Health and fitness is considered as a balanced situation in which mental, physical and emotional status of a person are in equilibrium. An individual has to be disease free, emotionally substantial and mentally sound for being healthy. Different health and social care problems are often weighted in terms of legal and ethical principles which have been designed by the society for maintaining discipline. This essay present the situation of Edward who is in coma from a long time. The various legal and ethical issues which are related with his situation have been discussed in this essay for developing an insight towards wise decision making.
1. Legal authority
According to the mentioned case scenario Edward has refused for any type of medical treatment. It is an negligence that has been shown by Edward toDrummond, M.F. and et.al., 2015.wards his health and due to that serious health impacts have been observed by him. Paramedics does not have legal authority to institute treatment for his diabetic coma with taking consent of the patient. It becomes legal duty of the paramedics to render proper medical assistance and treatment to the patient that has been admitted in the hospital (Drummond and et.al., 2015).
2. Elements to prove consent to be valid
It is vital that all the elements that are requirement to make a valid contract should be present when an agreement is signed. It is vital that prior permission from Edward should be taken for administrating the treatment. Informed consent is explained as an process in which the treating health care provider takes initiatives for disclosing the information to a competent patient. It supports the patient to take decisions to accept the treatment or for refusing the treatment. A patient has legal right for involving in the health care treatment that are being provided to him (Hazelwood and Burgess, 2016).
Major elements of the informed consent includes the nature of the decision/procedures. The next element is reasonable alternative that are available for the proposed solution. In addition to that the relevant risk, benefits and uncertainties related to each alternative is also included as an element that are included under full informed consent (Ben-Assuli, 2015). It is vital that assessment of patient understanding should also be made and the acceptance of intervention of the intervention by the patient are also included in the list of elements that are essential for taking consent. It is assertive that consent must be related to the service provided. In addition to that it is required that consent must be voluntary and no fraud method and interpretation methods should be used while taking consent of the patient (Gostin and Sridhar, 2014). Other than this it is also required that consent must be informed and client must be able to ask questions.
3. Rationale for supporting legal obligation
There are some legal requirements that are needed to be considered when a patient lacks decision making capacity. If a patient lacks decisions making capacity than it is required that appropriate legal considerations should be considered. It is required that assent should also be taken. Adolescents are legally authorized for giving their consent in case they are emancipated. If a patient lacks proper decision making capacity than the consent can be presumed and it will be declared as an implied consent (Hall and Antonopoulos, 2016). These type of consents are only be taken in the emergency situations when the patient is unconscious and incompetent to take decisions related to his health.
It is the duty of physician and health care service provider to render better treatment as per the medical requirement of the patient. If the patient is incompetent for taking decisions for himself than a surrogate decision maker is required to speak for the patient. In case if surrogate decision maker is not available for giving consent to the patient than the physician who is providing treatment is authorized to take best decisions in the best interest of the patient (Shortliffe and Cimino, 2013). In case any guardian is not present than court can appoint guardian to take best decisions for the patient. In the present case there is conflict of interest between Una and Genevieve.
4. Potential option available
There are some options that are available for health care service providers for taking consent of the patient that are being administered in the hospital. Consent can be taken from the patient if the person is competent and capable for taking decisions for himself. In case the individual admitted in the care home lacks appropriate decision making capacity for himself than surrogate can take decisions for the person (Costello, He and Merikangas, 2014). Moreover, if guardian of the patients are not available than legal assistance can be taken and in this case court can appoint legal guardian of the patients who will be accountable for taking decisions for them. Physicians who are providing medical services to the patients (Drummond, M.F. and et.al., 2015) are also authorized for taking decisions for the patient in best interest of him.
5. Course of action
If there is disagreement between substitute decision makers than in this case there are some options that are available for the health care practitioners. If there is disagreement between substitute decision makes than in this case two specific options are available for the health care practitioners (Gunn and Taylor, 2014). In the present case scenario Genevieve and Una are having conflict of interest for taking decisions for the patients and Genevieve and team of physicians believes that the treatment that is being provided to Edward should be stopped. However Una believes that if better medical services should be provided to patient than it will help for making significant improvements in the health conditions of Edward and so better improvements can be gained.
6. Factors that will be taken into consideration
There are some particular factors that are needed to be taken into consideration while making decisions as to whether Edward's life-sustaining measures can be withdrawn. It is vital that health conditions of the patient should be properly assessed so that better decisions can be taken about providing medical treatment to the medical service users (Drummond and et.al., 2015). In addition to that it is vital that there should not be any conflict of interest among the surrogate who are responsible for taking decisions for the patient.
It is assertive that consent should be taken from the medical service users so that better and effective decisions should be taken and Edward should be provided with better medical services and care. It is the prime responsibility of health care practitioners to ensure well being of the patient and it becomes their duty to render proper medical services to the patients. Moreover, Edward's consent can be presumed as it is an emergency situation and there is conflict of interest among the guardians who are accountable for taking decisions for the patient.
1. Ethical principles related with this scenario
In the present scenario, Edward's mother is taking a stand against his wife's decision of removing life support system. The perception of Edward's medical conditions has two sides. His mother believes that he would be cured someday and hence life support machines must be continued in functioning. On the contrary, Edward's wife and the medical experts believe that his condition would not improve in any situation and it would be difficult for both the family and Edward to continue such completely dependent life. Hence, her decision favours removal of life support machines. The Universal Declaration on Bioethics and Human Rights entails a number of principles which guides the decision making when an individual is facing bioethical or medical issues (Universal Declaration on Bioethics and Human Rights, 2017).
Article 7 of this Declaration is applicable in the current scenario. It provides guidelines regarding situations in which a person is incapable to provide consent for a medical research or practise (Universal Declaration on Bioethics and Human Rights, 2017). It has been depicted that authorisation for continuation or discontinuation of any medical procedure should be followed with best interest of concerned individuals. Furthermore, Article 18 of the Declaration has provided principle guidelines which need to be followed while making decisions and addressing bioethical issues. It is a matter of concern for the family to take decision on Edward's ethical issue. His wife though stated that he had provided earlier consent regarding such consequences. He would have agreed on removal of life support machines if he was in a conscious state. The Article 7 and 18 support public debates and opportunities to concerned professionals for engaging in a dialogue that will help in formulating effective decision (Fitzgerald and Byrne, 2015).
2. Possibilities of conflicts between principles
Stakeholders for the given scenario are Edward, his mother, wife and both children. Any decision which is made with respect to his current condition will definitely have a deep impact over life of these stakeholders. The principle Article 7 of the Universal Declaration depicts that any sort of medical research and practise which is proposed to be carried out on the patient must be in greatest interest and benefit of the person. Moreover, in case of incapability to provide consent, domestic law must be concerned for generating alternatives (Kuhse, Schüklenk and Singer, 2015). The potential health benefits that will be addressed by patient or respective individual must be completely evaluated and risk level should be minimum. Article 18 is about the decision making process which is to be initiated when such situations occur.
Conflicts will arise when people won't agree or challenge the definitive content of these articles. There is a probable clash amongst health care practitioners, Edward's wife against his mother. Edward's wife and medical experts are favouring the scientific validity of acquired facts while his mother is completely revolting on the basis of her belief. Ethically, it is inhumane to take out the life support system before person's death. But it is also incorrect or lethal to support an individual's survival in condition where they do not have the freedom and capability of performing basic human activities (Beauchamp, 2016). Hence, a significant conflict can be visualised in this ethical issue with regards to aforementioned principles.
3. Model for ethical problem solving
Kerridge and et. al. (2013) developed a model which is efficient in resolving ethical issues and helps in making effective decisions with atmost reliability. It has eight consecutive stages which involves identification of the ethical problem, gathering available facts, evaluating facts which are further required, reviewing ethics literature, considering ethical principles, identification of potential ethical conflicts, considering relevant laws and lastly making a decision (Andorno, 2014). Applying this model for resolving the ethical conflict in presented scenario, it has been assessed that ethical problem is uncertainty of Edward's situation. His family and medical practitioners are in a dilemma whether to continue the treatment and life support system.
The available facts depict that scientifically there is no scope of progress or recovery for Edward. On the other hand, there is an emotional belief on the basis of certain miracles, that Edward would become normal and recover very soon. This belief has been justified by his mother. Furthermore, there is a requirement of generating more details regarding medical support which is provided to Edward. The ethics literature and ethical principles have described that when an individual is not capable of providing consent or make a decision then greatest benefits must be considered as the basis of decision making (Teays, Gordon and Renteln, 2014). It is important to consider that if a person is suffering from extreme pain then it is considered ethical to relieve that pain either in the form of treatment or death. This model can be helpful in making effective decisions regarding this ethical issue.
This essay is a medium through which one can understand that a medical situation like that of Edward is a critical instance wherein different types of conflicts and issues arise for favouring the maximum possible benefits. By considering the legal issues, it can be concluded that physicians hold the responsibility of taking a decision because Una and Genevieve are facing conflicts of interest. On the other hand, ethical considerations and principles depict that public debate and opportunities to pluralistic groups must be provided for evaluating different aspects of Edward's situation.
- Andorno, R., 2014. Human dignity and human rights. In Handbook of Global Bioethics. Springer Netherlands.
- Beauchamp, T. L., 2016. Principlism in Bioethics. In Bioethical Decision Making and Argumentation.Springer International Publishing.
- Ben-Assuli, O., 2015. Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments. Health Policy.119(3).
- Costello, E. J. and et. al., 2014. Services for adolescents with psychiatric disorders: 12-month data from the National Comorbidity Survey–Adolescent. Psychiatric Services. 65(3).