The 1973 decision of Roe v. Wade is still debated heavily in politics. Ian Kennedy, ‘What is a Medical Decision?’ in Ian Kennedy, Treat Me Right: Ethics in Medical Law and Ethics (Clarendon Press 1988). David Hume, An enquiry concerning the principles of morals, 1998. (Kant, Immanuel. For Hume, the wrongness lies not in the object but in us. Was she offered escorted chances in a smoking area to exercise her wish? • Reporting an incompetent or impaired colleague • Owning up after making a medical error The human rights contained within this law are based on the articles of the European Convention on Human Rights. The first involves the rights of an individual to decide her own fate, even against her physicians' judgments. In its simplest terms, consent may be defined as giving permission: “… in current usage consent is defined as a voluntary compliance, or as a permission. The law provides—on its face—two concepts: those who have, and those who lack, capacity. Richard Huxtable, ‘ ‘In a Twilight World’? A abstains from doing so in order that B may be drowned, A will have committed no offence (S Fitzjames, Digest of Criminal Law1887).This example clearly shows that there is no positive duty for B to act, even though B holding his hand out may have saved A’s life. In the 1960s, Ionia State Hospital, located in Ionia, Michigan, was one of America's largest and most notorious state psychiatric hospitals in the era before deinstitutionalization. Ethical Dilemma. The man did not authorize the use of his bodily tissues or fluids, and researchers did not obtain informed consent. First of all, ANMC [19] indicated that Nurses value informed decision making (p. 8). He did not want his donation to generate commercial profit for private entities. Dina has lived at this Nursing facility for nine years where she has slipped into what her doctor agrees is Alzheimer’s disease. The parents of a child born with horrible birth defects request the right to refuse treatment and keep the child off life support. When we see certain actions a feeling or sentiment arises within us and we adopt either a disapproving or approving attitude towards it. There are many reasons as to why abortion poses an ethical dilemma for most women. They cannot take a person’s life unless it is absolutely necessary. This principle will result in the denial of the patient’s autonomy and right to play full part in decisions about their treatment but will be justified by the belief that patients cannot possibly be as well informed as their doctors and can therefore make no useful contribution to decision making. I believe that it is justifiable for patient autonomy to be the most important principle as ultimately it is the patient who should decide what happens to their own body and not family members or officials for societal good. Numerous blood tests and scans at the hospital showed that her platelet blood count is abnormally low and her spleen was mal-functioning (scan showed metastasis tumor). respect for private and confidential information, particularly the storing and sharing of this information (in the UK this is largely covered by the Data Protection Act 1998: the right to have confidential and unlimited communication with others, the right to control how information about your private life is shared, A sister is charged with euthanizing her brother after he has medical problems. Robert C Solomon, ‘Corporate roles, personal virtues’ in Statman, op cit, p 217. Section III of the MCA goes on to consider patient values in relation to the concept of the medical decision, which requires to be understood by reference to the multiple ‘stakeholders’ involved in it: the patient herself (Dina), the authority responsible for resource allocation (the nursing home and hospital) as well as the person making the clinical determination (the doctors / hospital). The complexity of her case meant that Dina needed urgent medical intervention. She has requested to smoke but have been ignored on numerous occasions. (2007) The Human Rights Act and Mental Health Law: has it helped? This is because the consequences of an action are often without our control and cannot be easily predicted. The decision is with regard to whether or not to allow the closure of the department of emergency for the purpose of saving costs of care for the organization. A 21-year-old girl is in a persistent vegetative state. A clinical case study of an ethical dilemma that occurred in a cross-cultural context is examined. Rule Utilitarianism, on the other hand, doesn’t believe assessing individual situations is appropriate, or even possible. An Act Utilitarian would say it depends on other aspects of the individual situation. In the Bolam testa patient suffered severe injuries as a result of receiving Electro Convulsant Therapy (EVT) without muscle relaxants. The dilemma stems from a conflict between two leading ethical principles. So long as the aggregate happiness is maximized, there is nothing wrong with minority interests being served on certain occasions. Medical ethical dilemma essay rating. John Coggon, ‘Varied and Principled Understandings of Autonomy in English Law: Justifiable Inconsistency or Blinkered Moralism?’ (2007) 15(3) Health Care Anal 235. This principle acknowledges that patients have the right to control their own lives and so can decide when to accept treatment or not. Consider the ethical dilemma the health care professional faces in the selected case study. (Kant, Immanuel. This does illustrate nicely the law and the public’s increasing acceptance of others apart from the patient as having say in what procedures are allowed. Case and Commentary Nov 2020 How Should Risk Managers Respond to Cases for Which No Risk Profile Exists? It was the day after Thanksgiving. Hazel Biggs and Caroline Jones, ‘Legally Vulnerable: What Is Vulnerability and Who Is Vulnerable?’ in Michael Freeman, Sarah Hawkes and Belinda Bennett (eds), Law and Global Health (OUP 2014). M. Komrad, ‘A Defence of Medical Paternalism: Maximising Patient Autonomy, ‘Journal of Medical Ethics, 1988. Some cases have been remarkable for starting broad discussion and for setting precedent in medical ethics. Prison officials question whether to force-feed inmates who are on hunger strike. The amount of information provided is at the discretion of the doctor, as demonstrated by Sidaway v. the Board of Governors of Bethlhem Royal Hospital (1984). Another pointer may be a question into her refusal to attend to dine and eat properly. Free resources to assist you with your university studies! 16th Dec 2019 In total, there are 16 rights set out in the Human Rights Act. James R. Thobaben, Health-Care Ethics (Downers Grove, Illinois: IVP Academic, 2009). In 2004 GlaxoSmithKline (GSK) sponsored at least four medical trials using Hispanic and black children at New York's Incarnation Children's Center. The parents of a brain-dead boy wanted to keep him on life support. This could be treated in law as a form of degrading treatment as Dina may have become very distressed at the refusal. Ethical views on autonomous decisions determining whether a life has lost value are gaining momentous. It must be noted that this ultimate decision may not have been in her best interest as in the case of Sidaway vs Bethlem Royal Hospital Governors 1985. Instead Rule Utilitarian believe that we should stick to general rules of conduct such as ‘Don’t lie’ or ‘Always keep your promises’ because these rules in turn tend to produce good consequences overall. Her husband and family wish to remove life support. The manager at the Nursing Home became alarmed and after consulting with her staff it was decided that Dina is transferred to a hospital facility for clinical investigations. The principles of justice are chosen behind a veil of ignorance”. Before the Dementia progressed, she was a very bubbly lady who could be found wherever a group had gathered. To reach that conclusion, my analysis will aim for conceptual clarity on whether Dina’s attending doctor offered her rights within case law or that because of her Alzheimer’s condition the medical team denied her rights and took a completely autonomous decision because the law appears to be edging towards giving these groups more recognition. In Dina’s case, the nursing home manager made a decision to refer her to a hospital facility after she became alarmed at her deteriorating state. A woman is in a persistent vegetative state. This is why Dina’s brother is seen to be taking a paternalistic approach. It happened when I was a director of case management at a large medical center in New York City. Ultimately, the patient must decide whether the potential benefits outweigh the potential harms. She is not allowed to leave the hospital grounds. (Hasman, A., Mcintosh, E. and Hope, T. 2008), Jackson however has argued that doctors do not consciously apply rationing to decisions, in day to day practice; at the most ‘If a patient is suffering from symptoms which are very likely to be caused by a minor illness but there is a remote chance that there is something much more serious wrong with them the doctors will adopt a wait and see approach. 1785). Euthanasia violates codes of medical ethics which have existed since antiquity. While other cases, such as pregnancies resulting from criminal acts, … Laws are a familiar concept, and provide a basic social framework of right and wrong to which the majority adhere. Legal rules regarding anticipatory decision-making suggest that a patient’s more recent values should be prioritized if there is a conflict or apparent change over time. Christine suffered from oral cancer. Autonomy means "self-rule" and involves the right of an individual to make choices that may go against a physician's treatment advice concerning treatment, or non-treatment, of an existing health issue. Treatment without consent may be regarded as battery, but legally this consent still does not have to be fully informed in the UK. Published by, 1834, vol 1, J. Bentham, Principles of Morals and Legislation in 1789. However, some moral choices don’t involve getting any happiness at all. This group can still present thornier conceptual, legal, and ethical problems. Dina finally died ten hours later. After retirement, Dina, who has never married and never had children, sold her home, and moved into a Nursing Home. Public authorities, like a local authority or the NHS, must follow the Act. Words: 632. My intension is to present a problematic case that poses a medical-ethical dilemma for patients, families, and healthcare professionals. Physicians recommend a biopsy. David Hume, An enquiry concerning the principles of morals (Tom Beauchamp, ed), Oxford University Press, 1998, Department for Constitutional Affairs, Mental Capacity Act 2005—Code of Practice (TSO 2007), D. Pretty  v The UK, (Application no.2346/02) (2002) 35 E.H.R.R 1 ), Emily Jackson, Medical Law, Texts Cases and Materials (2nd ed OUP 2010) 64, Ethics & Medicine: An International Journal of Bioethics 27(1), Spring 2011, 13-16. The right of minors to request contraception from their doctor without parental consent. Section IV then considers judicial interpretations of how best interests should be understood and applied. The ethical dilemma in the case discussed below involved whether or not to continue treating a client who clearly needed occupational therapy services based on medical necessity, yet the payer-source (Medicare) coverage criteria for services to be delivered at home was questionable. Decisions continued to be taken on Dina’s behalf until she went into hypotensive shock and eventually her death. Her parents wish to remove her from artificial respiration. In the court of appeal, the patient claimed negligence as she had not been informed of the risk of this procedure. The intent of this coursework is also to offer ethical analysis and medical recommendations that are consistent with moral principles. Book review:The Plutonium Files: America's Secret Medical Experiments in the Cold War, "Fact Sheet on the 1946–1948 U.S. Public Health Service Sexually Transmitted Diseases (STD) Inoculation Study", United States Department of Health and Human Services, "Guatemalans 'died' in 1940s US syphilis study", "Acres of skin: human experiments at Holmesburg Prison. They wanted the hospital to allow them to travel to the U.S. for an experimental therapy that may have provided some temporary benefit but likely would not have improved his neurological condition, due to a, The hospital removes life support from an unconscious immigrant from. The principle of beneficence is often seen as the overriding duty in healthcare. Bland was the first patient in English legal history to be allowed to die by the courts through the withdrawal of life-prolonging treatment. The Stanford prison experiment was a study of the, Human radiation experiments were directed by the. As my scenario is based on a real case, some details have been changed in the effort to maintain patient confidentiality. They have also provided supporting documents and readings to assist you in working through each of the cases as part of your in-practice teaching with your GP Registrar. June 25, 2008. Was she offered the necessary alternative to be served in her room and encourage to eat or even be fed by the staff or were trays of food left and cleared up with food untouched? The Guidance for Professional Practice -(UKCC 1996). Article 8: Right to a private and family life – is a qualified right, which includes: respect for your sexuality, the right to make choices for yourself, and the right to have your body and mind respected. Patients must be informed how necessary a procedure is, any alternatives, and any common or serious consequences of it (Sidaway vs Bethlem Royal Hospital Governors 1985). The conflict is between the duty of the medical team to respect the instructions of the patient’s next of kin, who have explicitly given consent to firstly medical intervention and (perhaps) a duty owed to Dina to pay attention to her wishes. This is not to say however that consequences never matter. A couple request the legal right to commit suicide together, although only the husband was ill. A man who suffered severe burns requests the right to die. By basing morality on reason we not only guaranteeing its objectivity but also its authority or sovereignty. Other interesting ethical questions in this case will also involve conflict between the demands of commonly-held moral values. The Sidaway case makes reference to a patient who was left with paralysis after an operation to relieve a trapped nerve. It is best conceived as being about respecting a patient’s determination of her interests by reference to her reflectively endorsed values, rather than non-substantive reverence for bare choice in itself. On the contrary, one could argue that an appeal to justice would compel cessation of further intervention so that expensive resources would not be used on Dina who was later seen to be benefiting less from the treatment. C. Faulder (1985:32). It must be noted that together they all help aid decision making in ethical dilemmas (Ambrosino and Goldstein 2008). He also showed a positive attitude towards the whole medical process to benefit his sister. Identify and clarify an ethical dilemma facing your chosen discipline, health and medical assignment help The goal of the Session Long Project is to identify and evaluate the ethical principles used in resolving ethical dilemmas, and to apply the principles to specific ethical issues that may have professional, sociological, economic, legal, and possible political implications. Harris and Woods argue that patients have a moral duty as in everyday life to public interest and medical law should be no exception. Parents and doctors agreed to withhold life-prolonging measures of severely disabled newborn baby, including surgeries and medication, while Right to Life activists claimed the baby was murdered. The emphasis was placed on pain and symptom management by promptly changing Dina’s care level to palliative care. A true story of abuse and exploitation in the name of medical science", "Report on Ely Hospital. A final ruling was aimed at promoting a culture and a way of working that actively challenges poor practice and promotes compassionate care across the system. These four principles consist of respect for persons’ autonomy, principle of beneficence (and non-maleficence) and the principle of justice. Consent may be implied, verbal, or written, but accurate records must be kept by the professional as to the information given and the consent granted by the client. Since the time of Hippocrates in medicine, there have been common ethical tenets. As we have seen, healthcare and medical technology is constantly evolving. Many of these virtue traits can also be seen in the character of Dina’s brother as he was very cooperative with the hospital consultants’ views to provide medical interventions on his sister. Dissertation Kant, Immanuel. Now, on this occasion, the actions of Dina’s consultant failed to promote the best possible consequences which led to her death. Dina’s later life in the nursing home during which she was unable to get out of bed. There is a vast amount of case law in this field which will be used to illustrate the exceptions to an omission. Therefore the moral worth of an act must derive from something intrinsic to the act itself rather than extrinsic to it. Major health care interventions are based on the principle of autonomy. Was there negligence in the hospital setting? Company Registration No: 4964706. Jeremy Bentham introduced the Principles of Morals and Legislation in 1789. However, as far as moral assessments go, they are irrelevant in calculating the moral worth of an act; only good intentions or motives matter. A family wishes to keep life support for a man in a persistent vegetative state. I will never forget my biggest ethical dilemma. Section 3.2 of the Nursing & Midwifery Council Code of Professional Conduct for instancestates that “you must respect patients’ and clients’ autonomy- their right to decide whether or not to undergo any medical or health care intervention – even where a refusal may result in harm or death to themselves”. For the purpose of this essay, I will only highlight the situation where there is a special relationship between doctors and patients. Normally trials on children require parental consent but, as the infants were in care, New York's authorities held that role. The English legal system does not have a ‘good Samaritan rule’ neither is there ‘no duty of easy rescue’. by J. Bowring. The Hippocratic Oath, taken by doctors on graduation since the 5th century BC, specifically prohibits doctors from helping their patients die. Lack of ethical, legal, and clinical consensus about best practice sometimes combines with a poor clinical evidence base. David Hume provides almost thirty virtues in total: honesty, loyalty, sincerity, courage, reliability, trustworthiness, benevolence, sensitivity, helpfulness, cooperativeness, civility, decency, modesty, openness, cheerfulness, amiability, tolerance, reasonableness, tactfulness, wittiness, gracefulness, liveliness, magnanimity, persistence, prudence, resourcefulness, cool-headedness, warmth, hospitality. It must however be mentioned that within this same code of practice, section 3.8 conflicts the whole autonomy idea and states that “where treatment is necessary to preserve life, care should be provided without the patients’ or clients’ consent”. doi: 10.1001/amajethics.2020.1004. A situation can be considered an ethical dilemma when several possible solutions to the problem are valid and relevant but mutually exclusive, with no evident advantage to any of them (Weber & Pockett 2011). These are known as Act Utilitarianism and Rule Utilitarianism. In conclusion I believe that patient autonomy has huge importance in English law but that it has not gained too much importance. Simply put ‘acting from duty is doing so simply because you know it’s the right thing to do, and not for any other reason.’ Kant is particularly keen to emphasize the distinction between acting from duty and acting from inclination. A woman is declared brain-dead by her physician. Harry Frankfurt, ‘Freedom of the Will and the Concept of a Person’ (1971) 68(1) J Phil 5; Gerald Dworkin, The Theory and Practice of Autonomy (CUP 1988). Click on each Case Study to view. This paper presents a clinical case study, identifies the ethical-legal dilemma, and discusses the ethical and legal principle that applies in this case. This principle explains why in British law, a doctor has the right to choose what information is provided before consent is given. Doctors at this hospital diagnosed African Americans with schizophrenia because of their civil rights ideas. That is, should one continue to treat the client and uphold the principle of beneficence yet run afoul of the law, or should … Case 1: A woman enters the emergency room with stomach pain. Choose one of the scenarios on this site, or select a case of your own choosing from another resource. It is generally recognised that the more closer the relationship the more likely the law will impose a duty (French Penal Code Article 63). In simple terms, there is generally no liability for failing to act, however there are six exceptions and if a person fails to act then they will be committing a criminal law offence. A mother euthanizes her adult sons to relieve their suffering from. “First Section: Transition from the Common Rational Knowledge of Morals to the Philosophical”, Kenneth Veitch, The Jurisdiction of Medical Law (Ashgate 2007), Lynn A. Jansen, “Consensus and Independent Judgment in Clinical Ethics,” Journal of Clinical Ethics 20, no. This duty also applies to people who are informal patients. Rawls in his 1971 publication ‘A Theory of Justice’ argued that people have a duty to act according to the law that they would propose if they were unaware of their present socioeconomic status: “… no one knows his place in society, his class, position or social status, nor does anyone know his fortune in the distribution of natural assets and abilities, his intelligence, strength, and the like. "[34], In January 2012, GSK and two scientists who led the trials were fined approximately $240,000 in Argentina for "experimenting with human beings" and "falsifying parental authorization" during vaccine trials on 15,000 children under the age of one. The judge rejected the petitioner’s claim as a respectable body of medical opinion agreed that it was not necessary to warn a patient of every risk (Bolam test – see below). With the explanation and case examples above, it can be noted that Dina’s consultant acted in her best interest even though she suffered harm and finally death as a result. Section 1(1) MCA stipulates that we should assume that adults have capacity, and the tests in sections 2 and 3 provide the means by which that assumption might be displaced. However, if his actions were not a generally accepted practice within the hospital setting then it would generate far more pain for society as a whole. If the child dies, the parent may be charged with murder. 1785), Kant also argues that a good will is not good because of what it achieves; it is intrinsically good in and of itself. (Yorke J, 2010). [35], Termination of mechanical ventilation and life support, Withholding life-prolonging medical treatment, "Tuskegee Study – Timeline". There is a requirement for emphasis to be made to autonomy within capacity law. As the theory of Utilitarianism was developed and refined over the years, there emerged two distinct branches of Utilitarianism. In the case of D. Pretty  v The UK, 2002, the courts exercised a utilitarianism approach and sacrificed Mrs. Pretty’s autonomy interests for the greater good, to protect vulnerable people in society who may be coerced into giving up their life. Because many medications, procedures, and interventions cause harm in addition to benefit, the principle of non-maleficence provides little concrete guidance in the care of patients. The Guidance for Professional Practice – (UKCC 1996). A parent is charged with critically harming his child who is on life support. Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience. The conflict is between the duty of the medical team to respect the instructions of the patient’s next of kin, who have explicitly given consent to firstly medical intervention and (perhaps) a duty owed to Dina to pay attention to her wishes. (Rumbold 2000) is often used by doctors as an argument against informed consent. Jonathan Herring and Jesse Wall, ‘Autonomy, Capacity and Vulnerable Adults: Filling the Gaps in the Mental Capacity Act’ (2015) 35(4) LS 698. They instead proceed by concentrating on the character of the person who performs the act, outlining which virtues they typically have rather than what actions they perform or what motives they have. The judge ruled that the doctor had not been negligent and noted that “A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular act.” (Bolam vs Friern Barnet Management Committee 1957). GMC. Supposing Dina had capacity and could give consent, then there would not be a dilemma. (V. Tschudin 1989). Dina) can be grouped with the latter two. Unconscious patient's 'Do Not Resuscitate' tattoo creates ethical dilemma for ER staff . V. Tschudin, Ethics In Nursing: The Caring Relationship 1989:339, Williams G, ‘Assisted Suicide, the Code for Crown Prosecutors and the DPP’s Discretion’, (2010), Common Law World Review, Yorke J, The Right to Life and the Value of Life Orientations in Law, Politics and Ethics, Ashgate Publishing Limited, 2010, Page 6. These resources could be used for other patients who might benefit more. The ethical dilemma, in this case, is brought out in the fact that the CEO is faced with two decisions, both of which are right. In this situation the ICU consultant was concerned about providing additional medical treatment that the patient may not have wanted. According to this ethical value statement, Mr Green's decision of suicide should be respected. Medical Ethics Dilemma . “When the consent of the patient is not sought for any treatment or intervention, that person’s life is devalued. By Toni Cesta, PhD, RN, FAAN Senior Vice President Lutheran Medical Center Brooklyn, NY.
2020 medical ethical dilemma cases