Table of Contents
Making Ethical Decisions
Making Legal Decisions
This report is based on a case study of a woman in jail who had to undergo medical complications. This report mainly looks at the angles of ethical and legal issues in what is to be undertaken by the people in charge. When a person decides that she would not live if she has to rely on others, there are many legal and ethical considerations.
The value that is reflected in the statement is that Doreen does not want to be under intensive care where she has to suffer. She does not adhere to suffering and the thought of other people taking care of her needs while she is suffering herself is too overbearing for her. The decision that Doreen might take as a result of the presence of this value in her thought process will be pain-free for her (Chong & Lee, 2017). She cannot bear the thought of having to go through a lot of pain. By taking such decisions, what Doreen is doing is that she is releasing herself from potential times where she would have had to suffer a lot. The feeling of continuous suffering knowing that no person can reduce or eliminate it from her life is a lot of burden on the mind of the person suffering.
The value that Bea reflects in this statement is that of friendship. Bea and Doreen are both prisoners and it is assumed that both of them do not have good relations with friends and families that belonged to them. Hence, the bond that they form in prison is of primary importance. Here, they are the only ones who can take care of each other. It is their ability to make sure that their friend is physically in the right position (Lee, Lee & Park, 2016). They feel that it is their responsibility too to make sure that the friend is doing alright and they are performing all the steps that are within their capacities to perform. In relation to Doren, in most of the circumstances, the decisions taken by Bea would result in something good for her.
Molly is a doctor who has the responsibility of taking care of the patient’s health. Molly made the decision of following the regulations as laid down in Doreen's AHD. Doreen had already proclaimed that she does not want to remain alive if she cannot take care of herself. Therefore, it was decided that she would not take the service of CPR if her condition became bad enough to do so. It had the chance to keep her in a medical state where she would need constant caregiving from the nurses and the doctors. This is what Doreen was principally opposed to when she signed the AHD (Lipworth, Mason, Kerridge & Ioannidis, 2017). What Molly exercised is the rule of autonomy. She had the right to leave it up to the patient to decide for herself if the medical condition of the patient became critical. Here. She is not interfering with the autonomy of anyone else. Rather, she is exercising her authority to make sure that the autonomy of another person is paid attention to. Here, she has to consider one important fact. She has to consider whether Doreen has the capability of making her decisions. Since Doreen is someone who does not have any physical condition that would prevent her from taking her own decision, Dr. Molly has the full right to enable her to exercise her own autonomy.
The decision taken by the MET is fully within the provisions and is consistent with article 7. The decision that was to be taken by the MET was to whether add CPR to the facilities of Doreen. However, when they were made aware of her AHD, they saw that she consented to not continue to live when she would have t rely on others for her physical needs. Putting her on CPR is such a situation that would compromise with the legal document that is signed by the person herself. Article 7 mainly speaks about people who do not have the capacity to consent. However, this does not hold at all in the case of Doreen. Doreen had the capacity to consent when she signed the AHD (Lipworth, Mason, Kerridge & Ioannidis, 2017). Therefore, when MET receives the AHD that is signed by her, they receive a document that is created by a person of sound mind and capacity. If they are to follow the instructions laid down in the AHD, they are within the law in exercising such activity. Therefore, Doreen is someone who has the capacity to consent and the action taken by MET is not inconsistent with article 7.
The legal obligation for tracheostomy was base on the fact that Doreen did not have any next of kin and the decision made by the doctors and the medical professionals in the facility had to be on point. The obligation of the doctors was to make sure that the patient’s situation revives and for that, it was necessary for them to go ahead with the tracheostomy. They found that by using it as a medical precaution, Doreen’s life could be protected and her situation would become better (Gallagher, 2017). The professional obligation that the doctors or the medical personnel have is to treat the patient in a proper way and not let any other obligation come in the way of achieving that. If the decision making about Doreen’s condition was difficult due to the prevailing set of circumstances, it was obligatory for the doctors to ensure that Doreen would receive the best possible care. The fact that Doreen had no next of kin made the situation difficult for them and they had to find a way (Dubey, 2019).
The prison governor does not possess the authority to provide consent to perform any medical activity on the patient. It would be wrong if the medical authority goes ahead with the procedure of treating a patient by seeking the consent of the prison governor. A governor is a person who has the obligatory duty to make sure that the prisoners stay in the prison and they are provided with proper treatment (Caporale & Pavone, 2018). They do not assume any further role in the lives of the prisoners. They do not have the authority to make decisions on behalf of the prisoners at all. A prison or a correction facility is a place where the relations between the head authority, or the governor, and the prisoners themselves are found to be hostile in most of the circumstances. So, it can be said that the intention of malice cannot be ruled out in the set of circumstances. A decision-making process is something personal and something close to the person especially if it is medically related. In that sphere, the Prison Governor does not fit in any place.
In the situation, as has been presented here, only the people who are related to Doreen would have the legal authority to provide consent for pacemaker insertion. However, there is a catch in this method. Since Doreen is a woman who has spent a significant amount of days in prison, it is likely that the person related to her would not have the right intentions concerning Doreen. Hence, it is essential for such a person to pen down a next of kin list so as to make the decision-making processes easier in her case (Caporale & Pavone, 2018). However, it is found that Doreen has lost contact with all her friends and relatives due to her actions and she does not have a next of kin. In this situation, the legal authority goes to the medical professional. For the medical professional, or to be specific to the doctor, the profession obligates to treat the patient in a suitable way at the time of concern.
AHD stands for advanced health directive. It basically makes the patient list down the will or the medical document that would provide the doctors and the nurses with directives as to what is to be done to the patient in the case of a health situation. It is a legal document and it is laid down by the patient. Under normal circumstances, it is the next of kin of the patient who has the authority to provide consent or directions to the doctors to make their decisions. However, for a person like Doreen, it can be quite different. Doreen does not have a next of kin who will have the decision-making authority on her behalf. Hence, the situation calls upon her to complete the AHD (Caporale & Pavone, 2018). However, the prison doctor has to make sure that certain circumstances have prevailed while the decision has been made. The doctor has to make sure that the person is not manipulated to take any decision on her behalf by the prison authorities. The doctor would also need to make sure that the person is in a sound state of mind while making the decision.
In a situation where the decision making is the priority, the doctors would have to rely on something that is full proof. It will be better for the doctors if something is available to them in a documented form. In that case, they would not have to seek for other ways to get consent to perform their objectives (Tinnon, Masters & Butts, 2018). In this case, Doreen has provided the AHD which is a written legal document that allows the medical professional to make decisions on her behalf if she is under medical observation and unavailable for consultation. The AHD is a reliable document. This is because it is the person who by herself has given the consent to the doctors in writing. If that is available to the doctors, nothing more would be necessary for them to carry on with their job. She has written the document when she was of sound mind. The document was received by a doctor who by professional obligation, has to make sure that the person signs it without being under the influence on something else. Therefore, it is a document that the doctors can rely upon when a situation will develop for the patient. The legal document makes it clear for the doctors to go ahead with their procedures.
First of all, the substitute decision-maker must consider the fact that the decision that he or she takes in this situation is something that Doren herself would not find objectionable. This can be termed redundant if Doreen is a person who has shown tendencies to cause harm to herself on a regular basis. However, it has been established based on the history of Doreen that she is not someone who is possessed with such mentality (Stahl & Coeckelbergh, 2016). Hence, this consideration will hold for Doreen’s case. Secondly, the person has to make sure that Doreen’s immediate family or immediate close relatives are informed about the news. They would possess the right to know about Doreen’s condition even if they do not participate in her life. Doreen is a person who has spent a large part of her life in prison. She is someone who would be vulnerable to make decisions that can be emotional. The person who has the secondary authority to make decisions on her behalf has to consider this while making the decisions. None of the ultimate decisions made as a result should be taken with an emotional point of view. Her health has to be the primary consideration (Peter, 2018). If Doreen makes it clear that she does not want to live a life that is dependent on a lot of nurses and the doctor, the secondary decision-maker has to take in the consideration of her health. That should be the primary concern of the decision-maker.
Through these criteria, it was possible to come to the conclusion that the decision taken by the doctors and the MET was consistent with the legal and ethical considerations. The mistake that can be pointed at in this whole ordeal is the fact that Bea or anyone else did not decide to make the immediate family of Doreen heard about the results of her medical situations.
Caporale, C., & Pavone, I. R. (Eds.). (2018). International biolaw and shared ethical principles: the universal declaration on bioethics and human rights. Routledge.
Chong, Y. R., & Lee, Y. H. (2017). Affecting factors of the awareness of biomedical ethics in nursing students. J Korean Acad Soc Nurs Educ, 23(4), 389.
Dubey, A. (2019). Artificial Intelligence: Ethics in Healthcare. J Pharm Drug Res, 2(4), 140-141.
Gallagher, A. (2017). Care ethics and nursing practice. In Key Concepts and Issues in Nursing Ethics (pp. 55-68). Springer, Cham.
Lee, K. J., Lee, E., & Park, Y. S. (2016). Comparison on influencing factors on consciousness of biomedical ethics in nursing students and general students. Journal of Digital Convergence, 14(12), 377-388.
Lipworth, W., Mason, P. H., Kerridge, I., & Ioannidis, J. P. (2017). Ethics and epistemology in big data research. Journal of bioethical inquiry, 14(4), 489-500.
Peter, E. (2018). Overview and summary: Ethics in healthcare: Nurses respond. OJIN: The Online Journal of Issues in Nursing, 23(1).
Stahl, B. C., & Coeckelbergh, M. (2016). Ethics of healthcare robotics: Towards responsible research and innovation. Robotics and Autonomous Systems, 86, 152-161.
Tinnon, E., Masters, K., & Butts, J. (2018). A pragmatic approach to the application of the code of ethics in nursing education. Nurse educator, 43(1), 32-36.
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