Case Study: 2805NRS Legal and Ethical Principles in Healthcare

This essay examines a case study involving Richard, a patient in a minimally conscious state, focusing on the ethical considerations of forgoing treatment and the differing viewpoints of his wife, Meryl, and his friend, Lucas. The essay delves into legal issues such as patient consent, legal obligations, Queensland legal authority, and the role of a substitution decision-maker. It applies Kerridge’s ethical decision-making model to analyze the ethical dilemma, highlighting the conflict between Meryl's hope for Richard's recovery and Lucas's adherence to Richard's prior wishes. The essay also discusses the importance of patient consent before treatment, legal exceptions in emergency situations, and the legal framework for decision-making when a patient lacks capacity, referencing the Guardianship and Administration Act 2000 and its implications for healthcare decisions.

Running Head: 2805NRS LEGAL AND ETHICAL PRINCIPLES IN HEALTH CARE
Student Name:
Essay title: 2805nrs Legal and Ethical Principles in Health Care
Word count: 2012 words (excluding title page, reference list/bibliography and appendices)

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Introduction
Legal issue is a legitimate question which is the underpinning of the case. It requires
decision from court. Ethical issue is referred to as any problem which is solved on the basis
of right that is ethical and wrong (Phelps, Regen, Oliver, McDermott & Faull, 2017). This
essay will focus on a case study of Richard, who went to minimally conscious state and has
lost his decision making ability and hence, cannot give his consent during his treatment. The
ethical issues discussed in the essay are whether forgoing treatment in case of Richard is right
(ethical) or not, different point of views of Meryl and Lucas regarding Richard’s treatment.
Legal issue explained in the essay are importance of patient’s consent prior to treatment, legal
obligations, Queensland legal authority and substitution decision maker.
Ethical issue
Kerridge’s introduced an ethical decision making model consist of 7 steps using
systemic approach. It is used to detect the ethical issue and the values of the acknowledged
issue is evaluated. According to the model of ethical decision, at first it is required to gather
the facts about the patient to make an ethical decision (Walker & Lovat, 2016). Here the
patient is Richard, who was heavily injured during a blast in a mine. He had several head
injuries and facial and skull fractures. During treatment, he went into a minimally conscious
state and the chances of his recover is very less. The model also describes the problem from
other’s perspective who are close to the patient and cares for the patient. It is done when the
patient is not in the state of decision making and have to rely on others for the decision
regarding the treatment.
Meryl being his wife, is the most closest to Richard. After several attempts also,
Richard’s health is showing poor progress and is life threatening for him and was provided
with life sustaining treatments, but then also Meryl believes that withdrawing the treatments

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is not the solution. She knows that Richard’s condition is showing no progress then also her
mind believes that Richard will get well soon. Withdrawing life sustaining treatment is
extremely painful for the families. No one wants to lose their loved one, even though they
know that chances of there is almost no chance of recovery. In such cases, family should be
well prepared to look how actually the death process looks like (Phua, et al., 2015).
Another person, who is close to Richard is Lucas. Lucas is the crew manger of the
mine and his best friend. He believes that forgoing life sustaining treatments is best in case of
Richard. Richard is in minimally conscious state. By observing the health progress of Lucas,
he supported the doctor’s suggestion to stop the treatment. Family members and closed one
remain in confusion till the treatment is on (Hickman, Keevern & Hammes, 2015). They do
not want to lose their loved ones but life sustaining treatments are extremely costly and it
creates a financial pressure on the family. In addition, the patient also has to go through a lot
of pain and sorrows as the treatment is really painful. The patient is not able to take care of
themselves and going through a lot of distress. It is usually done in a patient who have almost
no chance of recovery (Curtis, et al., 2016).
Meryl and Lucas both have different beliefs regarding Richard’s treatment. Meryl
believes that Richard is able to understand everything and will recover. He was unable to
move even after insertion of tracheostomy and hence, doctors suggested that it is better to
stop the treatment as it is only increasing the financial pressure on the family, but Meryl
disagrees. She has done research and has gone through several cases similar to that of the
Richard, where she has studied that, several people had recovered from coma and traumatic
brain illness after prolonged period. Even though she knows that Richard hates being reliant
on others, she is against the idea of stopping the treatments. She is in the hope that even if he
does not recover fully, he will be able to live and communicate with her and their children. In
contrast, as being Richard’s best friend he was in the favour of the decision, as it was earlier

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decided by both of them (Richard and Lucas). Richard had already said once that if
something like this (blast) ever happened in the workplace and he will get into the situation
where he will be unable to take care of himself, he did not want the treatment to be continued.
Lucas knows that Richard does not want to be a reason of distress to his family and the
person who loves him the most, hence supports the decision.
UNESCO has formulated several principles based on the ethics which is named as
Universal Declaration on Bioethics and Human Rights. One of the principle is of article 7 –
person without the capacity to consent. According to the Principle, person who have lost his
decision making ability, research is to be carried out extensively before withholding or
withdrawing the treatment (Magnus, 2016). Here according to doctor and Lucas after
observing Richard’s health result, withdrawing the treatment is the best approach, but Meryl
have different point of views. According to her research, many patient have recovered from
such situation. Hence Meryl has hope that he will recover sooner or later. Another principle is
of article 6- consent. According to this principle before starting any therapeutic and medical
treatment, considering the consent of the patient is very necessary (Ten Have, 2014). After
considering the patient’s consent only treatment should be withhold or withdrawn, but here
Richard is not in his full sense and lost his decision making ability and cannot provide his
consent regarding the treatment. Even though, Lucas told that Richard told him to withdraw
treatment is such situation arise, there is no legal prove of that and hence it cannot be taken
into consideration.
Legal issue
While working in a mine, Richard got a heat shock and paramedics arrived, but after
some time he returned to his senses. Richard respiratory rate had slowed down and
paramedics went to check his blood pressure, but he denied any further medical treatment
from them. For the treatment of heat shock, permission from Richard is must. Treatment

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cannot be started without his consent. It is really necessary to obtain patient’s consent prior to
treatment. If the treatment is done without patient’s consent it can lead to legal consequences
(Spatz, Krumholz, & Moulton, 2016).
In Australia there is a law, Informed consent: common law and statute, which creates
pressure on physicians and paramedics to consider patient’s consent before starting any
treatment. According to these law, patient has right to refuse for treatment if they want. If the
health care providers, physicians and paramedics provide treatment without taking any
consent for the patient, it can lead to legal consequences such as, they have to pay
compensation and can also lead to imprisonment (Ginsberg, 2015).
Richard was in his full senses when he has refused the treatment from paramedics
during heat shock, but during the head injury he was in unconscious state and has lost his
decision making ability. In such condition, when the patent is in unconscious stage and
requires urgent treatment, it is legal to provide treatment without waiting for anyone’s
approval. Hence it is legal for paramedics to administer immediate treatment during head
injury (Katz, Webb & Committee on Bioethics 2016).
Informed consent rule is referred to as where the patient has the right to reject for such
treatment and physicians has no right to continue treatment in such conditions without patient
consent. There are some exception to these rule such as, either if there is an emergency
condition, medical treatment is required to patient suffering from serious injury or illness or
the patient is unable to provide his consent for further treatment, similarly in case of where he
is unable to give permission but needs emergency care (Rebers, Aaronson, Van Leeuwen &
Schmidt, 2016).
After the head injury, Richard went into minimally conscious state and was not in the
state to make any decision regarding his treatment. Legal obligation is a type of legal bond

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where one party is refrained from performing duty or acting. Richard has lost his decision
making ability due to his brain injury and his progress is also very poor. As Richard is unable
to give his consent, doctors are unable to take any further decision because of the legal
obligations. Here in such condition another person is allowed to take decision in behalf of the
patient to avoid any further legal obligations (West‐Oram & Buyx, 2016).
Queensland legal authority is a guardian ship system which gives someone the
authority for taking decision in behalf of the patient when the patient is not in the state of
decision making ability. According to the system the patient will take their decisions until
he/she is fit and fine, but when the patient is not in the condition to take any decision or has
lost his senses, then one of the adult family member is able to take decision for the patient
(Jackson, Tyler, Hough, Bradford & Mentovich, 2014). In this case also, Richard has lost his
decision making ability, he cannot provide consent regarding treatment. Richard’s health
condition is very poor and hence doctors suggested to withdraw treatment as there is only
minimal chance of Richard’s recovery, but Richard is not able to make any decision
regarding his treatment. In some cases patient has already prepared medical power of attorney
to avoid any future complication. If the patient has already given medical power of attorney
or have prepared any deed regarding his future treatments it can used as patient’s consent for
treatment (Lakin, et al., 2016). In the case of Richard, he has once said Lucas that he did not
want to continue in such condition, but has no legal evidence. Hence in such cases, according
to the Queensland legal system, any family member or closed one is selected to take a
decision regarding patient life. In case of Richard, Meryl, his wife is selected to take the
decision in behalf of the patient.
Meryl, wife of Richard do not want to withdraw treatment as she believes that there is
chances that he will recover and hence do not want to end her husband’s life. The
Guardianship and Administration Act 2000, states that people who have lost their decision

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making ability needs support regarding their treatments to ensure healthy life (Alston, 2017).
According to the health care principle of the act, the health care is provided to patient in order
to promote patient’s wellbeing and is should also reflect the patient’s view. The decision
Meryl want to take contrast the healthcare principal of Guardianship and Administration Act
2000. According to the principle it is provided to promote patient’s wellbeing, but in Richard’
condition, his health progress is very poor and has very minimal chance of recovery and
along with that the ongoing treatment is also extremely painful for the patient. The health
care principle also states that it should reflect patient’s own view, but here also Meryl
decision disagrees with the principle (QCAT, 2019). As Richard hates being reliant on others
and also he do not want to distress his family, but if the Meryl will take the decision, he will
have to rely on others for his own care which will provide distress to his family. Hence Meryl
decision opposes the healthcare principle of the Guardianship and Administration Act 2000.
Conclusion
From the above essay it can be concluded that, there are several ethical and legal
issues are associated to the case study. Ethical issue associated with the case study is that,
Meryl (Richard’s wife) is in hope that Richard will recover sooner or later and hence do not
want to forgo treatments. In contrast, Lucas (Richard’s best friend), and physicians thinks that
it is better to withdraw the treatment considering Richards health condition. Legal issues are
also linked to the case study such as, it is illegal to withdraw or withhold patient’s treatment
and if the patient is not in the state to make any decision, consent from the family member is
accounted. Other legal issues are Richard already have refused any further treatments from
paramedics, hence is it legal for paramedics to treat him during the blast and Meryl
opposition of healthcare principle of guardianship and administration act 2000.

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References
Alston, B. (2017). Towards supported decision-making: Article 12 of the convention on the
rights of persons with disabilities and guardianship law reform. Law in Context, 35(2),
21.
https://search.informit.com.au/documentSummary;dn=260425797311324;res=IELHS
S
Curtis, J. R., Treece, P. D., Nielsen, E. L., Gold, J., Ciechanowski, P. S., Shannon, S. E., ... &
Engelberg, R. A. (2016). Randomized trial of communication facilitators to reduce
family distress and intensity of end-of-life care. American journal of respiratory and
critical care medicine, 193(2), 154-162. https://doi.org/10.1164/rccm.201505-
0900OC
Ginsberg, M. (2015). Informed Consent and the Differential Diagnosis: How the Law
Overestimates Patient Autonomy and Compromises Health Care. Wayne Law Review,
60(2). http://dx.doi.org/10.2139/ssrn.2464735
Hickman, S. E., Keevern, E., & Hammes, B. J. (2015). Use of the physician orders for life‐
sustaining treatment program in the clinical setting: A systematic review of the
literature. Journal of the American Geriatrics Society, 63(2), 341-350.
https://doi.org/10.1111/jgs.13248
Jackson, J., Tyler, T., Hough, M., Bradford, B., & Mentovich, A. (2014). Compliance and
legal authority. International Encyclopedia of the Social and Behavioral Sciences,
Second Edition (2014 Forthcoming). https://ssrn.com/abstract=2403795

82805NRS LEGAL AND ETHICAL PRINCIPLES IN HEALTH CARE
Katz, A. L., Webb, S. A., & Committee on Bioethics. (2016). Informed consent in decision-
making in pediatric practice. Pediatrics, 138(2), e20161485. Retrieved from:
https://pediatrics.aappublications.org/content/pediatrics/138/2/e20161485.full.pdf
Lakin, J. R., Isaacs, E., Sullivan, E., Harris, H. A., McMahan, R. D., & Sudore, R. L. (2016).
Emergency physicians' experience with advance care planning documentation in the
electronic medical record: Useful, needed, and elusive. Journal of palliative medicine,
19(6), 632-638. https://doi.org/10.1089/jpm.2015.0486
Magnus, R. (2016). The universality of the Unesco universal declaration on bioethics and
human rights. In Global bioethics: The impact of the UNESCO international bioethics
committee (pp. 29-42). Springer, Cham. DOI https://doi.org/10.1007/978-3-319-
22650-7_4
Phelps, K., Regen, E., Oliver, D., McDermott, C., & Faull, C. (2017). Withdrawal of
ventilation at the patient's request in MND: a retrospective exploration of the ethical
and legal issues that have arisen for doctors in the UK. BMJ supportive & palliative
care, 7(2), 189-196. http://dx.doi.org/10.1136/bmjspcare-2014-000826
Phua, J., Joynt, G. M., Nishimura, M., Deng, Y., Myatra, S. N., Chan, Y. H., ... &
Wahjuprajitno, B. (2015). Withholding and withdrawal of life-sustaining treatments in
intensive care units in Asia. JAMA internal medicine, 175(3), 363-371.
doi:10.1001/jamainternmed.2014.7386
QCAT. (2019). Principles of the Act - QCAT Queensland Civil and Administrative Tribunal.
Retrieved from https://www.qcat.qld.gov.au/matter-types/guardianship-for-adults-
matters/principles-of-the-act

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Rebers, S., Aaronson, N. K., Van Leeuwen, F. E., & Schmidt, M. K. (2016). Exceptions to
the rule of informed consent for research with an intervention. BMC medical ethics,
17(1), 9. https://doi.org/10.1186/s12910-016-0092-6
Spatz, E. S., Krumholz, H. M., & Moulton, B. W. (2016). The new era of informed consent:
getting to a reasonable-patient standard through shared decision making. Jama,
315(19), 2063-2064. doi:10.1001/jama.2016.3070
Ten Have, H. (2014). The principle of vulnerability in the UNESCO Declaration on Bioethics
and Human Rights. In Religious perspectives on human vulnerability in bioethics (pp.
15-28). Springer, Dordrecht. DOI https://doi.org/10.1007/978-94-017-8736-9_3
Walker, P., & Lovat, T. (2016). Dialogic consensus in clinical decision-making. Journal of
bioethical inquiry, 13(4), 571-580. DOI https://doi.org/10.1007/s11673-016-9743-z
West‐Oram, P., & Buyx, A. (2016). Conscientious objection in healthcare provision: A new
dimension. Bioethics, 30(5), 336-343. https://doi.org/10.1111/bioe.12236