Analysis of Legal and Professional Issues - Case Study Example

Introduction In life, there are certain decisions that should be made in time in order to save the situation. Some of the decisions include giving consent to a certain form of medical treatment or procedure, such as, a lifesaving procedure. Generally, most of these decisions have certain legal, ethical and professional issues that must be considered before any appropriate decision is made. This paper intends to shed light on some of the cases that involve such decisions and subsequently highlights some of the legal and professional issues involved in each scenario. Patient A The case of a 16 year old boy who has refused to undergo more chemotherapy is relevant to the Australian law on informed decision making among patients, especially those under palliative care. Informed decision refers to a two-way communication that takes place between one or more medical practitioner and a patient that is critical to the patient’s healthcare. This shows the ethical opinion that every patient has a right to make a decision that is suitable to them, considering their personal priorities, beliefs and circumstances. This involves the patient’s right to either accept or reject the offer of a particular healthcare and make a contrary decision. However, NSW Government (2005) says that to enable patients to exercise their rights to decide, they need relevant information. Consent entails a critical legal principle reflecting an individual’s agreement to an offer. From the healthcare’s point of view, consent implies an individual’s agreement to a procedure carried out on them or a sample requested from them. Legally, informed consent depicts that a patient has gained all the relevant information to them to enable them make informed decisions and allow for the healthcare to take place. Ethically, when a patient gives an informed consent, this shows a complete process of commitment in which at least one health professionals have aided the patient to make an informed decision regarding the healthcare proposed (NSW Government, 2005). To enable a patient make a valid informed consent about healthcare, some principles must be met. Firstly, the patient must be capable of making a decision relating to the particular issue at a given time, and should be influenced by alcohol, therapeutic and other medicines. Secondly, the consent should be voluntarily given and not manipulated or based on undue pressure from medical staff, family or other social forcible elements. Thirdly, there is need for transparent and balanced discussion between the health practitioner and the patient. This should entail a two-way communication that is sensitive to the circumstance (NSW Government, 2005). Fourthly, the health practitioner’s should provide a patient with information in an easily understandable means to facilitate easy comprehension. The patient should be clearly informed about the diagnosis; recommended healthcare including advantages, side effects and optional healthcare; materials risks and complications; a decision to decline the offered healthcare; significant emotional, physical, social, mental, and sexual outcomes; and expected recovery implications. In addition, a patient needs enough time to make all considerations before making any decision on his healthcare (Thomson, 2004). According to the Powers of Attorney Act 1998 (Qld), it is mandatory to ensure that a patient making an advance health directive to be a competent adult, that is more at least 18 years old. This implies that a young person or a child is incapable of making such a sensitive decision concerning his health. In this case of a 16 year old boy who wants to decline further chemotherapy on him, the Australian law clearly rules on the contrary. While the law grants the citizens a right to informed decision in healthcare, the same law has its exceptions based on age. For instance, patient A is regarded as a child by the Australian law; hence incapable of making such a decision on his own. Nevertheless, this does not concur with the with the norm that allows a young person or a child who is mature enough and can understand all issues to make decisions on their own (Queensland Government, 2012). In relation to patient A’s case, if he is mature enough and can understand all issues surrounding his health, then he may be allowed by the law to make a decision on his own. Otherwise, the family is allowed by the law to make a decision on his behalf. According to Thomson (2004), the significance of the evidence of a young person or child’s ability on a specific matter largely depends on the importance of the decision about to be made. The young person or child intending to reject or withdraw consensus to life supporting treatment requires a substantial level of maturity that equals that of a competent adult who intends to make the same decision. With reference to patient A, the nature of the decision to be made is so significant that it determines the boy’s life and death. Therefore, by allowing him to make such a decision alone yet he is still a child may be illegal. In Australia, the appropriate age of consent for healthcare varies across various jurisdictions. For instance, Western Australia’s age of medical treatment consent stands at 18 years, which is a general age for most of Australia. Nonetheless, in South Australia and NSW, the proper age of making a decision concerning medical treatment has undergone legislative amendments to sixteen and fourteen years, respectively (Western Australia, 2006). Basically, any healthcare given to children below sixteen years of age needs the guardian or parents’ consent. Notable, parents are only allowed to give their consent to medical attention that serves the child’s best interests. In all the jurisdictions, the consensus of the child alone could be enough in situation where they have adequate intelligence and understanding to allow them to fully comprehend any proposed medical treatment (Thomson, 2004). In South Australia, amendments have been made such that a medical practitioner can allow a child to consent if he is satisfied that they fully understand the nature, risks, consequences and that the procedure is in the child’s best interests of well-being and health. It also indicates that the medical practitioner’s opinion must be supported in writing. Additionally, it permits parents to decline some treatments. In cases where treatment involves serious, irreversible and invasive surgery, neither a parent nor child may consent unless they obtain a court order. Patient B In this case scenario, the health officer realizes that the patient he is handling is a victim of a failed suicide attempt. In the process of handover, he learns that the condition resulted from a suicide-murder involving the patient’s two young children who died from the drugs that she intentionally gave them. This is a tricky situation that requires both legal and professional considerations. According to the Privacy Act (1988) in Australia, all health professionals owe their patients confidentiality of their information in the process of taking care of them. This implies that they should not expose or share any information they come across in the course of their duty. This action serves to protect the information disclosed, created or received either directly or indirectly within the context of patient and the health officer relationship. The law also requires that everybody including the administrative staff that comes across the patient’s information during their care process have an obligation to handle the information with appropriate confidentiality. Here, the general aim of this is to prevent the disclosure of patients’ information to persons and organizations that are not part of the healthcare process. The confidentiality of the information remains even when the professional relationship or even upon the patient’s death (Privacy Act 1988). Nevertheless, there are certain exceptions that allow the disclosure of confidential information, such as in the cases of minor, mental cases, possible danger or harm, public interest and statutory reasons. Australian law does not give any obligation to health professional to share their patients’ information with the police. They can do so if it is absolutely necessary for them to offer assistance to the police. Whoever decided to share the information with the police, they are required to give truthfully information (Thomson, 2004). In this case, the health care provide is bound by the law of maintaining confidentiality at the same time he is required to be careful so as not to obstruct the police from ensuring justice. This implies that he should handle the patient’s information with confidentiality (Privacy Act 1988). Nevertheless, in case the police require him to help with the investigations, he is required to comply. The health worker could also disclose the information on grounds of mental status of the patient. This information could help the psychiatrist to give her appropriate attention and save her from suicidal ideation. Thus, the law may allow the health professional to disclose the patient’s information in order to enable her get psychiatric attention as well as to save her life from attempting suicide again. Patient C The Australian law clearly has certain provisions for patients that are unable to give consent regarding their medical treatments. A person termed as a not competent if he is unable to give consent to medical treatment proposed. Presently, there is no legal definition or test of competency. Nevertheless, for one to be competent enough to give consent, or decline treatment, a patient should be in a position to understand and retain healthcare information and consider it before making a decision. Determining a patient’s competency entails establishing their particular ability to perform a certain decision-making activity at a given time. There is a possibility that a patient may be competent to give some but not all consent regarding their treatment (Faunce, Shats & Adams, 2008). It is worth noting that a patient can lack the capacity to consent due to various reasons including mental illness, dementia, intellectual impairment, brain damage, temporary factors, such as, medical condition and less than 14 years old. According to the Guardianship Act, there are methods available for getting consent for treatment for individuals aged 16 years and above who are unable to give consent. Anyone with no capacity to give consent is unable to understand the general nature and impact of the proposed treatment (Government of Western Australia, 2006). Generally, as the Government of Western Australia (2006), Australian law presumes that all adults have an ability to make a decision about whether they want to accept or reject a given medical treatment. However, there are certain cases under which the law gives the third parties permission to make decision on their behalf. In Queensland law, capability implies full understanding of the nature and impact of the decisions concerning a treatment; voluntarily and freely making decisions on the treatment; as well as communicating the consent in a certain way. According to Faunce, Shats and Adams (2008) in order to give a legal informed consent, patients should be able to do through expressing their choices, understanding the information relating to their decision and appreciate the importance of the information relevant to their circumstance, especially illness and other options. They should also be capable of using relevant information to logically decide. Patient C is incapable of making any informed decision because of his mental condition; that is the recent CVA. Since the medical procedure to be made on him involves food and antibiotics, the health practitioners and patient C’s spouse find it necessary for his recovery and wellbeing. The Australian law also has a provision that allows the patient to give consent for his treatment if it is done for the patient’s best interest and well-being. The law states that in a situation where a patient is under 16 years of age or incapacitated by other conditions such as mental status or medical condition, the spouse is allowed to give consent with the particular authority from the patient. Since Mr. C cannot give consent on his treatment because he seems not to fully understand his condition, the spouse is legally allowed to decide for him. Patient D The issue in this case is that RN Z mistakenly injects the patient KCl as a bolus into the IV line instead of the normal saline. As a result, patient D gets a cardiac arrest. Clearly, this is a case of negligence by RN Z. The Australian Therapeutic Goods Act 1989 (Cth) offers a guideline on the way medical devices and medicines should be regulated in order to enhance safety, effectiveness and quality. Medicines that are identified to have a greater level of risk should be assessed and registered, while those with lower risk including vitamins and complementary must be evaluated for safety and quality. The act sets out regulation requirements for their labeling and advertising. According to Thomson (2004), negligence refers to a failure to undertake something that a reasonable individual would do or fail to do and that consequently causes another individual injury, damage or loss. This normally happens in a situation which one individual owes another person a duty of care (Donoghue v Stevenson). In a medical setting, negligence often relates to a situation in which a health worker or medical practitioner fails to offer a patient a duty of care as required. Whenever a medical practitioner or health worker willingly accepts to attend to a patient’s medical opinion, he or she owes the patient a duty of care. Here, the doctor’s responsibility is to give the patient the best care available, but is not obligated to cure them. This responsibility applies to both senior and junior doctors as they are all registered and recommended to the public as capable of offering the reasonable standard of medical care. The Australian law also states that anyone intending to sue for medical negligence should prove beyond any reasonable doubt that the professional in question broke his duty of care and subsequently damage arose (Faunce, Shats & Adams, 2008). Both health workers in this case are liable for medical negligence. First, the registered nurse Z acted on negligence by administering the wrong drug to the patient, yet they were clearly labeled. Secondly, the registered nurse W who was busy at the emergency department (ED) is liable for medical negligence. Even though she checked the ampoules before RN Z administers them to patient D, she did not confirm that they were correctly labeled. Since she was busy at the ED, she should have ensured that the ampoules were labeled correctly before administration in order to avoid any mistakes. Therefore, she shares in the medical negligence committed by RN Z. The damages emanating from this case scenario include deadly cardiac arrest suffered by patient due to wrong administration of drugs. Secondly, the patient that suffered cardiac arrest was the main bread winner to two young children. The medical negligence caused an untimely incapacitation or death of the children’s mother and provider. The children or relevant authorities should claim a compensation for the pain suffered in the process and the future incomes lost due to the damage. Conclusion Under certain circumstances, some decisions have to be made in order to save lives or improve patient’s well-being and recovery process. In this paper, four cases have been used to highlight some of the legal and professional issues involved in the process of making informed choices. In case of patient A, the family is allowed to give consent to enable the health practitioners continue administering him chemotherapy because he is only 16 years and incapable of making an informed decision on his health. Patient B case requires the healthcare provider to keep the patient’s information with privacy and confidentiality unless if he is required by the police to help in certain investigations to enhance justice and also share with the psychiatrist to attend to the patient’s mental status. In patient C, the spouse may be legally allowed to give consent for Mr. C’s treatment. Lastly, in patient D’s case, RN Z and RN W are liable for medical negligence that caused the patient to suffer a cardiac arrest. References Australian Medical Council. (2009). A Code of Conduct for Doctors in Australia. Good Medical Practice. Accessed on 10th May, 2015 from http://www.health.nt.gov.au/library/scripts/objectifymedia.aspx?file=pdf/39/02.pdf Breen v Williams (1996) 186 CLR 71. Donoghue v Stevenson [1932] AC 562). Faunce, T., Shats, K. & Adams, C. (2008). Overview of Health Law in Australia. Legal issues in Plain Language. Accessed on 10th May, 2015 from http://www.legalanswers.sl.nsw.gov.au/hot_topics/pdf/health_64.pdf Government of Western Australia (2006). Guardianship and Administration Regulations 2005 State Law Publisher. NSW Government (2005). Policy Directive. Consent to Medical Treatment - Patient Information. Accessed on 10th May, 2015 from http://www0.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf Queensland Government (2012). Queensland Health. Guide to Informed Decision-making in Healthcare. Accessed on 10th May, 2015 from http://www.health.qld.gov.au/consent/documents/ic-guide.pdf Privacy Act 1988 (Cwlth) Thomson, C. (2004). The Regulation of Health Information Privacy in Australia. National Health and Medical Research Council. Australian Government. Accessed on 10th May, 2015 from https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/nh53.pdf Read More