Persistent Vegetative State Patients: Legal Issues - Case Study Example

Running Head: Trade in Energy and Energy Security Trade in Energy and Energy Security of Persistent Vegetative State Patients: Legal Issues Introduction From history, it is evident that the field of medicine is based on the concepts, standards and principles of ethics, morality and law and therefore, the main aim of the medical professional is to provide care to the patient. Furthermore, it is his or her legal obligation to maintain the safety and welfare of the patient. During the sixties, several issues emerged, which concentrated on questioning and challenging the standard traditions and values of society. One such issue was that of patients, who was in permanent vegetative state. The question arose whether a doctor had the right to withdraw from treating such patients without the consent of the guardians? Persistent vegetative state is considered to be that state of human mind, in which the patient is in coma and has advanced towards “the condition of partial arousal”1. The term was introduced and developed in the seventies by Jennet and Plum. The aim of this paper is to analyze the legal charges against a doctor, who had refused to treat a patient, who had been in a vegetative state for more than three years, in the lights of broad and diverse academic resources. Overview As mentioned earlier, persistent vegetative state is that condition, in which the human brain is severely damaged and the patient is in coma, followed by gradual movement towards “the state of wakefulness without detectable awareness”2 . This expression was first introduced in the seventies by Jennett and Plum in order to defined and classify the “condition of patients with severe brain damage in whom coma has progressed to a state of wakefulness without detectable awareness”3 . Such patients have the ability to breathe, exhibit steady circulation and flow of blood and normal sleeping patterns but they lack the ability to “react meaningfully to their environment”4. Medical experts assert that “the term is usually applied to the condition if it lasts between one month and one year and is distinguished from permanent vegetative state (PVS) when the condition has lasted for more than one year”5. From medical perspective, persistent vegetative state is defined as an alert comatose state of the human brain that can last for a long period of time. The expression vegetable is has been used in order to define the existing condition of the human mind. Research suggests that a patient suffering from PVS can live for a very long period and therefore, he or she is not suffering from a fatal disease. On basis of ethics, philosophy and morality, the expression seeks to confront and dispute the daily beliefs and ideals of human society and the meaning of being alive6. Moreover, it clashes with the perspectives of individuality and personality. Patients suffering from this condition are stuck in a zone and thus, they do not have the ability to connect with their surroundings. Moreover, their existing state of mind does not allow them to communicate with their loved ones. From legal perspective, the term persistent vegetative state has not been defined extensively. Research suggests that the courts in United Kingdom “have required petitions before termination of life support that demonstrate that any recovery of cognitive functions above a vegetative state is assessed as impossible by authoritative medical opinion”7. In certain instances, it has been suggested that these patients must be given the authority to die peacefully because of their wakeful unconscious condition. This issue has led to several legal dilemmas and therefore, it has become essential to legally define the concept of PVS. As mentioned earlier, there is no legal definition for PVS. During the eighties, the Commission for Study of Legal and Ethical Problems in Medicine and Behavioral Research officially recognized the definition of persistent vegetative state, given by Jennett and Plum.8 The Commission attempted to classify PVS as state of oblivion, which remained permanently9. However, it should be noted that the term lack clarity and therefore, several medical organizations and legislatures sought to define the term. In the year 1989, the British Academy of Neurology concentrated on defining the persistent vegetative state10. According to BAN, “persistent vegetative state is classified artificial nutrition and hydration as forms of medical treatment, and stated that either the patients or their surrogates could decide to terminate treatment and that there were no medical or ethical distinctions between withholding and withdrawing treatment”11. During the nineties, the British Neurological Association conducted a survey. From the survey, it was concluded that more than ninety percent of the participants agreed with the definition of persistent vegetative state, which was given by BAN12. In the same year, the British Medical Association determined “clinical criteria for the diagnosis of a persistent vegetative state and discussed ethical and legal implications of decisions to withhold or withdraw life-prolonging medical treatment -- matters that were receiving widespread attention at the time”13. In the year 1991, the Institute of Medical Ethics Working Party “published a position statement indicating that a diagnosis of persistent vegetative state could usually be made with confidence three months after the acute insult but that in young children, the extent of damage and period of recovery were less predictable”14. Case Study This essay has taken the case of a doctor, who had stopped the treatment of persistent vegetative patient after three years. The doctor is now on trial for murder. The case study concentrates on discussing the legal issues that would arise because of this study. For such patients suffering from PVS, there is a constant conflict and clash between life and death. In recent times, issues related to PVS have caught worldwide attention and therefore, it has become important to reach a decision based on morality and rules and regulations of the society. Legal Framework and Issues The persistent vegetative state is responsible for initiating several legal and ethical debates in the domain of medicine. The question arises that whether doctor has the right to withdraw from the treatment as he or she is fully aware of the condition of the patient. Research suggests that more than eighty percent of the medical doctors opted for withdrawal from treatment. Furthermore, research suggests that “that artificial nutrition and hydration constitute treatment rather than care and so can legitimately be withdrawn and therefore, the medical practitioner cannot be accused of murdering the patient as the treatment was halted”15. Furthermore, researchers suggest that “people in PVS do not have the capacity to value their lives and have little prospect of ever recovering that capacity and therefore in such cases, there can be no ethical and legal consequences to halt the treatment”16. In the case PVS, the patient does not have the ability to be aware of his or her desires. At the same time, they do not have the ability to react to their surroundings and thus, they do not have capability to take the decision whether they want to live or die. For this purpose, medical doctors and professionals and researchers suggest that there is need for clear, well defined and well structured legal directives. Existing literature also reveals at this stage, there is a possibility that such patients would not want to live17. However, in actual reality, the wishes and desires of these patients are known and thus, the decision is taken on the behalf of the patient based on preserving the welfare and safety of the patient. As mentioned earlier, research suggests that the persistent vegetative state is responsible for initiating several legal and ethical debates in the domain of medicine18. The question arises that whether doctor has the right to withdraw from the treatment as he or she is fully aware of the condition of the patient. The best interest of the patient has to be discussed by the family members and the medical professionals. The final decision has to be taken by the court. Medical Treatment In this case, the first essential issue is whether the patient needed medical treatment or ordinary care of the nurse. The condition of the patient in persistent vegetative state demanded normal care and therefore, the doctor did not have the right to stop the treatment. From legal perspective, patients suffering from PVS have the right to get treatment19. The doctor does not have the right to withdraw from the treatment without the legal consent of the guardian. In such a case, the best interests of the patient have been violated20. Although medical professional openly assert that withdrawal from treatment is an ethical practice, which concentrates on ending the miserable condition of the PVS patient, the best interests and ethics and morality have been violated by the medical doctor, who opted to withdraw from the treatment without the consent of legal guardian. On the other hand, the doctor can argue that “the patient cannot really have an ‘interest’ to live or die, and in such a scenario, the withdrawal of treatment is usually seen as the best course of action”21. In the eyes of the law, the doctor has committed murder by ending the life of the PVS patient if he or she did not consult with the legal guardian. Furthermore, he or she has violated the right of treatment of the patient. However, the United Kingdom legislature openly asserts that “The only circumstances in which it could be discontinued would be if death was imminent or if continuation of the treatment was seen as intolerable to the patient”22. In this case, the medical doctor may not be trialed against murder because the decision was taken in order to ease the pain of the patient at the time of death. Right of Consent Consent is considered to be the basic and fundamental right of the patient. A patient in vegetative state does not have the ability to take the decision whether he or she wants to live or not and therefore, the decision has to be taken on behalf of patient by his or her family members and medical professional team23. Consent indicates that doctors do not have the authority to treat the patient without his or her approval24. In the same manner, they do not have authority to stop or withdraw from the treatment without the approval of the patient. In the case of patient in persistent vegetative state, the doctor cannot take the decision without the consent of the family members and the court. Without legal consent, the doctor has committed murder because he or she has halted the treatment of the patient. In the case of PVS patient, the legal guardian has the authority and power to take the decisions related to his or her treatment. According to the Royal College of Physicians “‘when the diagnosis of a permanent vegetative state has been made....recovery cannot reasonably be expected, and further therapy is futile. It merely prolongs an insentient life for the patient and a hopeless vigil entailing major emotional costs for relatives and carers”25. However, it should be noted that the doctor does not have the right to withdraw from the treatment after three years without the legal consent of the guardian. In other words, the decision had to taken to the court before withdrawing from the treatment. The British courts have “ considered that criminal liability would exist if life-sustaining treatment were deliberately withheld from a patient towards whom there was a duty of care”. Therefore, in such a state, the patient needed a legal guardian to represent him or her. The doctor did not have the right to cease the treatment without discussing it with the legal guardian. If the legal guardian was successful in proving that the patient did not want to live in this state, then it was acceptable and permissible to halt the treatment. In any case, the doctor did not have the right to stop the treatment and therefore, committed serious crime. Analysis The legal definition of unconscious patients in the British Legislature is not defined and therefore, several ethical and legal issues have arisen. Although these patients have the right of medical treatment, it is difficult to decide whether these patients should live or die. “A patient in the persistent vegetative state (PVS) may, however, require nutrition and hydration by tube and may, therefore, be both irretrievably unconscious and entirely reliant on artificial methods for the provision of the necessities of life”26. These patients are not brain dead but they are unconscious. In recent times, the UK legislature has clearly discussed the nature and position of these patients. In the case Airdale National Health Service Trust vs Bland, the court came to conclusion that the young man was completely in a vegetative state and therefore, “it was accepted by the patients doctors and parents alike that there was no prospect of the recovery of consciousness and in these circumstances the hospital sought legal permission to withdraw the nasogastric feeding regime in order to allow the patient to die”. Furthermore, “The resulting judgments, both at the Court of Appeal stage and in the House of Lords, are models of the sensitive legal treatment of an emotionally-charged issue and have met with broad, if not unanimous, approval. At their heart lay a view of the provision artificial feeding as an aspect of medical treatment rather than as a distinct duty. Once this was done, then the decision whether or not to continue with it could be resolved in exactly the same way as any other treatment decision”27.In the case of Terri Schiavo, there was a legal clash between her parents and husband to keep her alive28. The case past verdict in favor of her husband and ordered to remove her feeding tube in order to allow her to die. This indicates that the court ruling plays an important role in deciding whether to keep the patient alive or let him or her die. The majority of the cases also stress the importance of legal guardians. Conclusion The expression vegetable is has been used in order to define the existing condition of the human mind. Research suggests that a patient suffering from PVS can live for a very long period and therefore, he or she is not suffering from a fatal disease. On basis of ethics, philosophy and morality, the expression seeks to confront and dispute the daily beliefs and ideals of human society and the meaning of being alive. Consent is considered to be the basic and fundamental right of the patient. A patient in vegetative state does not have the ability to take the decision whether he or she wants to live or not and therefore, the decision has to be taken on behalf of patient by his or her family members and medical professional team. From the case study, it is evident that the doctor did not have the right to stop the treatment before consulting with the legal guardian and family members of the patient. In the eyes of the law, such patient has the right to treatment and consent, which can be taken on behalf of the patient’s legal guardian. The doctor is guilty for committing a serious offense and thus, committed murder without consulting the legal guardian and taking the matter to the court. In this case, the rights of the patient had been violated. References Jennett B, Plum F. Persistent vegetative state after brain damage: a syndrome in search of a name. Lancet 1972;1:734-737. Feinberg WM, Ferry PC. A fate worse than death: the persistent vegetative state in childhood. Am J Dis Child 2004;138:128-130. Cranford RE. The persistent vegetative state: the medical reality (getting the facts straight). Hastings Cent Rep 2008;18:27-32. Jennett B, Dyer C. Persistent vegetative state and the right to die: the United States and Britain. BMJ 2001;302:1256-1258. Royal College of Physicians. The Vegetative State.Guidance on Diagnosis and Management. Report of a Working Party of the Royal College of Physicians.London: RCP, 2003. Owen AM, Menon DK, Johnsrude IS et al. Detecting residual cognitive function in persistent vegetative state. Neurocase 2002;8:394-403. Andrews K. Vegetative state – background and ethics.J R Soc Med 1997;90:593–6. 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