Abstract
According to the given scenario Mr. Jones arrived to the hospital with his daughter. He is suffering from respiratory distress and several medical conditions. After doctors evaluate Mr. Jones, found he was suffering from Alzheimer’s disease and that he has gangrene on his right foot. Prompt intervention is needed since Mr. Jones is a diabetic patient. Doctors agree that Mr. Jones must undergo to a below the knee amputation procedure to save his live but Mr. Jones refused the surgery by saying he must die with his body intact. Contrary to Mr. Jones’ opinion his daughter wants the doctors to do the procedure. She told doctors that they had to do everything for his father so that she can take him back home; although, she may be afraid of an investigation for elder-neglect. This paper aims to address the various legal and ethical challenges of this scenario as well as provide a satisfactory solution to all parties.
Challenges in Capacity and Decision Making
The law presumes that adults are capable of making their own health care decisions, but what happens when patients do not meet the criteria to decide on their own? Every day physicians access the decision-making capacity of their patients at every clinical encounter. Decision capacity is the concept in health care law and ethics that will be discuss in this document.
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Legal Aspects
Clinicians always want to achieve the best possible outcomes for patients; however, they face multiple legal boundaries. The first legal issue in this situation is the patient consent. Doctors need the patient’s consent or the authorization of the legal guardian to do any medical intervention or move ahead with any treatment. If a doctor performs a treatment without this consent they could be charged for battery or negligence. Mr. Jones said that he does not want any intervention and that his body must remains intact so the doctors cannot undertake the proposed treatment. However, Mr. Jones daughter disagrees. She wants the surgery because she fears an investigation for elder-neglect if her father dies due to lack of treatment.
Legal rights of the patient versus his daughter’s rights
The major parties involved in this dilemma have opposite points of views. According to legal statutes in the United States, patients have the right to take decisions about the treatment which they undergo. Patients can employ or remove any person from providing health care to them at any time. On the contrary, if a patient is not competent to make this decision, the care giver gives the authorization for the treatment. Only if Mr. Jones is declared incompetent, then his daughter can take over the decision for him but Mr. Jones expressed his will loud and clear. Mr. Jones’ legal rights are higher than his daughter’s rights because he is the patient and he is capable of making his own decisions.
Ethical Issues of the Case
In this case the patient denies undergoing a treatment proposed by the doctors. The first ethical dilemma faced by doctors is whether to treat the patient without his consent. This decision will have legal implications if they do. The other option is to leave Mr. Jones on his condition, which is ethically wrong. In addition to doctors, Mr. Jones daughter is facing a huge ethical dilemma since she is unable to decide for her father to assure him an adequate treatment. It is for sure that Mr. Jones daughter cannot take the decision on his behalf, unless Mr. Jones is declared incompetent through a capacity assessment.
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A capacity assessment is an analysis that evaluates the functional abilities of a patient to verify whether the patient is in position or not to take health care decisions. The study analyses if the patient is able to understand the information provided and whether he or she can analyze the consequences of those decisions. Then, doctors may decide if they should respect the patient consent or start the right treatment option as per agreed. Given the above circumstances that Mr. Jones has been diagnose with Alzheimer’s disease and mild dementia he needs to undergo through a capacity assessment. These mental disorders might affect the decision-making capacity of patients so doctors need to screen the patient’s ability to understand relevant information, appreciate its consequences, and their ability to manipulate the information rationally.
Recommendations
Hospital’s ethics committee provides ethical consultations for ethical dilemmas when patients and clinicians are not able to establish a satisfactory resolution. The committee promotes a share decision making process by providing psychiatric and emotional support. In this case, Mr. Jones needs the information and support that aim to enhance his decision-making capacity; respecting his values and preferences. For analyzing difficult cases such as Mr. Jones’, the committee uses a bioethics methodology. The process includes the analysis of all diagnoses, treatment options, life quality of the patient, and the desired outcome. The patient’s preferences and values are central to determine the best and most respectful course of treatment. These encounters consider the family, legal aspects, hospital policies, culture, and financial issues. After the process is done, clinicians are able to identify the best course of action available to them.
Ethical dilemmas exacerbate the tension among patients, family, and doctors. It is difficult for a doctor that a patient refuses to undergo a treatment that could save his life. However, under such situations patient’s values are over any considerations. Only if the patient lacks his capacity for decision-making, the care giver or surrogate will make that decision. It is necessary to analyze this kind of clinical scenarios to make appropriate corrections for such dilemmas.
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References
American Bar Association. (2009).
Assessment of older adults with diminished capacity.
Washington: American Bar Association.
Charland, L. (2008, January 15).
Decision-Making Capacity. Retrieved December 7,
2014, from http://plato.stanford.edu/entries/decision-capacity/
Pozgar, G. (2013).
Legal and ethical issues for health professionals (3rd ed.).
Burlington, MA: Jones & Bartlett Learning.
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