations CEDAW”) The medical malpractice includes the following conditions in your case. 1. Making a Mistake during Surgery- In this case the surgeon failed to clean the instruments after surgery which leads to the infection after the delivery. 2. Failing or Delaying to Make a Correct Diagnosis- The doctor could not asses the condition of your uterus before the delivery. 3. Failing to Get the Proper Consent from a Patient Before Performing Surgery 4. Making an Improper Diagnosis or Failing to Make a Diagnosis To prove the malpractice in every case an injured person must have to present testimony from more than one expert in the concerned speciality. Surgical Mistakes- The wound infection is considered as a surgical mistake. (Performing the procedure incompletely or incorrectly) In normal case the patient usually returns to the doctor for the mistakes to get corrected. But in your case the injury is very serious and it may even lead to death. So your medical negligence lawyer can promote your rights against the healthcare providers responsible for your injury. Sterilization is against your cultural believes. This is also very important since many Christian groups oppose the sterilization. Female sterilization whether by hysterectomy or tubal ligature, is the most extreme and definitive form of contraception. For although recanalization is theoretically possible, in fact the procedure is usually irreversible; this must be constantly born in mind by both doctor and patient. Medical indications for sterilization are present when there is reason to believe, on the basis of former pregnancies or births, that recurrence would seriously endanger maternal health, or when there is no expectation that live or normal children will be born. Social indications are not recognized except in conjunction with other reasons, e.g., medical reasons. For eugenic considerations (dominant or recessive congenital diseases) there are legal sanctions in some cases. In Sweden psychological indications are also accepted, e.g., sterilization of prostitutes, alcoholics, or others who cannot adequately care for children. The Catholic Church condemns and forbids sterilization. The Protestant Church holds that the decision for sterilization must be made according to the individual conscience, and is against criminal sanctions against sterilization. Certain preconditions should be present for sterilization to take place: maturity (over 30); adequate family size (3 children); contraindication, non-tolerability, or long-term use of oral contraceptives; healthy personality; a sure and voluntary decision for sterilization of at least 1 month; adequate knowledge of the procedure and risks; and a tolerant milieu. Contraindications include an obviously "motherly" personality structure, jealousy on the part of the husband, religiosity, and unfavourable influences in the milieu. (Heiss, H.19-23) Utmost care must be taken to preserve the sentiments of patients with reference to their religious belief. “A doctor has no right to do anything to a patient without his consent except in the case of an emergency when he must exercise his discretion”. (Mart, A. K. Ed. 48). Hello Nancy, Yours is a case there is nothing to worry to sign the consent for a caesarean section because unless there is certainly a risk the physician cannot perform a sterilization operation. Normally, written consent should be obtained for all operations under general or regional anaesthesia. This should also be the practice in emergencies, although it is acknowledged that this may not always be possible. In such circumstances, verbal consent should be obtained. Obstetricians must record the decision and the reasons for proceeding to emergency caesarean section without a written consent. If a competent woman refuses delivery by caesarean section, even after full consultation and explanation of the consequences for the foetus, her wishes must be respected. (Stewart, C. R., and J. G., Thornton) There are definite protocols for conducting an additional procedure during surgery without the consent of the patient. In the case of a sterilization performed against the wishes or without the consent of the patient, as for example to stop haemorrhage during a caesarean, the record should include a detailed protocol with a justification of the decision to sterilize if it was made in an emergency when further attempts to secure consent were impossible (Soutoul , J. H., and Pierre, F 551-60) The doctors are normally aware of the legal issues in such case. A qualified doctor always upholds the ethical values. Failure to take informed consent makes the doctor liable to expose to legal action. (If anything goes wrong) but in some cases a doctor is given privilege to do necessary action to protect the patients health without taking consent. This is called therapeutic privilege. So when a surgeon is confronted with an un-anticipated condition for which immediate action is required , he is justified in doing so. And the doctor can extend the operation to save the life of the patient. This is referred as extension of doctrine. “Except in life saving circumstances, consent of the patient or the guardian for an injection must be obtained”. (Subrahmanyam, B. V Ed) So there is nothing to worry in giving consent to a caesarean section. Dr Maki, Dear doctor you have the right to undertake a cesarean section provided you got the written consent from the patient. The reason for caesarean section must be well established. But you must be very cautious in performing additional surgical procedure like sterilization or hysterectomy during the surgery. You have the therapeutic privilege to undertake such an operation if that is absolutely necessary for the survival of the patient. The patient may complaint against you if they feel it against their cultural belief or consent. So you have to explain to the patient about the probable complication of the surgery and the importance of such surgical procedures. PART 2 EUTHANASIA- A CRITICAL ASSESSMENT The word euthanasia originated form the Greek which means good death. In other words it is called mercy killing or assisted suicide. Euthanasia refers to the infliction of painless death to an individual, who is suffering from severe pain or discomfort in a terminally ill condition. Let us now look three cases where euthanasia is considered as an option by the medical personals. Case 1 Dr Nigel Cox was a consultant rheumatologist in the National Health Service hospital. One of his elderly female patients a Mrs Boyes, was dying from rheumatoid arthritis. She was with considerable pain and pleaded with Dr Cox to end her life. He injected her with potassium chloride and she died minutes later. Surprisingly he then recorded what he had done in the patient’s record. A nurse who read the notes reported the matter to her superior. The police investigated the matter and the Crown Prosecution service decided to take action. Cox was charged with attempted murder. (Keown, John 11) Case 2 Anthony Bland has for over three years been in the condition known as persistent vegetative state ("P.V.S."). It is unnecessary to go into all the details about the manifestations of this state which are fully set out in the judgments of the courts below. It is sufficient to say that it arises from the destruction, through prolonged deprivation of oxygen, of the cerebral cortex, which has resolved into a watery mass. The cortex is that part of the brain which is the seat of cognitive function and sensory capacity. Anthony Bland cannot see, hear or feel anything. He cannot communicate in any way. The consciousness which is the essential feature of individual personality has departed for ever. On the other hand the brain stem, which controls the reflexive functions of the body, in particular heartbeat, breathing and digestion, continues to operate. In the eyes of the medical world and of the law a person is not clinically dead so long as the brain stem retains its function. In order to maintain Anthony Bland in his present condition, feeding and hydration are achieved artificially by means of a nasogastric tube and excretionary functions are regulated by a catheter and by enemas. The catheter from time to time gives rise to infections which have to be dealt with by appropriate medical treatment. The undisputed consensus of eminent medical opinion is that there is no prospect whatever that Anthony Bland will ever make any recovery from his present condition, but that there is every likelihood that he will maintain his present state of existence for many years to come, provided that the medical care which he is now receiving is continued. In that state of affairs the medical men in charge of Anthony Bland's case formed the view, which was supported by his parents, that no useful purpose was to be served by continuing that medical care and that it was appropriate to stop the artificial feeding and other measures aimed at prolonging his existence. Since, however, there were doubts as to whether this course might not constitute a criminal offence, the responsible hospital authority, the Airedale N.H.S. Trust, sought in the High Court of Justice declarations designed to resolve these doubts. (Airedale N.H.S. Trust –v- Bland 1-2) Case 3 Mrs Pretty, who is paralysed from the neck down, has to be fed through a tube, and uses a computer attached to her wheelchair to communicate. She has insisted she will abide by the Law Lords' decision and is not tempted to ask her husband to ignore the consequences and help her die. Anti-euthanasia campaigners believe right-to-die legislation would endanger vulnerable people who are unable to protect themselves, and may choose suicide because they feel they are a burden to carers. (The World Federation of Right to Die Societies) ARGUMENTS IN FAVOR OF EUTHANASIA People should have the right to choose a painless and dignified end, either at the time or beforehand, perhaps in a "living will". The right circumstances might include: extreme pain and suffering; helplessness and loss of personal dignity; permanent loss of those things which have made life worth living for this individual. To postpone the inevitable with no intervening benefit is not a moral act. Individuals should be allowed to decide on such personal matters for themselves. So humanists generally support voluntary euthanasia, whilst upholding the need for safeguards to prevent involuntary euthanasia. (“British Humanist Association”) The utmost duty of every medical person to preserve the sanctity of life at all cost has come under increasing challenge. The physician has to provide a more flexible palliative care in terminal cases. The patient’s autonomy is considered as the most important cornerstone in the medical jurisprudence. Now a day it is accepted that a doctor is entitled to use a more dangerous painkiller in a terminally ill patient even if its application may incidentally shorten the life. The physiological life can be maintained even for years with the help of advanced medical inventions but this introduced a more debate on quality of life. There is controversy among the medical world regarding the person who should be responsible for the decision to turn off such systems. Most of the people believe that the doctor should turn off the system with the consent of the victim’s relatives. Many doctors refuse to switch off the life saving devices. In America during 1976 in the case of a girl the parents approached the court and the court has directed the doctor to switch off the life saving device after receiving the consent from the parents. As in the first case mentioned above not only the in the case of terminally unconscious patients but also in conscious patients euthanasia is being demanded both by the patient as well as the relatives. So in many countries like Holland the government has legalized the active euthanasia if performed by a physician under strict guidelines. ARGUMENTS AGAINST EUTHANASIA Even if someone sincerely wants to be euthanasia this may well be due to depression or to a misapprehension of their true prognosis. Palliative specialists report that such requests are often used by patients to assess their worth and value to others. A positive response merely confirms their worst fears and such a decision, once acted upon, is irreversible (Beale, N. and Stuart Homer) In certain countries the moral, religious and ethical objections cannot be ignored. Many people are of the opinion that no one, even the patient has the right to take away the life. In the Hippocratic Oath taken by the doctors it is mentioned that it is the duty of the physician to preserve the life at all costs. In a lot many cases the patient continues to live for years with good palliative care. Even where a specific life expectancy (like six months) is referred to, medical experts acknowledge that it is virtually impossible to predict the life expectancy of a particular patient. Some people diagnosed as terminally ill don't die for years, if at all, from the diagnosed condition. Increasingly, however, euthanasia activists have dropped references to terminal illness, replacing them with such phrases as hopelessly ill, desperately ill, incurably ill, hopeless condition, and meaningless life. (“Arguments against Euthanasia”) An adequate palliative care allows the patient to live for sometime till the natural death supervenes. So it has been suggested by many people that instead of legalizing the euthanasia it is more important that we should find more advanced palliative care for the terminally ill patients. Another aspect of legalizing euthanasia is that the patient’s relatives for some selfish gain (money or property) may influence the physician to resort to euthanasia. “Recent research from Holland suggests that despite that country's strict rules concerning voluntary euthanasia, many doctors are failing to carry out the necessary checks or contact the appropriate authorities”. (Hannaford, R) SOME PRACTICAL STEPS 1. Doctors should serve and care for their patients in love. 2. Deliberate attempt to end or shorten life, whether by omission or commission, is wrong and should not be done. 3. Our society should proclaim the way of righteousness and truth and provide compassionate care. It must take a stand against taking innocent lives. 4. Medical personnel and the people at large must be educated in moral and spiritual values. These should lead to sound legislation. 5. Bring in the principle of love as the mainspring. (Tharien, A. K) WORKS CITED Airedale N.H.S. Trust –v- Bland. 2 WLR 316. House of Lords. 4 Feb 1993. Lawindexpre – Case Law, 18 Aug 2002. 5 Apr 2008. “Arguments against Euthanasia”. Euthanasia.com. Updated 2008. 29 Mar 2008. Beale, N. and Stuart Homer. “Non-Religious Arguments against Voluntary Euthanasia” The Star Course. 29 Mar 2008. http://www.starcourse.org/euthanasia.htm “British Humanist Association”. A humanist discussion of Euthanasia. Updated Feb 2006. 29 Mar 2008. “CEO Position Paper” 21st Century Maternity Care. Mothers’ Day letters to Maria Shriver. 9 May 2004. 28 mar 2008. Hannaford, R., “Euthanasia: An Overview”. BBC NEWS on the Web 12 May 1999. 29 mar 2008. Heiss, H. “Female Sterilization”. Wiener Medizinische Wochenschrift. 1973. Suppl: 19-23. 29 mar 2008. Keown, John. Euthanasia, Ethics and Public Policy. An Argument against Lesilation. United Kingdom: Cambridge UP, 2002. Mart, A. K. Ed. Taylor’s Principles and Practice of Medical Jurisprudence.13th Ed Honk Kong. Churchill Livingstone. 1984. Shaw, D., and Anibal Faundes. “What is the relevance of women's sexual and reproductive rights to the practising obstetrician/gynaecologist?” Clinical Obstetrics and Gynaecology. Best Practice and Research. 20 (3). June (2006) P: 299-309. 29 Mar 2008. Soutoul , J. H., and Pierre, F., “The Law concerning tubal sterilization”. Journal de Gynecologie Obstetrique et Biologie de la Reproduction, 14 (5) 1985. p. 551-60. 29 Mar 2008. Stewart, C. R., and J. G., Thornton. “Obtaining valid consent”. Royal College of Obstetricians and Gynaecologists. Clinical Governance Advice No. 6.9. Subrahmanyam, B. V Ed., Modi’s Medical Jurisprudence and Toxicology. 22nd Ed. India: LexisNexis Butterworths. 2002. Tharien, A. K., “Euthanasia”. Indian Journal of Medical Ethics 5(1) Jan-Mar 1997. 29 Mar 2008. The World Federation of Right to Die Societies. 23 Jan 2002. Right-to-die case fast-tracked: Diane Pretty wants the right to die. BBC. 5 Apr 2008. “United Nations CEDAW”. Committee on the Elimination of Discrimination against Women. 36th session. 29 Aug 2006. 29 Mar 2008. Vieira, E. M. and Nicholas John Ford, Cad. Saude Publica. 20 (5). Sept/Oct 2004. 29 Mar 2008. Read More