Patient-Facing the Capacity to Refuse Life-Sustaining Treatment - Case Study Example

Assignment 3 Name Course Name Institution Name Date Introduction E is a patient facing numerous medical problems, which are traced to sexual abuse during early years. E suffers from anorexia and has other problems including alcoholism and personal disorder. E has been admitted and received different medication and has written the advance directive to refuse life-sustaining treatment. Questions exist on the significance of the advance directive in refusing life-sustaining treatment and the role of different bodies in addressing E requirements. The aim of the paper is to analyze whether E has the capacity to refuse life-sustaining treatment, the second part determines whether the advance directives refusing treatment are valid, the third section provides mechanisms of implementation of the advance directives while the last part discusses ethical and others factors, which may inhibit or improve the implementation of E proposals. E Capacity in Refusing Life Sustaining Treatment With prospective patients at the end of life, the decisions should be weighed in the significance of medical treatment against its potential of creating challenges to the patients and the community (Silvester & Detering, 2011). The decisions of a patient should incorporate aspects of loss of independence, compromise of dignity, suffering and pain, which have to be factored in the decision making process. Weighing or assessing the potential benefits and treatment burdens through the use of different levels of probability disregarding absolute certainty are categorical in making informed choices (Rhee, Zwar & Kemp, 2012). The patient and the doctors have to analyse the importance and significance of any medication, and these aspects are communicated to the patient. E has the medical experience and knowledge on the medication and variables contributing to the problems (Gray et al. 2013). It is likely E made the decision to pursue the medical career and excelled while in school. It may be extended into meaning E has the capacities to make appropriate decisions including refusing life-sustaining treatment. All patients, irrespective of lifestyle, culture, gender, race, and age are entitled to the same quality of life, compassion, and dignity (Chesterman, 2013). It does not foresee a situation in which the individuals are forced to make inappropriate decisions in matters such as the end of life care. A patient such as E understands the problems and the solutions to the problem (Willmott, White & Downie, 2013). E understands the future is not bright because E was not able to proceed with the medical course due to complications of anorexia. The mother is also facing the challenges and understand the problems E faces (White et al. 2011). Both E and the mother are in unison when it comes to health requirements since E experienced since childhood different problems. Due to the historical background of E, E has the capacity to refuse life-sustaining treatment. Assessing the capacity of E is important, and this can be achieved through a process rather that employment of a single framework. In E situation, the capacity is present because of the contributing variables and the factors resulting in the decision. It is likely E has discussed the issue with the family because the mother is supportive of the decisions (Eburn, 2013). E has gone through different medical facilities including the role of the courts in the entire process and information sought from other health professionals (Willmott, White & Downie, 2013). The E condition is worsening because of the movement into and out of different medical facilities with the worsening situations of drug abuse and alcoholism. In addition, the personal disorder can worsen. E faces different medical problems such as psychiatric (personal disorder), lack of nutrition (general health wise) and difficulties in eating. E is aware of these different problems and decisions of refusing life-sustaining treatment is valid and appropriate. Thus, E has the capacity to make the informed decisions of refusing life-sustaining treatment. Validity of E’s Advance Directives in Refusing Treatment The validity of the proposed decisions is premised on the medical situation and other variables influencing the health of E. The best strategy to determine the validity of the requirement is to analyse the issue from a legal perspective. The basic common law in Australia requires an individual caring for the other who is unable to care for self due to physical and mental incapacity a duty to provide necessaries of life (Bloomer et al. 2010). Criminal proceedings can be brought forward if an individual makes decisions to withdraw or withhold potentially life-sustaining treatment. In addition, the component of a doctor is integral in determining whether an individual can refuse treatment. The first criteria are querying “necessaries of life,” and in the case of E food is an integral component including appropriate medication. Without nutrition, it is nearly impossible for E to continue living. In Brightwater Care Group v Rossiter (2009) 40 WAR 84; [2009] WASC 229, Rossiter was sick and what kept the individual alive was the delivery of hydration and artificial nutrition through a tube placed in his stomach (Willmott, White & Downie, 2013). Rossiter was not in the terminal phase and Martin CJ one of the judges stated that the use of artificial feeding was a necessary of life even though it was lawful to withdraw the artificial feeding. Another important criterion is the aspect of “care and charge of a person.” The component is contained in the Criminal Code of Western Australia, and if the medical facility had an aspect of “having charge of” Rossiter, the medical facility was required to continue providing with the life-sustaining treatment. However, the aspect of “have charge” is debatable because of the experiences and qualification of E. According to the case study, E has extensive experiences in medicine and is able to make independent decisions (Willmott, White & Downie, 2013). In E’s capacity, E can seek health assistance from another facility, which is similar arguments present in the court. Thus, the Code of duty may not suffice because of knowledge and experiences of E in making independent decisions including the provision of advance directives. In Application of Justice Health; Re a Patient (2011) 80 NSWLR 354; [2011] NSWSC 432, Judge Brereton J argued that the doctor contributes to the decisions and medication requirements of the patient (Willmott, White & Downie, 2013). According to the Judge, a patient does not have a right to demand a specific treatment whether it comes to drugs and other specific treatment, and the prerogative is for the doctor (Sprung et al. 2014). Therefore, the doctors have the unilateral permit to withdraw or withhold treatment because these individuals have the capacities and knowledge to support the treatment requirements. The New South Wales Supreme Court may also rely on Crimes (Administration of Sentences) Act 1999 (NSW) in decision making and withdraw any medical assistance (Queensland University of Technology, 2016). The argument is premised on whether a prisoner who lacks decision making and who had end stage lung cancer has a right to access cardiopulmonary resurrection even if the doctors state the medication is futile. The judge highlight Section 72A of the Act in which it states “necessary for the preservation of their health,” in that the assertion does not specify the patient should access cardiopulmonary resuscitation (Willmott, White & Downie, 2013). The judge stated there is a difference of health provision that can mere prolong the life of an individual and the necessity of preserving the health. Therefore, if it is a prolongation and the entire process is futile, withdrawing the services suffices. In Guardianship and Administration Act 2000 (Qld) Section 79, the health provider is required to receive permission from the patient or alternative decision makes to withdraw or withhold life-sustaining treatment. The Guardianship Act 1987 (NSW) including the section 11 of the Guardianship Regulation 2010 (NSW) contains information on addressing the medical treatment requirements and when it comes to other treatment needs such as major and minor treatment. The Act also provides mechanisms and processes that guide the decision making including the variables required to accomplish the treatment and health provision. The NSW Supreme Court and NSW Civil and Administrative Tribunal (NCAT) provide modalities to address the requirements of guardians and the capacities of guardians. Procedure Employed in Implementation of Directives In NSW, advance care directives are required to be implemented even though the lack of specific legislation. According to the precedents, the Supreme Court associates advance care directives with personal rights and should be implemented. The implementation is important, and if a health care professional does not provide the directive, the health practitioner can be sued for negligence (NSW Government, 2016). In Hunter New England Area Health Service v A [2009] NSWSC 761, the Supreme Court illustrates the importance of advance care directive and the requirement of is implementation. The Supreme Court stated that provided clear and unambiguous information is provided, the advance care directive has to be implemented. The health services have to decide the impact of the decision on the individual and to the wider community (NSW Government, 2016). The health service incorporates the views of the individuals and consequences of the decisions in the wider stakeholders. For example, will E be allowed to leave the hospital and assigned a nurse to gather for E needs and requirements (Human Rights Law Centre, 2014). These are some of the areas that require discussions and guides in the decision-making with the health facility (Hanks et al. 2011). The mother of E and other family members can be involved in the discussions and contribute to the final decision. The procedure will also require the inclusion of the government agencies especially community-based organisations and health services facilities. One argument is to leave E to die in the health facility while the alternative is to allow E to go home (DLA Piper, 2013). Querying the effectiveness of these decisions is important since the dignity of an individual is paramount and should be upheld even if the individual has independent decisions (Bloomer et al. 2010). E may decide to go home but is E eligible for painkillers and other strategies to support the improvement of individual capacity. Such decisions involve engagement of E including the family members and decision formed based on informed experiences and knowledge. The last aspect is mitigation of consequences of the decision. For example, based on legal precedent, E is eligible to advance the requirements of stopping any medication premised on the written consent. The aspect of validity is proven, and the health facility and the family should understand the consequences (Willmott, White & Downie, 2013). It may include the decision of the government agencies participating in providing programs and awareness of the consequences. Discussion and presentation is one thing, and the actualization of the refusal for medication may create additional challenges (Lewis et al. 2014). The awareness and related programs enable these individuals to understand the consequences and capacities of their respective actions. It also involves contingency measures and risks mitigation strategies depending on the worsening situations. Hence, numerous processes and procedure are crucial in fulfilling the independent decisions of E and impact to the wider society. Ethical Factors, Legal Principles and Critical Thinking Frameworks The ethical factors are important in making decisions that affect the life of an individual especially when it comes to death or death related issues. An individual has to weigh the benefits and threats of the decisions including the expectations and views of the sick individual such as E. truthfulness, trust and other variables are important in ensuring E is informed of the threats of decisions made and potential control measures such as forced feeding and provision of alternative medication (Willmott et al., 2011). Creating the awareness and engaging other stakeholders ensure the views are enshrined into the decision making, and reduces the burden of ethical requirements. Specifying the ethical threats of stopping forced feeding and proceeding with the decision to refuse life-sustaining treatment advances the ethical and moral expectations. The legal requirements are integral in the decision making process, and the legal requirements have to be upheld. The doctors have different legal requirements including a code of conduct and oath of administering quality services and products depending on the requirements of the patients. The patients also have individual capacities to determine stoppage of any medication has illustrated by the numerous Supreme Court and other jurisdiction directives (Ethics Team, 2016). For example, if a doctor refuses to follow the directives of the patients, the doctor can sue for negligence. It may be argued that the person with benefit and given more consideration is the patient because the individual determines the nature and circumstances of care. Hence, balancing the needs of the patient and the health provider experiences and knowledge are important in preventing legal complications. It is imperative to note, patients face numerous challenges and the decision making process is sometimes not straightforward (Rhee & Zwar, 2011). The important aspect is that all decision making has to uphold and reflect respect for life and the independence of the patients. The patients have the right to know and choose health requirements. The decisions have to adhere to standards of good medical practice. It means that balancing the needs and requirements of the patients should incorporate aspects of medical practice (Tassie et al., 2013). The healthcare professionals have the capacities to advise and provide appropriate medication and information. However, the independence of the patient should not introduce aspects of medical malpractices and other factors that does not meet the standards of good medical practice. In making decisions, it is imperative to receive appropriate documentation and information. In the case of E, it includes obtaining the prerequisite consent, which is possible through advancing a collaborative approach. The significance of the collaborative approach is to obtain and provide different information, leading in making informed choices (Bloomer et al. 2010). The doctor provides qualified information, and the patient is able to query the information and determine whether the current decision or previous decision is valid and viable. Hence, encouraging collaboration between the doctors and the patients (patient’s representative) is important in making informed decisions. The decision making is a demanding requirement, and the decisions made should reflect the requirements of the patients and the experiences of the medical operatives. In decisions made, transparency and accountability are important to weigh the effectiveness and efficacy of the decisions made. It is also integral for meticulous documentation in the decision making the process to enable tracking of the decisions made to prevent conflicts and misunderstandings. In addressing the views and perspectives of the team members, it is important to analyse the situation through the provision of crucial information including the legal requirements. These are achieved through effective communication and employing collaborative approach. It is paramount to raise the role of the health professional in advancing the welfare and health of the individuals. The welfare cannot remain as only the treatment but also following the requirements and expectations of the patient. A constrained view in which the health provider considers self-perspectives may be argued as selfish and highlighting these different requirements may improve the perception to the decisions and embrace the views of E. Conclusion E is facing medical and health problems due to the abuse she received at her early ages. E got admission to the medical school and was able to learn for some time, but the health problems limited her capacity to receiving treatment. E has the capacity to refuse life-sustaining treatment because is understand the terms and other medical professionals support the requirement. In addition, the advance directives are valid because of the extensive background including the support from the mother. The doctors and health professionals believe that any medical may not assist, and all strategies are in futility. Numerous court precedents including legislations and directives in place indicate the importance of fulfilling the requirements and needs of the patient. Therefore, incorporating the ethical and legal principles in the implementation of the directives is important and also effective communication and collaborative approach are important in advancing teamwork. References Bloomer, M. J., Tiruvoipati, R., Tsiripillis, M., & Botha, J. A. (2010). 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P., Willmott, L., Trowse, P., Parker, M., & Cartwright, C. (2011). The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment: part 1 (New South Wales). Journal of Law and Medicine, 18(3), 498-522. Willmott, L., White, B. P., & Downie, J. (2013). Withholding and withdrawal of ‘futile’life-sustaining treatment: Unilateral medical decision-making in Australia and New Zealand. Journal of Law and Medicine, 20(4), 907-924. Willmott, L., White, B. P., Parker, M., & Cartwright, C. (2011). The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment: part 3 (Victoria). Journal of Law and Medicine, 18(4), 773-797. Willmott, L., White, B., & Downie, J. (2013). Withholding and withdrawal of “futile” life-sustaining treatment: Unilateral medical decision-making in Australia and New Zealand. Thomson Reuters. 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