Emergency Law, Ethical and Judicial Affairs - Literature review Example

Section I: Reading Reports Muller JH, Desmond B: Ethical dilemmas in a cross-cultural context-A Chinese example, Cross-cultural Medicine-A Decade Later [Special Issue]. West J Med 1992 Sep; 157:323-327) The article focuses on the ethical conflicts that are raised due to issues such as disclosing prognosis and diagnosis, the role played by family members in various medical decisions and the decision to hold or withdraw the treatment of terminally ill patients. The article discusses all these issues through the case analysis of a Chinese woman who was diagnosed with metastatic lung cancer which resulted in her death. Muller and Desmond focus on the various ethical dilemmas and their impact on the patient, the family members and the physicians involved in the case. (Lee, E., 1991: pp. 201-206) The case especially exposed the problems of breaking bad news to the patient, the need to limit treatment and the role played by family members in medical decisions. Traditionally, it was believed that physicians should not disclose bad news to the patients due to the fear of worsening the condition of the patient (Veatch & Tai, 1980, pp 29-45). However, this attitude is gradually changing and the patients these days are fully informed about their conditions by the physicians. In this case however, the patient was denied any information due to family intervention (Muller 1987, pp. 275-312,). Cultural beliefs also hamper in medical treatment as seen in this case, wherein the family forbid the medical staff from telling the truth to the patient as the Chinese believed in giving peace and rest to a dying person and did not worry the patient with the news of impending doom.(Tung, 1990, pp. 23-25) However, this caused rift and tension between the family and the medical staff, who wanted to disclose the condition to the patient (Brotzman & Butler, 1991; pp. 426-427). The major conflict area was the decision to withheld treatment or takes the patient from life-support as suggested by the physicians repeatedly. (Kleinman, 1990, p. 45) However, the family refused to take such steps as they believed a person should only die after leading a full life and asked for more life support interventions (Muller 1987, pp. 275-312,). Thus, the paper raises a major question that in case of such ethical dilemmas how the medical community should react. On one hand there are cultural considerations, while on the other medical expenses and resources which could be used for treating other patients. It is a very difficult situation and in order to arrive at a solution, both the medical staff and the family should come on a common ground and find a solution that would be beneficial for the patient. Berglund, C. A. (1998). “When the patient is young, old or incapacitated”. In Ethics for health care. Melbourne : Oxford University Press, pp. 114-125. This article discusses the chapter 5 of Berglund’s book ‘Ethics for health care’ titled ‘When the patient is young, old or incapacitated’. The chapter focuses on the various dilemmas faced health care workers regarding making decisions for young, old and incapacitated patients. Berglund states that in such a situation it becomes difficult for the practitioner to ascertain the needs of the patient as the patient is not able to express his or her discomfort or opinion (Berglund, 1998). The chapter further focuses on the concepts of consent and autonomy, which are further divided into four aspects - competence, voluntariness, comprehension and information. The chapter discusses the complications faced by the health care workers when the patient is not able to understand the situation and therefore complicates the procedure to receive consent for certain course of treatment or therapy (Berglund, 1998, pp. 115-116). The concept of competence means that the person has required ability and skill sets to perform certain duties. In a situation of providing care, the healthcare worker should have the competence of assessing the condition of the patient and make informed decisions. Such decisions are being made particularly in the care for aged people, children and incapacitated patients. Competency in healthcare also focuses on the ability of the patient to provide information regarding his or her condition as well as giving consent for undertaking treatment (Berglund, 1998, pp. 116). The process of analyzing the information gathered is an important step towards the consent process. While dealing with people who has limited amount of competence, the process of collecting information and thereafter completing the consent process might become very difficult (Berglund, 1998, pp. 118). Often the patients are coerced into agreeing about a particular situation or course of treatment. This concept is known as voluntariness. Berglund discusses all these aspects in this chapter and suggests various methods to find out whether the patient possesses the ability to decide about his or her course of treatment (Berglund, 1998, pp. 119). Berglund states that in order to find out whether the patient would be able to help in making the decision, it is important to find out about the competence of the patient to provide opinions. In case the patient is able to communicate, comprehend the choices provided he or she should be asked about the course of action. Psychometric tests might also be undertaken to understand the comprehension situation of the patient (Berglund, 1998, pp. 120). However, if the patient is not able to make any decision and is incapacitated, the decisions for the patient might be made by a nominated surrogate decision maker. Section II: Overview of ‘Emergency law: Rights, liabilities and duties of emergency workers and volunteers’ Paramedics need to make various decisions under pressure situations that influence the life and death of a person. However, not all decisions are governed by medical issues; some are also influenced by the law, ethics and cultural considerations as well. Thus, the clinical decision might also depend on various factors such as taking consent from the patient for starting treatment. (Goldberg, D. S., 2007; pp. 18 – 20). As a result of this, paramedics knowhow on things as consent and refusal vis-à-vis their legal angle is a must while dealing with patients before they are hospitalized. In the book, “Emergency law: Rights, liabilities and duties of emergency workers and volunteers”, Eburn focused on various legal issues that one needs to take care while responding to emergency situations. Eburn (2010) highlights the provisions in law that focuses on the importance of taking consent from the patients before treating them. Further, it also emphasises on the legislative provisions to allow giving first aid without consent and to people who have refused to undergo treatment. (Eburn 2010; pp. 39-40) Taking consent from the patients before commencing treatment is not just an ethical requirement but also has legal implications. When a paramedic takes consent from the patient, he or she is also providing the fundamental right of the person to take his own decision and therefore, responsibility in the entire process. Further, consent is also important as various laws are also created around the aspect of consent. As paramedics are the first people being called on the spot to treat as well as transport the patient to the hospital, it is very important for them to take consent from the patient. Eburn in fact stated that it is the fundamental duty of the paramedics to take consent from the patient if he is in the position to give so and not taking the consent would amount to assault. He further said that in case the paramedic takes the consent for treating the patient, it would make the entire process legal, which otherwise would have been termed as a crime and tort. It has also been seen that in majority of the cases the paramedics take the consent from the patients. However, if the paramedic has come answering the call of a third party, the cooperation of patient is taken as consent. In case the patient is unconscious or is not able to cooperate or communicate, the patient is viewed as in need of restoration and rescue and therefore, the doctrine of necessity is applied and is taken as consent for treatment. Therefore, even when the patient is not able to provide consent, the paramedic needs to apply the doctrine of necessity and help the patient. Further, from the legal perspective as well, it is important for the paramedic to offer help to the patient even when he or she is not able to provide consent. Also, ethically it is the duty of the paramedic to help the patient in a dire situation. Section III: Reflective report on group work 1. Introduction Hurricane Katrina stuck on August 29, 2005 and caused massive damage to New Orleans. The entire infrastructure crumbled and people were left with no electricity, fresh water, sanitation system etc. The rescue team was faced with various issues during the rescue operations which included the hazard of civil and criminal liability, threat of civil complaints of malpractices and negligence (BBC News, 2006). In one such case Dr. Anna Pou and two nurses administered the drugs for mercy killing and to alleviate pain in four patients. However, the state of Louisiana also does not approve euthanasia or mercy killing (American Law and Legal Information, 2010). Further, even the American Medical Association is against euthanasia (Journal of American Medical Association, 1996). Thus, we conducted a group research to undertake a case study of the incident and understand the legal and ethical dilemma in the case. In order to conduct the case study, we followed a well organised process and divided the work equally among all the members. The following sections provide the detailed analysis of the process undertaken by the team to conduct the case study. 2. Theoretical process Two teams were formed; one asked to look into and understand legal issues and the other asked to chart out ethical considerations. We were five students in the group, with each group consisting of two people, with a group leader who introduced the case. Each of the group also divided the task among themselves with one group covering the laws related to the issue, while the other focused on the ethical issues. This helped in developing focused research for the case study. Also, while on the discussion table, all the aspects of the case could be presented and debated about (Yin, 2009, pp.172-201). I was in the group that researched on the laws about the issue, especially focusing on the civil law. 2.1. Undertaking research Each of us devoted at least a week’s time to evaluate the key ethical and legal issues considering the case study. We undertook a thorough research and consulted various academic papers, books and legal regulations for this case. We also took the help of our supervisor to understand the issue and the related legal and ethical considerations attached to the case. We also evaluated past cases of similar nature to understand the general verdicts in such cases. We drew clear pointers about the pros and cons of the case and various legal and ethical considerations governing the case so that we could present our thoughts in a comprehensive manner while discussing the case in the team meetings. 2.2. Group discussion This was one of the most critical part of our assignment, wherein the entire team sat together to discuss and debate about the various aspects of the case study. As the case study was emotionally charged and the question of euthanasia causes major debates, the team was also divided on their opinion about the case (Stake, 1995, pp.97-110). While one group was pro euthanasia, the other debated against it. Personal biasness also surfaced during the discussions. However, the initial discords were soon solved and the team started logical discussion on the issue. After careful consideration of every point, it is declared that Dr Puo and her team were not ethically or legally correct.. 3. Contribution to group work The group work was conducted in a well-organised manner. Although, during the discussion phase the group had initial discords, however, these were soon resolved and the team completed the project in a proper manner. In every member’s share came equal amount of work. Every member of the team was given equal amount of work to conduct. I was assigned with the task to research about the civil law associated with the issue of euthanasia. References: Council on Ethical and Judicial Affairs (1992) . “Decision near the end of life.” JAMA.;267: pp, 2229-2233 American Medical Association (2008). Liability Shield in times of disaster. American Medical Association: Opinion. Retrieved September 26, 2010 from   BBC News (2006). Hurricane Katrina. BBC News. Retrieved September 26, 2010 from Berglund, C. A. (1998). “When the patient is young, old or incapacitated”. In Ethics for health care. Melbourne : Oxford University Press, pp. 114-125. Brotzman, G. L. and Butler, D. J. (1991). Cross-cultural issues in the disclosure of a terminal diagnosis. J Fam Pract, 32, pp. 426-427. Eburn, M. (2010). Emergency law: Rights, liabilities and duties of emergency workers and volunteers. 3rd ed. Leichardt, NSW: The Federation Press pp. 37-91 Goldberg, D. S. (2007). Justice, Health Literacy and Social Epidemiology. American Journal of Bioethics, 7(11), pp. 18 – 20. Kleinman, A. (1980). Patients and Healers in the Context of Culture. Berkeley, Calif, University of California Press.p. 45 Lee, E. (1991). Mouming rituals in Chinese culture, In Walsh F, McGoldrick M (Eds): Living Beyond Loss: Death in the Family. New York, NY, WW Norton, pp. 201-206. Muller, J. H. (1987). On the Boundry of Lifes and Death: Care of the Dying by Medical Residents (Dissertation). San Francisco, Calif, University of California.pp. 275-312 Muller, J. H. (1992). Shades of blue: The negotiation of limited codes by medical residents. Soc Sci Med, 34, pp. 885-898. Muller, J. H. and Desmond, B. (1992). Ethical dilemmas in a cross-cultural context-A Chinese example, Cross-cultural Medicine-A Decade Later [Special Issue]. West J Med, 157, pp. 323-327. Stake, R. E. (1995). The art of case study research. Thousand Oaks, CA: Sage Publications.pp.97-110 Tung, T. M. (1990). Death, dying, and hospice: An Asian-American view. Am J Hosp Palliat Care, Sep/Oct, pp. 23-25. Veatch, R. M. and Tai, E. (1980). Talking about death: Patterns of lay and professional change, In The Social Meaning of Death. Ann Am Acad Policy Soc Sci, 447, pp. 29-45. Wilson, J. (2009). Not so special after all? Daniels and the social determinants of health. Journal of Medical Ethics, 35 (May), pp. 3-6. Yin, R. K. (2009). Case study research: design and methods. Thousand Oaks, CA: Sage Publications.pp.172-201 Read More