Case Study Analysis on Legal and Professional Issue

Running head: CASE STUDY
ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
Name of the Student
Name of the University
Author Note

1CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
Table of Contents
Introduction......................................................................................................................................2
Discussion........................................................................................................................................3
Legality to refuse life sustaining nutrition and food....................................................................3
Constitution of euthanasia...........................................................................................................4
The dissimilarities of withdrawal treatment and Euthanasia.......................................................5
Risks factors in compliance with the patient request...................................................................6
Advance Medical Directive (AMD):.......................................................................................7
Personal compliance of being professional.................................................................................8
Conclusion.......................................................................................................................................9
Reference.......................................................................................................................................10

2CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
Introduction
The primary focus of medical care is to cure illness of all individual and reserve life and
good health. All medical professionals including physicians, nurses, and other care givers are
engaged in a health care system and work under specific legislations and guidelines. However,
they have to take some decisions depending upon patient’s condition in emergency basis. These
decisions are made on patient’s wish, value, ultimate goal and also their family intention, the
burden of treatment. There are legal, ethical and social issues to direct the withdrawing or
continuing process. The health care professionals must consider some legislation to withdraw or
continue the treatment after considering the patient willingness. Good medical guidelines are
also present to evaluate the treatment procedure. These practices provide knowledge to the health
care providers, help in decision makings, and meet the challenges in provision of care. Some
incidents happen when the patients are in critical condition; the actions cannot be taken
previously. In this situation, it is difficult to decide the appropriate actions. At the ending time of
life of a patient, the health care professionals should consider the patient troublesome problems
like pain, suffering, and problem of self-esteem that would be rising from given treatment. This
situation deals with patients will and their family consent. The medical care givers respect the
patient’s choice in the end-life care earlier and it is the chief element in providing care with life-
threatening diseases. Although ultimate decisions are made by medical professionals, patient’s
consent, proper communications minimize the problem and ensure the patient desire in the care.
At the time of deciding continue or withdrawal, three main components come into the fact-
clinical, legal and ethical (Health.qld.gov.au, 2018). This paper discusses a case study about a
patient’s willing to death and whether the decisions are correct or not in the side of legal or

3CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
ethical. The article also describes the legal action of a health care provider and whether it leads to
euthanasia or not.
Discussion
Legality to refuse life sustaining nutrition and food
Artificial Nutrition and Hydration (ANH) refers to the artificial means of having food by
feeding tubes such as nasogastric or gastric routes and intravenous routes. ANH is required in the
patients with neurological impairment who are not able to eat orally or are not physically active
or suffering from disease like cancer, congenital heart diseases. It is very painful method for
them who are cognitively alive and other organs are not functioning properly. This event is
common in the patient with life-threatening disease, stroke, and paralysis. The patient has right
to decide or know about the chosen treatment or actions against their problem and they also can
reject the treatment any time (Druml et al., 2016). It is not lawfully accurate to make any
decisions against the chosen sections as a patient with Alzheimer’s or dementia like diseases.
Their willingness is not granted if they are suffering from these diseases as their mental state is
not in healthy condition. However, it approves the patients who are psychologically fit. In
Australia, it is not lawful to withhold or withdraw any life-saving measures. According to
Guardianship and Administration Act, 2000 the individual action of taking decisions about
continue or withdraws of treatment are not authorized except emergency conditions
(Chesterman, 2018). The willingness to death is not legal in Singapore; however, it is possible in
certain critical circumstances. In Singapore, the patient may choose voluntary death but in
special ground. According to the Advance Medical Directive act, the patient without mental
disability, who are not willing to take support of life-sustaining treatment, and also has survived

4CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
21years of age of their life, may select advance predictive death. In this context, the medical
practitioner shall prescribe about that the patient has suffering from terminal disease and give
rationale the purpose of choices (How & Koh, 2015). In case of Australia, the life supporting
actions are taken into consideration in collective way. That means when any choice is made, the
approval from both the care providers and the patient, decision-makers, families and supporter is
needed. For health care professionals, they have some principles to make decisions about life-
saving treatments. Among these principles, two rules are followed in this situation. One is all
choices should reflect for life and patient’s right and selection. Another is all struggle should be
prepared on appropriate approval through combined method. Hence, in this case of Ms. A, it is
legally correct to refuse from having Artificial Nutrition and Hydration (ANH) under specific
circumstances. She is lawful in terms of her age according to Singapore law. She also has no
mental illness. Apart from this, she has terminal illness as her respiratory organ is not
functioning and it is supported with diaphragmatic pacing. However, according to Australian
law, it is necessary to get support system from health care givers. In this case, the medical
specialists and nurses have not agreed to refuse from providing the system to the patient. It is not
legitimate in Australia to give any one-sided decisions. Therefore, the patient is able to reject the
life-saving treatment under different terms and conditions.
Constitution of euthanasia
Euthanasia is a term that describes the action of medical professionals that leads to the
death of the patient. In this system, the patient has full consent of performing this action. The
doctors assist to inject a toxic substance to the patient who is willing to die. Thus the physicians
intentionally kill the patient with consent (Kim et al.,2016). There should be a legal system to
perform this system. It is often termed as assisted suicide. Netherlands, Belgium have legalized

5CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
euthanasia but not in other countries. In this case study, Ms. A has spinal injury and became
quadriplegic. She lost her ability to swallow as a result she receives life-saving treatment
thorough a PEG tube. She is mentally alive but is physically inactive. She is also supported with
diaphragmatic pacing as she has respiratory function disability. In this context, she has desire to
cease her PEG tube and wants to die. However, the physicians and nurses hesitated with her
decisions. In compliance with her request, it does not constitute euthanasia. Since, the health care
practitioner and nurses have no consent with the patient’s decision, the physicians and nurses do
not perform the action of killing the patient. In Australia, there is a guideline principle of medical
practice for medical professionals so that they cannot overrule it. In Australia, the euthanasia is
currently illegal; although it was enforced in 1995 and cancelled in 1996 (Willmott et al., 2016).
In some viewpoint, the ethical concern is raised in performing this action among physician and
nurses. For constituting euthanasia, the patients, her family, and the service providers, decision-
makers should have collaborative approach to make a legal decision about the patient’s
condition.
The dissimilarities of withdrawal treatment and Euthanasia
There is a huge difference between withdrawal treatment and receiving euthanasia. In
withdrawal of treatment, the care procedure is discontinued. Therefore the patient undergoes
death for not receiving care anymore. This happens when the patient is taking any life-saving
measures for treating any life-threating disease. After removing the life-sustaining support from
the patient, it comes under normal process. Therefore, the patient dies that disease from natural
causes. In other hand, euthanasia is a process of death, where the patient is purposefully killed
those suffering from life-limiting diseases, painful diseases, or any other incurable diseases. In
this case, the patient dies from injecting a lethal injection that forcefully leads to death in them. It

6CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
is done by mainly healthcare professionals. Legal voluntary euthanasia is made when the doctor
is supposed to kill the patient legitimately. This issue has raised ethical concern in medical
ethics. In Australia, euthanasia is illegal in all regions except in Victoria. In Victoria, it is legal
under specific terms and conditions. There is not any law regarding euthanasia in Singapore;
though it has Advance Medical Directive (AMD) (Ipscommon, 2020). Under this jurisdiction,
the patients can share their feelings to doctors that they have no desire to live with the help of
any supportive care system as they have no hope of recovery. Thus the doctor may make
decisions with the patients and their family and other decision makers to take necessary steps
regarding this topic. From the above discussion, it is clear that in Singapore, the withdrawal
treatment is followed for the terminal patients that too with patient consent. Researchers
described withdrawal treatment as active euthanasia. Since this action ultimately leads to death
of the patient. In the case study the patient has willing to die that means she wants euthanasia. In
other way, the withdrawal treatment is described as assisted dying. It is related with the
terminated ill person only. Nonetheless, there should be specific law in this matter. The
terminated ill person should have choices to make decisions of timing and manner of death
(Meier & Ong, 2015).
Risks factors in compliance with the patient request
Euthanasia or assisted suicide is not legal, according to the law of Singapore and
Australia. Like the other western countries, a patient cannot design his/her death by voluntary
euthanasia. However, the advancement of legal rights and medical knowledge produced choices
for both the sufferer and the health care professionals (Lopes, 2015).

7CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
Advance Medical Directive (AMD):
Advance Medical Directive (AMD) is one of the sources to acquire the legal and ethical
issues by a critical patient. The Advance Medical Directive or AMD is a legal file engaged by
patience to inform the doctor that he/she is not willing to undergo any extraordinary life-
sustaining treatment to prolong his/her life. The AMD is signed even if the patient is mortally ill
to avoid unusual legal circumstances, but the creation of the bill must be voluntary. The patient
must be aged more than 21 years and mentally able to understand the importance of the bill (Ng
et al., 2017)
Ms A is an adult person and not mentally disabled. Therefore, he can create an AMD bill.
The doctor can assist him in undergoing voluntary euthanasia without facing any legal trouble if
the bill created voluntarily by Ms A and signed in the presence of two eyewitnesses. One
eyewitness must be the physician, and another one must be aged above 21 years person, who has
the proper knowledge about AMD. The AMD is only valid when it is sent and acknowledged by
the register of AMD. The voluntary euthanasia must be done only by the physician to avoid any
legal action. Assisted suicide is an event of one performing or helping an individual to die, which
is illegal in Singapore (Cholbi & Varelius, 2015). According to the Singapore law, Section 107
of the code, any act of encouraging or supporting suicide of anyone is illegal and counted as a
crime (sso.agc.gov.sg, 2020). It is counted as illegal if the AMD fails to fulfill any of the criteria
or anyone other than the medical team involve with the process. The AMD law is structured very
carefully and safeguarded the performer to help the sufferer without getting into legal troubles.
However, one should think, revise, consult and validate the action before being a part of the team
to assist the death of Ms A.
.

8CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
Personal compliance of being professional
Being a healthcare professional, it is difficult to decide whether to comply with Ms A’s
decision or not, but according to Section 309 of the Penal Code of Singapore attempting suicide
is an offence. Along with this, Section 107 of the Penal Code says encouraging someone to
commit suicide is also a crime. Under Section 306 of the Penal Code, it is said that the abettor
will be punished with imprisonment if he or she encourages committing suicide (Love, 2015).
The situation of Ms. A is critical, and personally, it is very difficult to watch her living in
immense pain. The condition of Ms. A is such that there is no treatment left that could help her
to recover. So, I support her decision to let her die. However, Section 6(5) states that a healthcare
professional should take a decision on the life-sustaining treatment of the patient and should not
be motivated by patient’s desire. Analyzing all the laws, as a healthcare professional, it is
commendable to stick to AMD Act that provides competent adults to refuse medical treatment
for a lifetime. The AMD Act relies on the patient’s wish and becomes relevant if the patient
becomes critically ill. The condition of the patient will be investigated by the concerned doctor,
including more doctors. According to AMD Act if two of the three doctors disagree, then it will
be referred to the committee of three specialists, and the decision will be given unanimously. The
AMD Act comes into play if the patient is not mentally disturbed.
Under this Act, the process of dying will increase, and palliative care will be ceased. The AMD
Act is designed in such a way that sticks to common law distinction between omissions and law
by authorizing recognition to grant a patient’s wish of not continuing with the treatment. Under
Section 17 of this Act, it states that it does not accelerate death but permits dying as a natural
process. This Act also includes that there is nothing in it that will approve, condone or authorize
the abetment of suicide or euthanasia (Koon et al., 2018). Ms A is not in a condition to get feed

9CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
by solid food and is alive feeding on liquid food. Moreover, she is in pain for a long time and
cannot bear the pain. Keeping all these in mind, as a healthcare profession following AMD Act
and comply with the patient's decision is the best way to ease her from pain.
Conclusion
From the above discussion, it can be concluded that the current case study discusses the
legal, ethical and social concern of a patient who has no hope of recovery from her illness. Since
she has spinal cord injury, and does not swallow anything. Therefore, she is supported with PEG
tube and she also has trouble with respiratory functioning. For that, she is sustained with
diaphragmatic pacing. In this current situation, the patient has no desire to live and her family
assent was also with her. Nonetheless, the doctor and nurses are not supposed to perform so.
Since it relates with ethical issue they are obliged to obey it. The patient is legally correct under
certain circumstances in the provision of refusing life-sustaining treatment. This incident has
different conditions in two countries like Australia and Singapore. In this context, the patient has
determination to die by ceasing her PEG tube. This incident constitutes euthanasia; though the
medical practitioner has restriction to perform this action. There is a huge difference in
withdrawal of treatment and euthanasia. In this, the doctors stop the care procedure and the
patient dies naturally. In case of euthanasia, the patient has consent and the physicians inject the
toxic substances and kill the patient intentionally. By observing the whole situation, being a
professional, it should be compliance with Ms. A’s request. Since, the patient has been suffering
from terminated illness, and the patient wants to relief from pain, harm, and any kind of
treatment, her desire should be respected.

10CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
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11CASE STUDY ANALYSIS ON LEGAL AND PROFESSIONAL ISSUE
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