Australian Government Departments of Health

Running head: ETHICS AND LAW - ANALYSIS OF HEALTH CARE
ETHICS AND LAW - ANALYSIS OF HEALTH CARE
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ETHICS AND LAW - ANALYSIS OF HEALTH CARE
Introduction:
Performing withholding and withdrawing nutrition and hydration (ANH) is a hotspot of
controversy occurs widely in a variety of health care settings. A significant number of
individuals around the globe experience chronic disease where active or passive euthanasia can
reduce the painful experience of the patient.Hence, the concept of withdrawing life-sustaining
nutrition fluids requires in-depth understanding and analysis of euthanasia for providing patients
with the favourable dying experience. The concept also requires an honest discussion of personal
belief of the health professionals who will provide care to the patients.
The case study involves a 46-year-old female, Ms A, who suffered in a fall due to
quadriplegic spinal cord injury. While she is cognitively intact, she is living in a nursing home
and requires assistance in her acute care. As she could not swallow, her nutrition and fluids
intake was through PEG tube and respiratory function. She has requested to cease her feeding
through PEG tube so that she can be allowed to die. Hence, this paper aims to analyse the
legality of MS B’s request in the Australian and Singapore legal standard. The paper will also
explore the differentiation of the removal of treatment and euthanasia, risks of the professionals
in the nursing home and professional issues regarding the refusal of complying with Ms A’s
request in following paragraphs.
Legal issues regarding the prerequisite of life-sustaining nutrition and fluid:
As discussed above, Ms A requested for the cessation of her feeding through PEG tube
so that she can be allowed to die. In this case, in order to comply with the request of the patient,
various factors are required to consider and analysis prior to agreeing. The factors include the
mental capacity of Ms A for requesting the cessation, laws that support the refusal of consent to
treatment and if refused treatment is part of palliative care. According to the SNB code of

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ETHICS AND LAW - ANALYSIS OF HEALTH CARE
Principle 2 which is identical to NMBA code of conduct principle 2.3, nursing professionals
must respect that individuals have rights to self-determination and they must be provided with
adequate information regarding treatment. However, assessment of mental capacity of the patient
is crucial for the person who is providing consent. According to Mental Health Act (2014), in
order to obtain informed consent from the patient, it is crucial to assess the mental capacity
whether one is able to understand the information provided and retain the information as it will
further be contributed to the decision making. On the other hand, Mental Capacity Act (2008) of
Singapore suggested the similar condition that the adultindividuals usuallyhave the capacity of
providing consent unless it is mentioned otherwise (Www2.health.vic.gov.au., 2020). Taking a
deep insight into the situation, Ms A has her cognitive capacity intact and no information
suggested deterioration of mental health. She already requests for the cessation of feeding which
will result in death, indicating she is already aware of the consequences of the decision. Hence, it
can be said that the patient has the ability to provide consent for withdrawing the treatment.
On the other hand, considering the legal requirement of refusal of medical treatment,
according to advance medical directive of Australia, a competent adult of 18 years or above can
refuse to receive life-sustaining treatment and provide power of attorney to others (especially
physician) to take the decision on behalf of him (Www.health.gov.au, 2020). The similar
condition present in the medical treatment act (1998) of Australia, suggested that individuals
over 18 years can turn down the process of life-sustaining treatment (Emanuel, 2017). The
legislation of Singapore also suggested that adult and competent individuals can turn down the
process of life-sustaining treatment, indicating both the jurisdictionssupported the decision of
Ms. A.

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ETHICS AND LAW - ANALYSIS OF HEALTH CARE
Thirdly, according to advance directive of Singapore, patients cannot choose to refuse
the life-sustaining treatment in the palliative care setting. The supreme court of Victoria
supported the fact that the patients cannot refuseCANH without gathering sufficient knowledge.
Consequently, in the clinical setting the patients must receive CANH provided by
professionals(Koon et al., 2018). However, while Rights of the Terminally Ill Act 1995 (NT)
refused to accept legalization of euthanasia, the End of Life law of Australia and Medical
Treatment (1998) of Singapore provide the rights to the adults to withdraw their life-sustaining
treatment if they have the capacity to understand the consequence of it (End-of-life.qut.edu.au,
2020). Therefore, Ms A can refuse to receive life-sustaining treatment and it is legal
responsibility of professionals to support euthanasia.
Complying with the request of Ms A:
Kennedy and Kennedy (2018) suggested that from the euthanasia is defined as the
deliberate act of ending a life of the patients for providing comforting, consented death devoid of
pain. Moreover, Treanor (2018) defined euthanasia as a spiritual state of dying at the impending
approach of death. Hence, both of these definitions justify the legal rights of a human being to
experience comfortable and painless death. While euthanasia is considered asan illegal exercise
practice by professionals, a range of definitions of euthanasia supported it as a legal action
respecting the autonomy and legal rights of the patients. Moreover, According to Voluntary
Assisted Dying Bill (2017) of Victoria, there are specific criteria for euthanasia and any act that
can justify these criteria constitute euthanasia (Www.parliament.vic.gov.au, 2020). These criteria
suggested that in order to request euthanasia, individuals must be older than 18 years and must
have the capability to make a decision. Moreover, the patients should have a terminally ill
disease and it must be painless. Considering the request of Ms A, the withdrawal of CANH will