Legal Issue 1- Living Will
The first issue in this case study is a legal one because the patient wrote a living will before becoming unconscious on what she wanted in the event she had to spend time in an intensive care unit. The living will was written in the presence of a lawyer and her husband. The will stated that upon the event of becoming unconscious and diagnosed with a terminal medical condition, life support and ventilator support should not be used. This is a legal issue because it involves a certified legal document, a will, which was written and verified by a practicing lawyer. The woman, currently unconscious on the hospital bed ,had made it very clear in her living will that she did not want the support of any artificial life support machines to help her live.
The concept used in describing this legal issue was the rights approach and the advance directives (University of Washington School of Medicine, 2013). The rights approach has dutifully defined that a physician should act ethically through the dutiful respect of others rights (Santa Clara University, 2015). This entails all aspects of acting through making a decision that has the best moral implications for everyone that is involved. However, the concept of advanced directives in clinical law informs health care providers that in the event of a legal document termed as an advanced directive, they should be followed to the letter to accord the patient his or her wishes (University of Washington School of Medicine, 2013). Advance directives record the patient’s wishes in advance so that they should be implemented if the patient lacks a decision-making capacity like in the scenario that is the basis of this analysis.
Legal Issue 2- Surrogate Decision-Making
The second issue is also of legal nature because it can be defined in the context of clinical law. The scenario that this analysis is based upon informs us that the husband of the unconscious patient was the immediate next of kin and, therefore, the surrogate decision maker according to the law (University of Washington School of Medicine, 2013). The fact is, due to the incapability of the patient to make a sound decision or a decision at all, the immediate next of kin can be chosen as the person with authority to make a decision based on the treatment approach to be taken with the patient. The husband to the patient was, therefore, in a legal position to make a decision. However, the decision he made contradicted with the patient’s advance directive, which informed the health care providers of another medical approach to consider in the event of permanent unconsciousness.
This legal issue has come up due to the conflicting wishes of the surrogate decision maker and that of the patient herself. Therefore, a legal issue is created that is tied up to the decision of the surrogate decision maker that tends to contradict that of the patient. The patient wanted no artificial life support machines to be used to further her life. On the other hand, the surrogate decision maker wants the life support machines to be used on the patient as her medical condition cannot be termed to be immediately permanent.
Ethical Issue – Plugging the Life Support Machines
In this scenario, there is no agreed upon final decision on whether to plug off the life support machine or not. The health care provider is faced with an ethical dilemma of sorts that tends to frown upon either decision that is chosen. It would be ethical for the health care provider to use the rights approach by respecting the right of the patient dutifully (Santa Clara University, 2015). However, there is also the issue of the rights of the other people involved in the decision: Most importantly, that of the husband who has decided not to pull the plug on the support machines that are keeping his wife alive.
Furthermore, considering the adult children of the couple, they also have rights that need to be respected. However, their take in this scenario is that their mother’s wishes should be respected as she had defined in her will. Therefore, they are of the opinion that the acts of the living will be accomplished without any delay. The health care provider is now faced with a dilemma of sorts that is founded upon her grounding in such issues of ethical and medical urgency. The issue, in this case, is by respecting the rights of the husband, the patient would go on to live a functionless life that is made worse by the permanent brain damage she has undergone. Furthermore, the rights of the patient would not have been respected giving probable cause for litigation cases to be placed against the health care practitioner.
Handling of Legal Issue 1- Living Will
Legal issue 1 entails the case of the advanced directive that was provided in the form of a living will be by the patient. The advance directive states that upon the incidence of the patient being in a medical condition that is terminal or places her in a permanent state of unconsciousness, no life support equipment should be placed on her. This legal issue has a unique aspect of decision making that makes the healthcare providers move on to carry out the legal direction stated in the legal document (University of Washington School of Medicine, 2013).
As a medical practitioner, I would handle this issue in the following way. First, I will consider the contents of the legal document and the time of its inception. Verifying the time when he document was written will aim at determining whether the patient was in a right state of mind when making this decision. Secondly, I would seek to establish what would be the medical condition or the life condition the patient would be in if the life support continued and she regains consciousness. The issue here is the quality of life to be led by the patient after recovering. Seeing that the patient has permanent brain damage and would not live a fully functional life, the best decision would be to grant her wishes as it is the most utilitarian thing to do in such an instance (Santa Clara University, 2015).
Handling of Legal Issue 2- Surrogate Decision-Making
The surrogate decision maker, the husband, has made a decision not to unplug the life support machines that are keeping his wife alive. In this scenario, as a medical practitioner with the knowledge of various aspects of clinical law, I will handle this issue in the following manner. First, I would consider all the rights of the involved people; that is, the patient, her husband, and their adult children. I will consider the most agreed upon decision that has the support of most people. Secondly, I will consider any legal documents or decisions that bind me to any course of action (University of Washington School of Medicine, 2013). Thirdly, from a legal perspective, I will consider the ramifications of not respecting the advance directive document, which may include a series of litigations that may have more monetary implication on me as the patient’s physician and the health care organization.
After considering the options above, which are of legal and ethical grounding, I will implement the utilitarian approach. This would entail a course of action that would ensure that less harm and the best results are achieved. Therefore, I would respect the wishes of the patient and those of her adult children and dismiss the wishes of the husband.
Handling of Ethical Issue – Plugging the life support machines
From an ethical point of view, healthcare providers take the oath of respecting and protecting human life. This oath is not only taken as a professional requirement, but also directs the health care providers of their duty that they have to humanity. With regard to the ethical issue in place, I would strive to uphold ethical standards when making a final decision based on the facts of the situation. Putting into consideration the right of every involved party, I would take the most productive approach of all that would guide me to achieve a common good in the end. I would pull the plug on the life support machines. This will result in the loss of life with consideration of the quality of life to be led if the patient survived. Furthermore, I would have upheld the patient’s wishes, the children’s wishes, and, therefore, the end result would have achieved more good than the harm done. The decision would, therefore, be grounded upon various aspects of ethical standards that conform to the most appropriate course of acting to be taken.
References
Santa Clara University: Markkula Center for Applied Ethics, (2015). A Framework for Ethical Decision Making. Scu.edu. Retrieved https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/
University of Washington School of Medicine, (2013). Clinical ethics and law. Retrieved from https://depts.washington.edu/bioethx/topics/law.html
