Chance of Mortality: Health Care Ethics - Essay Example

Chance of Mortality: Health Care Ethics Summary of the Case Study A 20-year old patient named Bob was admitted to hospital after a car crash. Since the patient has a 95% chance of mortality, the doctor suggest the strong need to amputate his leg above the knee. On the other hand, Bob will have full mobility in case he survives without his leg being amputated. The medical team explains the need for the operation. However, Bob refuses the amputation on the basis that he is on a football scholarship at a major university. Bob’s family and friends strongly supports Bob’s decision. Based on the report of a psychiatric consultant, “Bob” shows no signs of (clinical) depression and is fully competent at the time he has made his decision. In the end, Bob insisted that no operation take place. Purpose of the Study Considering the concept of pure health ethics, the researcher will determine whether or not the surgeon should amputate Bob’s leg. Along the way, the researcher will discuss the justification behind the recommended solution to the problem. Recommended Solution for the Case Study Considering that Bob is already 20 years old and shows no signs of clinical depression at the time that he decided not to go through the surgery, it is but ethically accepted that the surgeon should respect the decision of the patient given that the health care practitioners did their best in trying to convince the patient to accept going through the surgical operations. In line with convincing the Bob to go through the surgical procedure, the health care practitioners should provide Bob with a subjective description of the consequences behind accepting and rejecting the amputation surgery. As an ethically accepted practice, the health care practitioners should determine the mental condition of the patient during the time the decision for refusing the surgical treatment was made. In case Bob was not in the right frame of mind at the time the decision was made, health care practitioners should try to talk with the Bob regarding the surgery after giving him some time to cope with the emotional stress attached with losing a limb. After having done everything the health care practitioners could do to save Bob’s life, health care professionals are left with no other choice but to respect the final decision of Bob regardless of whether he will survive the car accident or not. Discussion At all times, health care practitioners such as the physicians, surgeons, therapists, and nurses are responsible in balancing their duty of care with regards to the autonomy1 or the practice of informed consent; including the practice of non-maleficence2, beneficence3, and justice4 when it comes to dealing with different cases of each patient. (Bailey, 2007) Importance of Autonomy or Informed Consent The modern nursing ethical theory supports the unique role of health care practitioners in terms of giving respect to the patients’ autonomy in decision-making for their own treatment as well as being informed with the general facts concerning the process of their treatment. In general, the practice of informed consent is a part of the general ethical practice when it comes with providing a major intervention on the health care service provided to the patients. (DOH, 2001a; p. 8) Based on the principle of informed consent, patients have the right to be informed about the health care treatment or physical inspection that will be provided to them regardless of their physical and mental condition. Basically, autonomy is not merely all about making a personal decision on proper treatment and care, it is also about ‘self-determination’ wherein the patient is entitles to make a voluntary plan on how he/she would go through with life. (Savulescu, 1994: 647) In line with the ‘self-determination’, the health care practitioners should assist the patient with the decision-making for the proposed treatment by initiating a subjective discussion with the patient regarding all the possible consequences behind a particular action. (Savulescu, 1994: 647 – 648, 654) In the case of Bob, the health care practitioners has already explained to Bob that: (1) there is a 95% chance that he will not survive the car accident without amputating his leg; (2) a football player could still be in the game with the use of prosthesis but the quality or the player’s ability to deliver a good game will significantly reduced; and (3) with or without wearing a prosthesis, Bob’s athletic ability is expected to decline as he aged. In the case of Bob, the patient would rather take the risk of saving his leg due to the fact that he is on a football scholarship program at a major university. As far as Bob is concern, loosing one of his leg would only mean giving away his entire life-plan. Considerations behind the Patient’s Voluntary Decision-making on Treatment In the process wherein the patient has voluntarily decided not to go through the necessary treatment procedures such as in the case of Bob, the health care practitioners has no other choice but to follow the decision of the patient regardless of whether the health care practitioners find the patients’ reasons behind the decision rational or irrational. (DOH, 2001b, p. 3) This is true especially when the patient is already a consenting adult or someone who is 18 years old and above. (DOH, 2001a; p. 4; DOH, 2001b; p. 7) Since Bob is already 20 years old at the time the car accident happens, a parental guidance is no longer necessary when making an important decision on treatment especially when the patient is capable of making his own judgement. (DOH, 2001a, p. 4; DOH, 2001b, p. 7) Instead, the health care practitioners should directly inform the patients with regards to the treatment procedure and seek an informed consent from Bob. Another important consideration that health care practitioners should take note prior to accepting the patient’s decision with regards to the provision of necessary health care treatments is the physical and mental state of the patient. In case the patient is psychologically or mentally depressed at the time he/she made the decision of refusing an important treatment procedure, the health care practitioners should give the patient a time to calm down prior to planning on talking with the patient to reconsider the treatment. (Savulescu, 1994: p. 651) According to the President’s Commission, “there is no reason for decisions about life-sustaining therapy to be considered differently from other treatment decisions since a decision to forego such treatment could hasten death…” (Savulescu, 1994: 653) The fact is, the idea of death is not always enough to change the patients’ final decision on accepting a treatment. This scenario can be applicable in the case of Bob, perhaps it is better to give Bob some time to think about the possible consequences of his own decision for refusing the amputation process. Since there is still six hours left before the operation will have to be performed, any of the health care practitioners should make an effort to try to seek for the Bob’s personal consent for the amputation. It is possible for Bob to change his decision at the last minute. In case Bob remains firm about not having his leg amputated, health care professionals should do nothing but to respect Bob’s final decision. By trying to convince Bob to reconsider the surgical procedures, the health care practitioners does not only satisfy the principles of autonomy but also the ethical concept of beneficence. (Bailey, 2007) Other Ethically Accepted Practices behind the Patients’ Decision on Treatment As part of an ethically accepted practice, all related information that is connected with sensitive matters such as the Bobs’ refusal on the leg surgery should be recorded properly in order to avoid some future miscommunication in case Bob died from not having his leg amputated right after he was confined at the hospital. (DOH, 2001a; p. 6; DOH, 2001b; p. 3) Conclusion When dealing with a life and death clinical situation, health care practitioners should always follow the health care ethics guidelines in order to deliver a universally accepted health care service all patients. In the case of Bob, the health care practitioners have already done everything they could do to convince the patient to undergo the amputation surgery. Since Bob is already 20 years old, the health care practitioners should directly deal with the patient in terms of seeking a legal consent for the surgery. Considering that Bob remains firm in his decision for avoiding the idea of going through the surgery, the health care practitioners have no other option but to respect Bob’s decision regardless of whether he will or not survive the car accident. In line with convincing Bob to undergo the amputation surgery, the health ethics requires all health care to follow the guidelines written behind the practice of informed consent. Table of Contents I. Summary of the Case Study …………………………………………. 3 II. Purpose of the Study ………………………………………………….. 3 III. Recommended Solution for the Case Study ………………………... 3 IV. Discussion ……………………………………………………………… 4 a. Importance of Autonomy or Informed Consent ………. 5 b. Considerations behind the Patient’s Voluntary Decision-making on Treatment …………………………... 6 c. Other Ethically Accepted Practices behind the Patients’ Decision on Treatment ………………………… 8 V. Conclusion ……………………………………………………………… 8 References ……………………………………………………………………... 9 References: Bailey, G. (2007). NASW Standards for Social Work Practice in Palliative and End of Life Care. Retrieved March 13, 2008, from National Association of Social Workers: http://www.naswdc.org/practice/bereavement/standards/default.asp DOH. (2001a). Retrieved March 13, 2008, from Reference Guide to Consent for Examination or Treatment: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4019079.pdf DOH. (2001b). Retrieved March 13, 2008, from Seeking Consent: Working with Older People: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009325 Savulescu, J. (1994). Rational Desires and the Limitation of Life-Sustaining Treatment. Bioethics , 8(2):646 - 661. Read More