Case Scenario
A 72 year old woman was admitted to the Neurological Intensive Care Unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up “living wills” with an attorney. She was diagnosed by her treating physician as being in a permanent unconscious condition. The patient’s living will specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition.
The patient’s husband is her legal next of kin and the person with surrogate decision-making authority. When the living will was discussed with him, he insisted that the patient had not intended for the document to be used in a situation like the present one. Further discussion with him revealed that he understood that the patient would not be able to recover any meaningful brain function but he argued that the living will did not apply because her condition was not imminently terminal. He further indicated that he did not consider his wife to be in a permanent unconscious condition. The immediate family members (the couple’s adult children) disagreed with their father’s refusal to withdraw life support.
The treatment team allowed a week to pass to allow the husband more time to be supported in his grief and to appreciate the gravity of his wife’s situation. Nevertheless, at the end of this time, the husband was unwilling to authorize withdrawal of life support measures consistent with the patient’s wishes as expressed in her living will. End of scenario.
1. Three Legal/Ethical Issues. Just list the three most important legal/ethics issues in this scenario that you will discuss. They must be three separate, different and distinct issues. Pay particular attention to the article I furnished with this assignment. No explanation needed, just state them 1, 2, 3.
2. Discussion of Three Legal/Ethical Issues. Discuss the three most important ethical/legal issues you listed above. Must use the relevant facts in the scenario to support your discussion of the legal/ethical issues.
3. How I would Handle Each Issue. First, in this section and for each issue, as a health care provider, how would you handle each of the three issues discussed above and why? Must use the relevant facts in the scenario to support your positions. Secondly for each issue, using the article in these requirements, entitled “A Framework of Thinking Ethically” fully discuss the specific ethics philosophy that would epitomize your handling of each issue. Fully define the specific ethics philosophy used and weave the ethics philosophy into your discussion. See article below entitled A Framework for Thinking Ethically.
Article One of Two
Clinical Ethics Issues and Discussion Article
Relationships: I. clinical ethics, law & risk management
- Definitions and sources of authority
In the course of practicing medicine, a range of issues may arise that lead to consultation with a medical ethicist, a lawyer, and/or a risk manager. The following discussion will outline key distinctions between these roles.
- Clinical ethics may be defined as: a discipline or methodology for considering the ethical implications of medical technologies, policies, and treatments, with special attention to determining what ought to be done (or not done) in the delivery of health care.
- Law may be defined as: established and enforceable social rules for conduct or non-conduct; a violation of a legal standard may create criminal or civil liability.
- Risk Management may be defined as: a method of reducing risk of liability through institutional policies/practices.
Many health care facilities have in-house or on-call trained ethicists to assist health care practitioners, caregivers and patients with difficult issues arising in medical care, and some facilities have formally constituted institutional ethics committees. In the hospital setting, this ethics consultation or review process dates back to at least 1992 with the formulation of accreditation requirements that mandated that hospitals establish a “mechanism” to consider clinical ethics issues.
Ethics has been described as beginning where the law ends. The moral conscience is a precursor to the development of legal rules for social order. Ethics and law thus share the goal of creating and maintaining social good and have a symbiotic relationship as expressed in this quote:
[C]onscience is the guardian in the individual of the rules which the community has evolved for its own preservation. William Somerset Maugham
The role of lawyers and risk managers are closely linked in many health care facilities. Indeed, in some hospitals, the administrator with the title of Risk Manager is an attorney with a clinical background. There are, however, important distinctions between law and risk management. Risk management is guided by legal parameters but has a broader institution-specific mission to reduce liability risks. It is not uncommon for a hospital policy to go beyond the minimum requirements set by a legal standard. When legal and risk management issues arise in the delivery of health care, ethics issues may also exist. Similarly, an issue originally identified as falling within the clinical ethics domain may also raise legal and risk management concerns.
To better understand the significant overlap among these disciplines in the health care setting, consider the sources of authority and expression for each………
SOLUTION
Assignment #4: Healthcare case analysis
Student
Maryland University Global
HMGT 372
12/10/2024
Healthcare Analysis
A 72-year-old woman was taken to the Neurological Intensive Care Unit after suffering a cerebral hemorrhage, which caused serious brain damage and required the use of a ventilator. She had previously been declared in permanent unconsciousness. A year before the incident, she and her husband had made living wills in which she stated unequivocally that she did not want to receive ventilation or other forms of artificial life support. Her husband, who is her legal next of kin and has surrogate decision-making authority, questioned the use of her living will in the current situation. He contended that the contract does not apply to her current situation because she is not in her dying days and that she is not in a state of permanent unconsciousness. The care workers gave the husband one week to grieve while the patient was still on ventilator support. However, the husband refused to remove life support following the patient’s living will.
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