Salient Facts of the Legal - Case Study Example

1. Identification of Salient Facts of the Case Mrs. X, a 30-year-old woman who had been married for a period of ten years had never given birth to achild and had been unable to bear any of her own. For the last two years, she had been suffering from congestive dysmenorrhoea, dyspareunia and menorrhagia. Previous examinations carried out in her pelvic region revealed that she had a slightly regular and enlarged uterus which was a bit tender. This condition was diagnosed to be about 10 weeks old. Further investigations through the techniques of ultrasonography carried out by a radiologist who happens to be quite senior, revealed that she had three fibroids each measuring 2x3 cm in her uterus. The investigations carried out on her husband’s semen did in fact reveal no anomalies. The patient has been offered some antibiotics to improve on her situation prior to a myomectomy being carried out. The couple have been advised to consent to a hysterectomy to solve the problem but have declined since they will be requiring their own children in future. The lady has been found to have a permanent condition on her uterus which can cause relentless bleeding and pain. This condition could also be easily responsible for the lady’s infertility problem. The patient could not be informed of the above conditions since she was under anesthesia. Her husband however consented to the operation despite his spouses disapproval. 2. Identify Ethical Issues at Stake in Case The consent given by the woman’s husband tends to contravene the ethics of medicine regarding the issues of justice, beneficence, nonmaleficence and autonomy of a patient undergoing such a procedure. The doctor has also been unethical by infringing on his patient’s autonomy and beneficence by disclosing her condition to her spouse without consent . He is however justified in disclosing the condition since the condition may affect their marriage and future. Both the doctor and the husband may also infringe on the principle of non-maleficence since the operation could do more harm than good to the woman despite her not consenting to the procedure. This could end up bringing injustices to the woman and her future in their marriage. Finally, the doctor contravenes the principle of beneficence which suggests that he should act in the best interests of his patient. The doctor will be infringing on his patients right of deciding whether or not she should undergo the operation. 3. Statement of the Ethical Dilemma A nurse at the hospital has raised concerns regarding the consent given by the husband allowing the doctor to proceed on the operation on his wife. The nurse objects to the operation on the grounds that the doctor has not obtained the consent of his patient, who happens to be unconscious. The patient had previously not given any indications of her acceptance of undergoing the medical procedures. The major dilemma created concerns infringing on the patient’s rights of beneficence, non-maleficence, justice and autonomy. The doctor however suggests that the spouse is responsible to make the best ethical decisions concerning his wife’s welfare. The doctor’s dilemma arises from the fact that he is confused on whether to follow the laid out medical principles which are ethically right or following the husbands wishes. This is because the operation could ease the lady’s problems or augment them in the future. 4. Analysis according to principles- including statement of recommendations for ethical resolution The field of medicine is guided by several principles, which guide it when doctors are treating their patients. These includes the principles of sovereignty, justice, beneficence and non-maleficence. These principles do help doctors in determining whether they should proceed with a medical procedure on a patient or abstain from it. Autonomy/sovereignty refers to the patient’s right to decide on whether he or she is willing to undergo a medical procedure. In this case, the patient was under anesthesia and could not give her consent as to whether she was ready and willing to undergo the medical procedure of hysterectomy. The procedure normally involves the removal of the woman’s uterus. The procedure is justified to be performed on the woman for several reasons. This is because it helps in the removal of fibroids that cause bleeding along with pain, uterus cancer, chronic pains in the pelvic areas and the instances of thickening along the uterus. This are the major problems that the woman is also suffering from and the procedure will greatly assist in eliminating them. However, the procedure could have adverse effects on the woman since it could greatly affect her ability of bearing her own children. Excessive bleeding during the operation could easily result in the woman’s death and the development of other medical complications. The doctor is required by the field of medicine to first inquire from the patient whether or not she is willing to undergo the hysterectomy. This will be important since if anything goes wrongly during the operation or its results are harmful, then the patient will be able to sue the doctor responsible for the procedure. The doctor’s move to operate on her based on her husband’s approval could be beneficial since it could help the patient in her recovery despite her disapproval. The principle of beneficence states that a doctor should take actions that are of the greatest interest and benefit to a patient. The patient had already proposed her intention of bearing her own children in the future. At the time of the operation she is under anesthesia’s and is lying unconscious in her hospital bed. The doctor has not been able to explain to the patient the advantages along with disadvantages of the procedure due to her current state. This implies that the patient is unaware of the consequences of this procedure. Mrs. X should therefore have been informed of the procedures at a time when she is conscious and able to give her final decision in a sound mind. The operation could have adverse effects on her health which will have been brought to her absent mindedly. It is unethical for the doctor to perform the operation on the patient while imposing her husband’s will on her. The performance of the procedure on the patient could also affect the patient’s ability to bear children of her own once her uterus has been removed. The other principle of non-maleficence states that a doctor shall perform an operation on a patient by first ensuring that the patient will not encounter any problems or harm in the future. The doctor in this case decides to carry out a hysterectomy which involves removing the patients uterus without her consent. The uterus is a vital organ in a woman’s reproductive system and its removal implies that the patient will not be able to bear children. This notion goes against the wishes of this patient who had earlier on emphasized on her need for her own children in the future. Such a move would result in an emotional and psychological breakdown for the patient who is unconscious prior to the operation which might go on without her consent. The patient is also not aware of the harm the operation will cause to her health as she is unconscious. On the other hand, the carrying out of the procedure which might bring harm to the patient could result in the doctor facing legal charges. This is because of the resultant harm that the procedure may cause on the woman’s life and family. Finally, the principle of justice in medical ethics suggests that the resources within a hospital’s environment should be distributed fairly and according to the varying needs of different patients. Justice in the hospital environment also implies that patients should get the best treatments available for handling their ailments. In this case, the patient is unconscious and unaware of the procedure she is about to go through. She is also unaware of the consequences of her husband and doctor’s approval of her undergoing the operation. This goes on without her consent and it only stops when a nurse intervenes on her behalf since she has not consented. The procedure will be unjust to Mrs. X since she will lose her ability of having children once her uterus has been removed. There are also other complications which may arise as a result of the operation on the patient which will be unfair on her. In contrast, there is justice being given to the patient since her condition may bring additional health problems to her. The consent that the doctor depends on is that of the husband who he considers as having the ability to decide what is ethically correct to do in this situation. This infringes on the patient’s right of deciding what she wants for herself and her family in the future. It could result in death and other numerous ailments which will have unfairly been brought to her since she did not consent to the performance of the operation. The doctor should have waited for the patient to regain her consciousness so that he could obtain her consent prior to performing the operation. He would have explained the effects and benefits of this procedure to the patient to ensure that justice, non-maleficence, autonomy and beneficence prevail in his practices. The doctor should also consider other alternative methods of treating the ailment that are less harmful to the patient and her future. 5. Counter Arguments entertained and refuted Prior to identifying hysterectomy as the operation which will help in eradicating the problem, the patient had been having problems with menorrhagia, congestive dysmenorrhoea along with dyspareunia. Menorrhagia is a medical condition that brings prolonged and very heavy periods of menstruation among women. The issue of having congestive dysmenorrhoea implies that a patient encounters a lot of pain during her menstrual periods, which affect her performances in various things. Finally, the issue of having dyspareunia implies that the patient has been experiencing excruciating pain when indulging in sexual intercourse. These medical conditions affected her for two years but were not identified as causing the infertility problem the patient suffered from. The patient also had a myomectomy performed on her after taking some antibiotics to ease her distress. This activities were all carried out in the name of healing her problem but were discarded when fibroids were detected in the woman’s uterus. This is when the doctor requested for the hysterectomy and the husband’s consent to carry on with it since the patient was unconscious. 6. Conclusion This case involved a thirty-year-old Mrs. X who had problems in bearing children and was on the verge of being sent to the operating theatre to undergo a hysterectomy. This was despite her being unconscious and under anesthesia. She has not given her consent to the operation being performed on her though her husband gives his approval to the doctor. The doctor is subjected by the ethics of medicine to always uphold the principles of justice, beneficence, non-maleficence and autonomy before performing any procedures on a patient. The moral dilemma in this case facing the doctor is whether he should perform a life saving procedure on a patient whose future will be doomed without his or her consent. The recommendations given are that the doctor should wait for the patient to regain her consciousness so as to obtain her consent on the performance of the operation. He should also use alternative forms of medication and other minor operations which will cause less harm to his patients such as minimally intruding operations. If these methods do not work, he should then try to obtain the patients consent before carrying out major operations. This recommendations are supported by the analysis which shows that the principles of beneficence, non-maleficence, justice and autonomy are vital in guiding safe medical practices within the hospital environment. Therefore, the doctor should not proceed with the operation because the odds against the act outweigh the benefits. He should not also proceed since the patient has not given her consent on the operation. Read More