Medical Legal and Ethical Issues - Term Paper Example

Applying Law and Ethic sin Practice Insert Name Tutor Date Medical legal and ethical issues When faced with an illness, the patient, his or her family and the health care givers will have to make a decision on the treatment that they want to seek. The right to make a choice is legally granted and affirmed by the medical ethics through acknowledgment of ethical principles of beneficence/non-maleficence. The decisions on the type of treatment are based on the goals of the medical care which vary as the disease progresses. However, in most cases, the ultimate goal is to cure but in some cases it may to improve the quality of life, to avoid premature death or to relief suffering. The patient and his or her family however need to be guided as they make such a decision. The medical team needs to offer them with information that will enable them to make an informed decision. Once they have adequate information, they will therefore set treatment goals according to their personal values. This paper therefore looks at issues of treatment vs non-treatment in a case of Mr. GB who is unable to speak and his fate is therefore in the hand of the decision to be made by his family on whether to take him for dialysis or not. The discussion is however based on the ethical principles of beneficence/non-maleficence. Ethical principles of beneficence and non-maleficence Beneficence is an action that is taken for the sake of benefiting other people. These are actions that are taken to prevent harm, or to end it in order to improve the situation of other people. Medical practitioners are supposed to avoid causing harm to the patients but at the same time they have the obligation of helping the patients. They are therefore bound by the obligatory beneficence as opposed to ideal beneficence which tries to benefic others in all circumstances. Due to the nature of the relationship that doctors have with their patients, they have an obligation to prevent harming them and to remove harm from them while at the same time weighing the balance between the risks and benefits of their actions (Kerridge, Lowe & McPhee, 2005, p 52). Non-maleficence means “do no harm”. This implies that healthcare providers must avoid giving ineffective treatments to the patients because these put them at a risk and they have no benefit at all but may harm the patients. They must also not perform any action that may cause harm to the patient if the benefits of that action are not worth the risk. However,. Since most medical interventions cause harm on top of the benefits, the principle of non-maleficence is helpful when it is balanced with beneficence. Therefore non- maleficence hypothesize that the risks caused by a certain treatment must be viewed in terms of its likely benefits (Timko, 2004, p 129). It is however the role of the patient to decide whether the expected benefits will outweigh the harm. Failure to give treatment that may not be effective like in the case of Mr. GB is an act of non-maleficence. Balancing Beneficence and Non-maleficence Balancing beneficence and non-maleficence poses an ethical dilemma in many situations. This in other words means maintaining a balance between the risks and the benefits of a certain treatment and it occurs in so many almost every medical decision. In such cases, an informed consent form the patient is required. However, the doctor must give all the necessary information to the patient regarding the type of potential risks as well as the benefits that they should consider in making an informed decision. Eventually the patient weighs the benefits versus the risks although in most cases the benefits must outweigh the risks for the intervention to be considered ethical. Treatment vs. non-treatment In cases where treatment is considered not to have an impact or not to add any value to the quality of life of the patient, it may be withheld or withdrawn. Withholding or withdrawing treatment that has no benefits to the patient is acceptable both in medical ethics as well as the legal community. Withdrawal of treatment indicates that the treatment which is medically futile is stopped while withholding implies that a certain form of treatment is not offered at all (Livingstone, 2008, p 113). These concepts are applied where it appears no longer beneficial to fight a certain disease with aggressive or costly interventions while it is evident that the disease cannot be controlled. The concepts are mostly applied in the context of life sustaining as opposed to life saving therapies. However, to just continue with life sustaining treatment is usually considered an unjustifiable goal. Withdrawal or withholding treatment allows one not to start a treatment that may not be effective in achieving the treatment goal therefore stopping to avoid death-in-progress that was artificially delayed by the previous means (Mappes, & DeGrazia, 2006, p 328-329). It is also legally and ethically accepted that when a treatment proves to be futile, it should not be given. Difficulty is however posed in the explanation of medical futility to the patient or the relatives. A futile treatment is defined by Zucker & Zuker, (2007, p 76) as treatment that is not fulfilling its intended purpose or has almost zero benefits, or one that has no possibility of achieving the intended goal in real sense. The benefits in this case are improvement in the medical condition and the quality of life. It is often a challenge for the patient or the family members to accept the withdrawal or withholding of life sustaining treatment especially from the doctor’s point of view. However, the family may also reach a point where they may also request the withholding of the treatment. The case of Mr. GB is also a life sustaining point. He is in a condition where it is 100% certain that treatment will not even improve the quality of life and is therefore futile. The treatment that may be given will only be to sustain him alive which may also be very costly to his family. The haemodialysis that he is supposed to be undergoing will be a life sustaining treatment and will not improve the quality of his life. A life sustaining treatment is one whose function is only to prolong life but does not reverse the underlying medical condition. Haemodialysis is one of the life sustaining treatment. Specific provisions for decisions about withdrawal/withholding of life sustaining treatment It is only justifiable to withhold life sustaining treatment when: A. The patient is in a position to make decision; he can clearly understand the consequences of that decision and has stated that he does not want the treatment any more. (This is competent patient). B. Where the treatment has no further benefits to the patient. In some cases, the patient may not be able to explain his wish regarding the treatment. Such a situation may be solved by an Advance Directive, or Surrogate decision makers. An advance directive is a document specifically indicating the kind of decisions that the person would wish to make in a situation where he is unable to participate. This is like a living will. In other cases, the person may state specific people to make health care decisions on his behalf (Olick, 2004, p1-5). Surrogate decision makers are involved where there is no written document. Here people who are close to the patient and familiar with what he could have wished are used. According to the law, the hierarchy of family relationship should be followed to determine who will speak on behalf of the patient though all the family members are involved in reaching a consensus. The recognized hierarchy is lined as follows: i. Legal guardian who bears the authority to make healthcare decisions ii. Individual who has been give the durable power of attorney iii. Spouse iv. Adult children of the patient v. Adult siblings of the patient In Queensland State, this issue is provided for by the Guardianship and Administration Act 2000 (GAA) and the Powers of Attorney Act (PAA) which are collectively referred to as guardianship regime. A substitute person who is making decision and who in most cases must be a family member or a close friend must apply or comply with the general principles and the health care principles. General principles are complied with when the decision is due to financial or personal reasons while the health care principles are complied with when the decision concerns health matters and is not specific to the life sustaining treatment. The guardianship regime allows for withholding of the life sustaining treatment if it is in accordance with the general medical principles. When the decision is being made by the substitute decision maker, consent of the patient may not be required unless if the doctor considers the withholding to be inconsistent with the general medical principles (Willmott, 2007, p 287-314). In the case of Mr. GB, the decision lies on surrogate decision makers who are divided on whether to withhold haemodialysis which in his case, may not be of any benefit to Mr. GB. Approach to assist families in decision making Where there is a disagreement among the decision makers on whether to withhold the life sustaining treatment as in the case of Mr. GB, the physician plays the role of assisting in reaching the conclusion. There are eight steps that need to be followed. These include: 1. The physician should be familiar with the policies of the institution and the state laws on the matter 2. Chose the appropriate setting for holding the discussion with the decision makers 3. Ask the family what they understanding regarding the situation 4. Discuss the values of the patient as well as the general goals of the treatment 5. Come up with the context for discussion 6. Discuss that particular treatment giving them all the information regarding what the intervention can achieve as per the patient’s condition 7. Respond to the views of the members 8. Establish and implement the agreed plan. A consensus must be established even among the health care team on whether to withhold the life sustaining treatment. However, most clinicians find it east to withhold the treatment rather than withdrawing it once it has been initiated. Time should however be taken to reach this consensus and to resolve disagreements among the family members. In most cases, it is difficult decision for the family members to reach. It is recommended that emotional support should be sought during the process of making the decision and after the decision has been made. The decision can however cause feelings of guilt when one considers the risks of the treatment, its benefits and what the patient would have wished for himself. Support should therefore be sought from professional counselors, member of clergy or the close friends (Goold, Williams & Arnold, 2005, 909–14).   Most people find it not justifiable to withhold the treatment because of the associated costs. it is however advisable to avoid costly interventions that may have no benefit but on the other hand the obligation of the family to the patient outweighs their obligation to save money. Agreement between the surrogate decision makers is however very important when considering withholding of life sustaining treatment. Conclusion Withholding or withdrawing treatment that has no benefits to the patient is acceptable both in medical ethics as well as the legal community. However, this is an issue that poses dilemma to both the surrogate decision makers and the health care providers. Physicians are guided by the principles of beneficence and non- maleficence on deciding whether to continue with the life sustaining treatment or not and the various states have laws governing this issue which the physicians are aware of. It is therefore important for the physicians to explain to the family members the ethical and legal implication of their decision. Disagreements often arise among the family members on whether to withhold the life sustaining treatments or to initiate them where the patient is not in a capacity to make the decision. Wide consultation is however required from the physicians, professional counselors and the friends to the patient and the family. Bibliography Goold, S., Williams, B., & Arnold, R. (2005). Conflicts regarding decisions to limit treatment: a differential diagnosis.  Journal of American Medical Association; 283: 909–14. Kerridge, I., Lowe, M. & McPhee, J., (2005). Ethics and Law for the Health Professions. Queensland:Federation Press. Livingstone, D., (2008). Medical Futility: Standards of Care and Policy Recommendations. University of Washington, USA. Mappes, T., & DeGrazia, D. (2006). Biomedical Ethics. New York: McGraw-Hill. Olick, R., (2004). Taking Advance Directives Seriously: Prospective Autonomy and Decisions Near The End of Life. George Town University Press. Timko, R. (2004). Clinical Ethics: Due Care and the Principle of Non-maleficence. Washington: University Press of America. Willmott, L. (2007). Advance directives to withhold life-sustaining medical treatment : eroding autonomy through statutory reform. Flinders Journal of Law Reform, 10(2): 287-314. Zucker, M. & Zuker, H. (2007). Medical Futility: And the Evaluation of Life-Sustaining Interventions. Cambridge University Press. Read More