Legal and Ethical Issues to Medical Treatment - Case Study Example

2972NRS HEALTH LAW AND ETHICS (A CASE STUDY) Name Institution Abstract In a characteristically chaotic world occasioned by competing interests and individual pursuits, ethics, as an underlying principle of social justice, has increasingly become a rare virtue. From social deviance to criminal intent, the society has become inherently unjust as nobody wants to take responsibility for their actions. The emergent society is virtually devoid of all virtues that humanity once stood for. Introduction As everyone would attest, life is full of incidents and events in which one’s reasonable judgment is called into play. With each decision comes ethical and legal liability. For the case of 69-year-old Bruce, the facts of the case are quite simple. He is an adult who continuously and defiantly refused to seek medical intervention for his condition. In a deteriorating condition, Bruce was not legally competent to give informed consent. In fact, he categorically states, “I don’t want any operations – I’d rather die.” With the consent of the wife, the surgeon proceeds. Under the auspices of Australian law as it appertains to patient’s consent, Bruce has a legal course of action. He was operated against his will and he actually suffered damages because of the involuntary medical intervention. The surgeon in question ought to have heeded Bruce’s request; no operation should proceed after a legally competent patient refuses to consent. The question of Bruce’s legal competency to render this decision may be debatable but the ultimate consideration is that the law protects patient’s wishes. Bruce is viable to seek compensation from the hospital, which bears vicarious liability on behalf of the surgeon. LEGAL ISSUES As it appertains to medical treatment, the law grants a patient the ultimate privilege to decide whether they will undergo any particular treatment (Roth, 2012). The rule of thumb, as stipulated under medical ethics, states categorically that the patient’s decision to accept or reject any form of treatment is final; all health professionals are under legal and ethical obligation to respect the decision made by the patient. It is equally as important to note that as soon as a patient makes the decision, the potential health benefits or prospective risks associated with the medical treatment in question become irrelevant (Grisso&Appelbaum, 1998). This is to say that a patient with the required legal competency can decide not to undergo a particular treatment even if failure to do so renders her life in danger. This was the case for Bruce. His decision ought to have been respected (Drane, 1984). Similarly, a patient may decide to undergo an experimental treatment irrespective of warning by the doctors that undergoing such a procedure would have potential dangers such as permanent blindness or even death. In the United States, the UK, and other commonwealth countries, the patient’s decision is final unless in face of extenuating circumstances where the patient lacks legal competency to make such decisions. Patients who often lack legal competency to make informed consent include the mentally handicapped and minors among other designated groups of patients. Informed Choice and Legal Competency Sources retrieved from the annals of Australian health law highlight the fundamental elements required for patient approval to qualify as informed consent. To begin with, the doctor must explain in the simplest and most comprehensible terms about the nature of the medical intervention in question in a way that a patient understands fully what she is getting into (Etchells et al, 1996). Likewise, the patient must know all viable alternatives available; it is the work of the doctor to explain this. In addition, the patient must be in full knowledge of any foreseeable risks, potential benefits, and uncertainties involved if they are to undertake any of the available alternatives. The next important step is for the doctor to assess patient’s understanding of these elements (Freedman et al, 1991). The patient must be competent enough to understand what is at stake; lack of understanding disqualifies any subsequent consent. The final element, and the most essential one, is patient acceptance of the medical intervention; here, the patient gives the doctor a nod that they have fully understood everything and that the doctor may proceed with the treatment. Professor Thomas Kimble of Stanford University further reiterates that informed consent must be voluntary. The professor notes that coercion, duress, and undue influence are scenarios that tend to arise in medicine. Patient’s ignorance, fear, and vulnerability may allow a doctor to manipulate patient approval (Norton, 1976) Even as Bruce decides to sue, the surgeon may have a viable defense in his case based on doctor’s autonomy. Given the sensitivity of medical care provision and the fact that patient recovery ultimately depends on treatment, various issues may arise from time to time regarding the doctor’s autonomy, professional and ethical regulations, and patient’s best interest (Markson et al, 2001). The law confers on doctors and health care professionals the discretion to do what they deem best as it appertains restoring patient’s optimal health. As such, doctors - in extenuating circumstances – may decide the fate of the patient in spite of what the patient deems fit. Keeping this in mind, determining whether a patient has, the legal competency required to decide if they will undergo treatment requires a critical assessment of their (patient) mental capacity. The requirement for mental assessment depends on the severity of medical condition. Dr. Ellie Hathaway, a health practitioner in Sydney, notes that, in essence, the work of a competent doctor is to balance patient’s autonomy against what is in the patient’s best interest. Ultimately, patient’s best interest matters most – or at least that should be the case. In fact, Dr. Hathaway confirms that the requirement for patient’s consent is to allow them the chance to be an informed participant in decisions that affect their state of health and recovery (Markson et al, 2001). In this particular case study, however, this may not suffice seeing as Bruce categorical refusal of surgery would trump doctor’s autonomy in a court of law, as was the case in Michael Jackson’s doctor in the case of wrongful death. Legally speaking, the defense is weak. ETHICAL ISSUES In virtually every profession, there is a designated code of ethical and professional conduct. This code highlights the conduct that all professionals must uphold. In the medical profession, impeccable character and high moral standing is essential for all agents. The surgeon in question in Bruce’s surgery was well aware that the patient refused to consent to the surgery. Ethically, he had an obligation to turn down Betty’s consent since it had no legal basis. Ethics is about right and wrong. In an attempt to distinguish the right course of actions from that, which is deemed wrong, moral, and ethical scholars, have engaged in a series of deliberations over the years. The fundamental starting point of projected moral and ethical conjectures is based on the integral question: what is the yardstick of determining what is right or wrong? According to Professor Mark Heeling of Sidney University, morality and ethics can be viewed from to broad perspectives: Immanuel Kant’s Deontological ethics and Jeremy Bentham’s utilitarianism (Beauchamp, 1991). The utilitarian principle for evaluating morality is based on the notion that the right thing to do is that whose outcome is beneficial for the greater good. This is to say that a moral/ ethical act is that which bring more happiness than pain to a greater number of people. The second utilitarian principle considers the motive of the doer such that if one does something wrong but for the right reasons, it is justifiable. The second moral benchmark is Immanuel Kant’s Duty-Based Ethics. In his book Groundwork for the Metaphysics of Morals, Kant highlights what he calls the Categorical Imperative as the ethical and moral cornerstone (Kant, 1964). Kant believes that people ought to ‘do unto others what they would wish them to do unto them.’ This implies that human beings owe their neighbors a ‘duty of care and responsibility to protect.’ The first maxim of Kant’s categorical imperative states that people should only act such that they would wish to see the basis of their actions become a universal law. The second maxim states that one’s actions should treat others as an end not as means to an end. The categorical imperative states unequivocally that human beings ought to act so that their choice of action treats others not as a means to an end but as an end (Beauchamp, 1991). Ethical behavior involves moral conduct. Abiding by medical ethics is a sign of a high moral standing since by so doing one exercise their duty of care towards other people. By defying the patient’s wishes, the surgeon now faces a civil suit in which Bruce has damages described as “a very large and disfiguring scar and some ongoing difficulties with swallowing.” Conclusion As it appertains to medical treatment, the law grants a patient the ultimate privilege to decide whether they will undergo any particular treatment. The rule of thumb, as stipulated under medical ethics, states categorically that the patient’s decision to accept or reject any form of treatment is final; all health professionals are under legal and ethical obligation to respect the decision made by the patient. REFERENCES Appelbaum, P (2011).Informed consent: legal theory and clinical practice. New York: Oxford University Press Beauchamp, L. (1991). Philosophical Ethics: An Introduction to Moral Philosophy. New York: McGraw Hill Beauchamp, T & Childress, F (1994).Principles of biomedical ethics. New York: Oxford University Press. Buchanan, E (1989). Deciding for others: the ethics of surrogate decision making. Cambridge: Cambridge University Press Drane, F. (1984).Competency to give an informed consent: A model for making clinical assessmentsSidney: JAMA. Etchells, E, Sharpe, G, Elliott C, & Singer, A. (1996)“Bioethics for clinicians: 3. Capacity” Australian Journal of Psychiatry Freedman, M Stuss, T, &Gordon, M. (1991) “Assessment of competency: the role of neurobehavioral deficits.”Ann Intern Med. Grisso, T &Appelbaum, T (1998). Assessing competence to consent to treatment: a guide for physicians and other health professionals. New York: Oxford University Press Kant, I. (1964). Groundwork of the Metaphysic of Morals. Harper and Row Publishers, Inc Lo, B. (1990). “Assessing decision-making capacity”Law Medicine and Health Care Markham, I. S. (1998).“Ethical and Legal Issues.”Oxford Journals , 1011-1021. Markson, J, Kern, C, Annas, J &Glantz, H. 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