Ethical and Legal Decision Making: Analysis of a Healthcare Scenario

This report analyzes a case study involving Doreen Richmond, focusing on the ethical and legal considerations surrounding her healthcare decisions. The report explores the principles of ethical decision-making, including patient autonomy, informed consent, and the role of advance health directives. It examines the legal implications of the Corrective Services Act 2000 (Qld), the Guardianship and Administration Act 2000 (Qld), and the Powers of Attorney Act 1998 (Qld). The analysis considers the roles of various stakeholders, including medical professionals, prison staff, and friends, in making decisions on behalf of an incapacitated patient. The report highlights the importance of respecting patient wishes, adhering to legal frameworks, and ensuring that healthcare decisions are made in the best interests of the patient, particularly in end-of-life care scenarios. The report emphasizes the significance of advance care planning and the role of substitute decision-makers in upholding patient rights and promoting ethical healthcare practices.

Running head: ETHICAL AND LEGAL DECISION MAKING
Ethical and Legal Decision Making
Name of the Student:
Name of the University:
Author Note:

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Introduction
Ethics is a central piece of geriatrics. Ethics, or the arrangement of ethical
consideration to the care of the patient, alludes to a structure or rule for figuring out what is
ethically positive or negative (Townsend et al., 2015). Ethical issues emerge when there is
strife about what is the "right" activity. This difficulty for the most part happens when
choices should be made whether a clinical intercession ought to be actualized and whether the
mediation is useless (McCarthy & Gastmans, 2015). There are legitimate issues related with
thinking about an older individual who can no longer think about oneself, for example, how
to deal with clinical requirements when they are crippled by dementia or another serious
disorder (Johnson et al., 2016). It is critical to have a power of attorney or a living will to give
care to the individual such that an archive of the desires of the individual in regards to what
occurs if a clinical circumstance emerges that makes them become debilitated and incapable
to settle on choices for oneself, for example, with respect to a required medical procedure for
their health improvement. In the following paragraphs, the scenario of Doreen Richmond will
be analysed to assess the ethical and legal decisions that have been breached and how the
situation could be handled otherwise.
Ethical decisions
According to the scenario provided, it can be understood that Doreen had always
hated the idea of not being able to take care of herself in the prison. Hence, it can be deduced
that she has been an independent person all her life and could not quite take or understand
that in her later years, she might not be able to take care of her as efficiently as she did
earlier. The value that could be inferred from the statement of Doreen is the presence of
responsibility within her to not be dependent on another individual at a later stage of life
(Carter et al., 2016). However, she was unable to comprehend the after-effects of the decision

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that was being undertaken by her because of the deteriorating health condition. It is with her
deteriorating health condition and ageing that she will be requiring support from an external
aide to carry out normal day-to-day activities (Maier, 2015). This decision of her of not
choosing any individual to take care of her at her end-of-life will be placing her in a huge life
risk as she will be devoid of the necessary care to make her health improve.
It is quite possible for an elderly woman like Doreen to make a friend in prison
because of no immediate family present alongside her. Bea was one of the friends who got
emotionally attached with Doreen and wanted to do any possible measure or action that could
observe a improvemt in the deteriorating health condition (Bester et al., 2016). It was the
value of human relationships that are formed beyond the scope of family members or close
relatives. In the case of Bea, she acknowledged Doreen to be extremely close to her and
wanted to everything possible in her scope to make her feel better (Osuji et al., 2018).
However, because she was not an immediate family member, she is not liable to take
decisions on behalf of the patient and is taking a decision emotionally. Doreen and Bea had
made a pact informally to take care of each other with no legal and ethical confirmation
which, in turn, it will influence the decision undertaken by Bea for Doreen. The instance of
Bea being worried and upset about the deterioration health condition of Doreen shows that
the level of compassion and the depth of frienbdship that had formed between because of
which she was so concerned about her health and wanted to do anything possible in her scope
to make it better.
The article 5 of the Universal Declaration on Bioethics and Human Rights revolves
around the right of people to make decisions, while accepting responsibility for those
decisions and acknowledging the rights of others, must be respected (Brännmark, 2017).
Regarding people who are not really capable of exercising their liberty, additional measures
should be taken which safeguard their freedoms and interests. In the case scenario provided,

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it can be inferred that Molly is an ICU consultant who asked Bea about the possible wishes
that had been previouslty made by Doreen. According to the article 5, special measures are to
be undertaken to ensure that the decisions that have been made by the patient previously are
given careful consideration such that an improvement in the health condition could be
established. It is because she was unaware of the presence of any health directive that she
asked Bea about it. It can be deemed under the category of the special measure as no
immediate family member could be contactred except for Bea. Hence, as per Molly’s best
understanding, she decided to ask Bea about the presence of certain directives that Doreen
would likely to undergo in case of an life-threatening health circumstance.
According to the article 7 of the Universal Declaration on Bioethics and Human
Rights, the medical professionals who are attending in emergency cases of patients who are
unable to consent to the treatment because of their incapacity, are liable to take effective
decisions based on the choices that have been made by the patient (Magnus, 2016). In the
case of Doreen, she had made a advanced healthcare directive which is used by the medical
professionals and nurses in case of an emergency situation. Doreen started coughing when
she was repositioned which led to her being cyanosed after certain point of time. Before this,
her health condition was improving and was able to understand basic instructions. As a MET
professional, they manually ventilated Doreen with her trache, however, Ned highlighted that
she had wished to not be resuscitated and no CPR was administered to her. It can be
understood, that the MET professional had adhered to the principle of article 7 as per their
best potential and tried to provide the best care in an hour of emergency.
Legal decisions
Consent derives from the legal concept of patient and global human rights self-
governance. Patients have the ability to choose what will or should not happen to their body

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and to collect knowledge before they consider a test / system / clinical approach. No one else
has the advantage of convincing the patient to behave in terms of a particular target. Without
a doubt only an expert in the nature of the patient will actually go around as a facilitator.
Nobody has the privilege to try and contact, not to mention treat someone else. Thus, getting
consent is an unquestionable requirement for something besides a routine physical
assessment. Informed consent must be gone before sufficient knowledge is added. Consent
can be sought on the basis that enough knowledge has not been provided to include the
patient in making a decision that is reasonable and understood.
According to the Corrective Services Act 2000 (Qld), the prison governor is liable to
contact a medical professional for the prisoner who is feeling unwell (Luckett et al., 2015). In
addition, they are liable to arrange to provide the best of cares to the prisoners present in their
prison. It is not in their scope of practice to direct a medical professional of a appropriate
treatment for the prisoner ("Guide to Informed Decision-making in Health Care", 2017). Hence, in
the case of Doreen, the prison governor, Vera Bennett does not hold the legal authority to
convey to the medical professional attending to Doreen for the administration of pacemaker.
It is a severe breach of Corrective Services Act 2000 (Qld) under which she is liable to be
convicted in the court of law if proven guilty (Carroll et al., 2016). In no situation, it is the
role of the prison governor to legally authorize the insertion of pacemaker inside Doreen.
According to the Guardianship and Administration Act 2000 (Qld), the stakeholders
who are able to give a consent to the medical professional on behalf of the incapable patient
are an individual aged over 18 who is not a paid carer for the adult but provides care,
individual aged over 18 who is in realation with the adult or a close friend and also not a paid
carer and thr spouse of the adult ("Guide to Informed Decision-making in Health Care", 2017). In
the case of Doreen, Bea is the close friend of hers in the prison and had promised to each
other of caring each other for life. Hence, Bea is one of the legal stakeholders who is able to

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take an effective decision on behalf of Doreen as she is incapable to consent to the treatment
and take an effective decision (Easteal et al., 2015). However, because Doreen is not in
contact with her relatives, they cannot be deemed as stakeholders for an effective decision
taker.
According to the Powers of Attorney Act 1998 (Qld), the capacity of an individual is
defined as the ability of the patient to understand the effect and nature of the decisions that
are being made by her for the treatment ("Guide to Informed Decision-making in Health Care",
2017). In addition, the ability of the individual to voluntarily make the decision and convey it
to the physician in an appropriate manner (Williams et al., 2017). The individual is required
to express a choice of the decision that is being undertaken as a part of their advance health
directive. In the case of Doreen, the prison doctor could assess the ability of the patient to
converse in a manner such that the nature and effectiveness of the decision undertaken by her
is rational and understood by her. Doreen was able to convey the information of her choice to
the prison doctor in an appropriate manner.
According to the Principle 2 of the healthcare guidance given to medical professionals
in Queensland on the grounds of advance care planning, the physician or the nurse is liable to
reject the usage of CPR with the presence of an Advanced Health Directive ("Guide to
Informed Decision-making in Health Care", 2017). Hence, in the following case, Dr Molly Bean is
required to check the presence of an directive from the side of the patient and then take an
effective decision on the behalf of the incapable patient ("End-of-life care: Guidelines", 2018).
Doreen had completed the advanced health directive on the recommendation of the prison
governor in case of an emergency situation where she is unable to take care of herself and
also, is unable to take an informed decision on the best treatme that could be administered to
her.

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According to the healthcare principles, the medical professional has a legal right to
not adhere to the healthcare directive if a photocopy or facsimile is provided ("Guide to
Informed Decision-making in Health Care", 2017). Hence, it is in these cases that a substitute
decision maker who is close to the patient is being called ("End-of-life care: Guidelines", 2018).
It is the responsibility of the decision maker to ensure that the treatment that is required to be
administered to the patient generates a good result and a positive health outcome is
established. In the case of Doreen, the substitute decision maker is liable to understand the
bad and good aspects of the healthcare options and take an effective decision. The past
medical history of the patient is to be given special consideration and the opinion of the
family members or close friends, in the case of Doreen, are required to be undertaken.
Conclusion
In conclusion, it can be understood that the medical condition of Doreen was
increasingly deteriorating and the presence of an advanced health directive was crucial for the
medical professionals to take an efficient decision because of her incapacity. The friendship
of Bea and Doreen was indeed, very deep which, in turn, provides her with an legal authority
to undertake a decision for the improvement in the health condition of Doreen. The rights of
the prison governor are being established in terms of insertion of pacemaker into the patient
and presence of stakeholders who have the legal authority to provide consent on behalf of the
patient.

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