Legal Issues
Every profession has certain legal and ethical norms, which, at times can tend to collide with each other. For example, in healthcare, the legal norms often contradict with the ethical norms and create dilemmas, making it very difficult to solve by choosing the right option. Ethical values followed by the healthcare practitioners are the standard rules of Bioethics, as set by the ‘Universal Declaration on Bioethics and Human Rights (UDBHR). This essay will discuss the legal and ethical issues faced in the medical field in regard to the given case, focussing on the principles of each that often contradict one another.
The elements of a valid “informed consent” must be present in the given scenario for the paramedics to conduct the treatment of Richard’s heat shock (Kim & Miller, 2015). Firstly, Richard must be let known about the pros and cons of treatment by the paramedics. Secondly, he must be made aware of the consequences of both having and not having the treatment done on him. Lastly, he must be made aware of the necessity of such treatment, by the paramedics.
The law on bioethics (healthcare) states clearly that the elements of informed consent must be present before the treatment of any patient. In addition, the law states that in case of treatment without consent of the patient, the medical practitioners will be held legally liable, leading to legal penalties (Wells & Kaptchuk, 2012).
The paramedics have the right to make treatment of Richard for his head injury, even though he had refused their treatment for heat shock, previously. It is so, because according to the exceptions to the principle of informed consent, a medical practitioner need not obtain the consent of a patient for treatment in case of emergencies (Flynn et al., 2012). Therefore, in this given case, even though the medical crew did not obtain Richard’s informed consent for the heat shock treatment, they can provide treatment for his head injury, as after his head was injured, Richard was unable to give consent and it was an urgent and emergency situation.
The law of bioethics states that, during a treatment, if another problem crops up in connection with the initial treatment, the medical practitioner need not require the consent of the patient (Kaye et al., 2015). Therefore, in this case, Richard was incapable of providing consent because of his head injury, and cranio-facial surgery was necessary. Therefore, the medical practitioners did not need consent for Richard’s cranio-facial surgery.
At the time of the head injury, Richard’s wife was not present, and Lucas took charge of Richard. He had called the paramedics after Richard suffered the head injury and after seeing Richard’s health condition, they decided to admit Richard to a hospital. Richard’s wife, after being informed by Lucas about Richard’s injury, straightaway went to the hospital. In such a situation, there are two alternatives available to the medical practitioners which can be adopted (Cohen, 2013). The medical practitioners have the option to abide by Meryl’s decisions, as she is Richard’s wife, and a family member, or by QCAT’s decisions. In this situation, the want of Lucas will not prevail as Lucas is just a friend of Richard and has no legal authority to take decisions for Richard’s treatment. Therefore, the medical practitioners can either abide by Meryl’s decision or if they disagree with Meryl’s decision, they can take the decision of the court (QCAT).
Elements of Informed Consent
The Queensland Civil Administrative Tribunal (QCAT) decides these kinds of cases, which are brought before it by any medical practitioner regarding the treatment of patients requiring special medical care. In such cases, the QCAT investigates the medical condition of the patient and after its investigation, gives a verdict based on the medical issue. The QCAT is the only legal authority in Queensland and will have the legal authority to decide the future treatment of Richard in the given case, if the medical practitioners don’t agree with Meryl’s wishes regarding the same.
In the circumstances, since Richard’s wife was present, every single treatment decision related to Richard depends on her, as she has a legal relationship with Richard and has the right to make decisions for him. Lucas, who initially took responsibility for Richard, will no longer be competent to make decisions for Richard, as he has no legal relationship with Richard. Hence, Richard’s wife will be the one to take decisions regarding Richard’s treatment (Stewart, 2012). In case of any disagreement regarding any decision for Richard’s treatment, between Meryl and the medical practitioners, the only option that will be left is to obtain the decisions of the QCAT regarding the treatment.
In order to withdraw the life sustaining measures Richard is surviving on, certain factors are required to be considered. Firstly, one has to check the current health condition of the patient. Secondly, whether there are any chances of recovery of the patient if life sustaining measures are continued. Thirdly, how likely it is for the patient to get cured on his own, if the life sustaining measures are stopped. It is so, because sometimes the patients are able to recover on their own, once life support is turned off. Fourthly, whether there is any other feasible option available that can cure the patient other than withdrawing the life sustaining measures and fifthly, the decision of the QCAT, in case such case is referred to it.
Healthcare practitioners have to find out, with their medical knowledge, skill and experience, whether Richard’s condition can be improved through treatment or not (Alberthsen et al., 2013). In addition to this, the case is referred to QCAT and the findings and judgements of QCAT will ultimately prevail as once a case is referred to the QCAT, the decisions of the QCAT becomes legally binding.
Two principles of healthcare, which can be identified in this case, are those of autonomy and beneficence. The principle of autonomy deals with informed consent. According to the principle of autonomy under the UDBHR, a patient, or their legal representative, has to be provided with information, by the medical practitioners, about the pros and cons of a particular treatment before the treatment is actually done. Disclosure must be made about the necessities of such treatment and the circumstances of avoiding it. However, the most important aspect of this principle is that the patient must give consent to go through a particular treatment, provided, they are competent to do so (Padulo et al., 2013). This principle also states that such a decision of the patient must be made without coercion or fraud (Herring, 2014). If the patient refuses to go through the treatment, then such treatment must not happen. No medical staff can refuse treatment if the patient wants it.
Treatment without Consent
The principle of beneficence states that the healthcare practitioners are required to perform, keeping in mind the benefits to the patient, with all the knowledge and skill they possess (Page, 2012).
In the given case, the principle of autonomy, that includes the principle of informed consent, applies because during Richard’s heat shock the paramedics could not conduct his treatment as Richard refused it. Later on the same paramedics took charge of Richard’s treatment and admitted him to the hospital without his consent. Both this incidents attract the principles of informed consent under the principle of autonomy. On the other hand, the principle of beneficence applies in the given case as there was a clash between the opinions of Meryl and Lucas and also the medical practitioners regarding Richard’s treatment. It is the principle of beneficence under which the differences in opinion will get resolved and the medical practitioners will be able to act in accordance with the best treatment process for Richard.
The stakeholders in the given scenario are Lucas and Meryl and the medical practitioners. Ethical values of the three differ. Lucas, in one hand, does not want his friend, Richard to go through the pain and suffer unnecessarily, as life supporting machines which were keeping Richard alive were not helping in improving Richard’s health. Therefore, Lucas wanted Richard to be relieved of this unnecessary pain and suffering by turning off the life sustaining machines, so that Richard could die peacefully. The medical practitioners were also of the same opinion. On the other hand, Meryl believes that Richard will get cured someday and she believes this, as cases of cure had happened before in similar cases. In this situation, there will be conflict between the values Meryl and the medical practitioners and the principles of autonomy and the principle of beneficence. The principle of autonomy will collide with the values of the medical practitioners because Richard’s or his representative’s consent is required for stopping the life supporting measures. The principle of beneficence will collide with the values of Meryl because according to the principle, the medical practitioners have an option to take such steps in complicated situations, which is beneficial for the patient as a whole (Beauchamp, 2016). According to the medical staff, they also believed that further treatment will not be of any use for Richard and as there was a clash of opinion of the medical practitioners with the opinion of Meryl, the medical practitioners can refer the case to the QCAT and the QCAT’s decision will prevail in this case.
According to Kerridge’s et al (2013) modified model for solving ethical issues, there is no particular solution to the ethical issues or problems that arise in the medical field. Kerridge’s modified model for solving ethical issues can be called as the ethical parameters, which are required to be maintained by all medical practitioners, during any medical or nursing practices. The model suggests that this void needs to be filled with a conceptual understanding in accordance with the nature of the situation which is difficult to deal with and where there are two or more alternatives which are equally undesirable (Degeling, 2015). However, according to this modified model of Kerridge, along with the Australian courts, the focus must be on the patient. One way to solve the conflict between ethical values and other contradicting principles is to put focus on the want of the patient. In this case, the choice that is better for the patient must be the area of importance, rather than remaining in a dilemma due to the conflicting values of the healthcare practitioners and Meryl. Kerridge et al. (2013) modified version states that the healthcare advancement and ethics vary from country to country and hospital to hospital. It is very difficult to find the same clinical ethics everywhere. In complicated medical cases, where the values and the medical ethics collide, it can only be solved when the medical practitioners use help of better medical practitioners and advanced technologies to determine the condition of the patient and to find out the suitable treatment, and also the patient’s wish. Therefore, according to the modified solutions for ethical problems in medicine, by Kerridge et al. (2013), as Richard’s health condition, even after treatment for a long period, was not improving and there is a clash between the values and decisions of the medical practitioners and Meryl regarding Richard’s treatment, the medical practitioners should first use the most advanced method to determine what is the best option regarding Richard’s health and then give importance to what Richard wants. The medical practitioners believed that the best option is to stop Richard’s treatment. Hence, the medical practitioners should consult QCAT.
Conclusion
From the above discussion it is clear that the healthcare profession is driven by various legal and ethical principles which often collide and create legal and ethical issues. It discusses these principles of ethics and laws, in relation to medicine, in the lights of a given case. It includes the principles of autonomy and beneficence. It states the steps a medical practitioner should follow under different situations and the steps they should take at times of ethical dilemmas. In addition, the above discussion also mentions the powers of the QCAT, which is the legal authority in Queensland, in relation to such complicated medical cases. Finally, the essay concludes by focusing on the modified model for solving ethical problems, especially in the field of medicine, by Kerridge.
References:
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