Analysis of Patient Autonomy and Legal Issues in a Law Case Study Essay

This essay analyzes the doctrine of patient autonomy and legal issues in a law case study involving a mentally impaired patient. It discusses ethical values, common law provisions, and the principle of best interest.

Running head: LAW CASE STUDY ESSAY 1
LAW CASE STUDY ESSAY
Student’s name
Institution affiliation

LAW CASE STUDY ESSAY 2
Introduction
The doctrine of patient autonomy is very imperative when it comes to the making of
decisions regarding the treatment and diagnosis that the patient should have administered to him
or her subject to the advice of the doctors. The doctor is only allowed at law to advise the patient
and makes him understand the nature of his or her health condition and the available treatment
and diagnosis alternatives and not to decide for the patient. This brief responds to a case study
involving Ewing who is suffering from a degenerative condition that has made him mentally
impaired.
Ethical issues
Based on the facts of the case study, it is evident that Emily holds the two important
ethical values of honesty and open-mindedness. With regard to honesty, it is evident that Emily
does is not feel comfortable with the struggles that the husband is going through by all standards.
This is anchored on the fact that she cannot stand to see the husband suffering and at constant
pains in the comfort of the home and that is why as a person, he was really not happy with the
fact that the husband was struggling at home. To her, it was proper for the husband to be taken to
the hospital where he could receive the best attention and care from the professional healthcare
officials instead of languishing at home and in the hands of his children who are not professional
enough to handle him in the best way. Being honest is an important value that someone should
endeavor to have since it helps in always going for real solutions and stating things as they are
without concealing any facts. An honest person is always straightforward and as such, he or she
cannot be accused of misleading others by lying to them for self-gain. Dean in this scenario is
very honest and ready to take the bull by its horns without any compromise whatsoever. Emily
demonstrates her honesty by keeping off her husband since she could not pretend to be taking

LAW CASE STUDY ESSAY 3
care of her when by all standards there was no hope for survival. In fact, given time and chance,
Emily could have proposed assisted suicide for her husband to relieve him from the constant pain
and anguish.
The next ethical value that is evident in Emily is that of being open-minded. This is
anchored on the fact that Emily does not pretend to support the idea that the husband is doing
well at home since after losing hope, she opted to keep off and cater for the children without
bothering the suffering man. This is an important development that is important to the scenario
given the fact that in as much as she rarely made efforts to visit her husband, she did not at the
same time struggle to file for divorce though she had this particular option at her disposal. She is
convinced that the death of her husband was imminent and as such, he was better off in the hands
of healthcare professionals and not in her hands since she was lacking in the necessary
experience to tackle or handle such a person.
The two values of Honesty and open-mindedness have the capacity to influence the
decision that Emily may hold concerning the treatment of her husband Ewing to the extent that
she may propose measures such as assisted suicide to be performed upon her husband. This is
anchored on the fact that she had lost all hope of ever having the health of her husband restored
subject to the confirmation of the doctors who had declared the health condition of Ewing to be
untreatable by all standards. she could thus decide for her husband to undergo assisted suicide to
relieve him from the unnecessary pain and anguish that he was going through since it was more
than obvious that he was going to die sooner than later. Such a decision could also have been
informed by the fact that there was the need to save the resources that were being used to
maintain the husband who instead of getting better, his condition was deteriorating by the day.

LAW CASE STUDY ESSAY 4
As a medical professional with full understanding and commitment to the Kerridge model
of ethical decision making, I could have addressed the disagreements among the family members
by considering what is in the best interest of the patient. This is based on the fact that given the
mental instability of Ewing and his inability to make decisions, I would have convinced the
family members to agree on the best way of taking care of the sick person instead of focusing on
their personal interests and what they feel (Kogetsu, Ogishima, & Kato, 2018). This could have
been the best approach since all that Ewing needed was constant care to the extent that the family
members could only be made to agree to hire a professional that could attend to his father while
at home instead of leaving him at the health facility where he could continue to accommodate the
health bills when it was obvious that there was no much of specialized treatment that Ewing
could get from the hospital. As a health professional I could thus solve the disagreements among
the family members by inviting their attention to the health condition of the old man Ewing and
look into the best possible ways that can be used to give him the best care instead of grumbling
and pointing fingers at each other something that could only end up into some form of conflict or
violence.
Legal issues
Part one
It is on record that at common law, adult persons are often presumed to be competent
unless it can be proven that they do not have the necessary competence to make sound decisions
regarding treatment and diagnosis. Basically, the law demands that the patient should not only be
able to comprehend but also to retain the information regarding treatment, believe and weigh the
information before finally making a sound decision and communicate it (Tierney & Perlas,
2018). This is also in line with the doctrine of patient autonomy which puts them at the center of

LAW CASE STUDY ESSAY 5
all the decisions touching on their treatment and diagnosis. In Victoria which also practices
common law, the functional test for competence is provided for in section 36(2) of the
Guardianship and Administrative Act 1986. Before the implementation of the Mental Capacity
Act 2005, common law had put in place the best interest principle which is only applied in
circumstances where the patient refuses to consent or agree to the treatment and in such
circumstances, the doctor who goes on to continue the medical treatment without the consent of
the patient can thus be held liable for criminal offense and also a civil suit can be filed against
such a medical practitioner in this respect. The consent of the patient should not derive from
undue influence. The best interest principle was established in the reported case of Sidaway v.
Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital where the doctors
were only allowed to advise the patient and not to make a decision on his behalf (Bryden,
McKnight, & Houston, 2018). The primary function of the doctors is only to tell of the
seriousness of the treatment and at the same time give advice to the patient regarding any
alternative treatment that can be applied to address the health condition at hand something that
was held in the reported case of Malette v Shulman at the Ontario Court where the defendant was
held liable in trespass and the right of individual autonomy and the principles of self-
determination were further stressed by the courts in this landmark case that involved a Jehovah
witness patient who was transfused with blood against his will.
Based on the facts of the case study and the above-discussion, it is proper to state the fact
that the paramedics had the authority to transport Ewing to the hospital by all standards. this is
based on the fact that in as much as the courts may be very much reluctant to interfere in the
decision of the patient who is mentally sound, the situation is however different in circumstances
in which the patient does not have the mental capacity to agree to the treatment. Under such

LAW CASE STUDY ESSAY 6
circumstances then the courts often provide assistance on the basis of the principle of best
interest. Ewing at the point of being taken to the hospital was in the most dangerous situation to
the extent that he was at the brink of death and at the same time he did not have such a stable
mind to make any sound decision as he did not understand the severity of the condition that he
was going through. The Mental Health Act 2005 thus supports the action of the paramedics to
forcefully carrying or rather transporting Ewing to the hospital after having been chocked with
food since there was the need for urgent medical attention that could not by any standard be
performed in the house. At the same time, the patient needed specialized examination so as to
have his condition fully addressed and restore his poor health to the condition that it was for him
to be able to swallow food without much struggle. Despite the various ethical reasons that
supports and vindicates the paramedics from the action of transporting Ewing to the hospital,
their greatest defense at law remains to be the deteriorated state of mind of the patient to the
extent that he did not have the capacity to fully understand what was going on and as such,
patient autonomy principle cannot be called into action under these circumstances. It is thus
prudent to underscore that in the principle of best interest as well-laid down under the common
law and the Mental Health Act 2005, the paramedics were in order to transport Ewing to the
hospital for further treatment despite his resistance and refusal or denial of consent (Blease,
Bishop & Kaptchuk, 2017).
Part two
As Emily who is the wife of Ewing who is ailing, the common law gives him priority as
the first decision maker with the alternative ones being the three children who are all of the
sound mind and able to make decisions on behalf of their father though this can only come into
play when Emily is not present or in the circumstances in which she may have been

LAW CASE STUDY ESSAY 7
incapacitated. Based on the facts of the case study under consideration alongside the
consideration of the law, Emily remains to be the lead decision-maker in her capacity as the wife
of the ailing husband who lacks the mental capacity to decide for himself in this case (Ashall,
Millar, & Hobson-West, 2018). The doctors only come in to make treatment and diagnosis
decisions in the event that the other four lack the necessary capacity to carry out such an
important function in the healthcare circles. The selected decision maker that could be the
alternative for Ewing is Emily who is the spouse and as such allowed to do so under the common
law provisions. The principle established in the Guardianship and Administration Act 2000
under section 36 is that of the functional test for competence and it designs the criteria that can
be used to establish whether the patient has the right capacity to make a competent decision
(Beeker, Schlaepfer, & Coenen, 2017). The outcome that I am seeking for which is to establish
that the paramedics were legally right and allowed to transport Ewing to the hospital falls right
within the province of this particular principle by all standards.
Conclusion
To sum up, this is a classic case that primarily revolves around the consent of the patient
when it comes to treatment and diagnosis especially in circumstances where it has been duly
established that the patients have impaired mental capacity to understand the seriousness of their
health condition and the various diagnosis and treatment methods available. The case also
involves the issue of making decisions on behalf of the patient since family members were in
disagreement with each other regarding some of the treatment alternatives. In the final analysis,
it is clear in the various pieces of legislation and common law that the impaired mental capacity
of the patient ushers in the principle of the best interest which is to be used in guiding the final
decision.

LAW CASE STUDY ESSAY 8
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