Analysis of Legal and Professional Healthcare Issues: Ms. Huang

This report analyzes the complex legal and professional issues arising from Ms. Huang's case, a 46-year-old quadriplegic woman seeking to withdraw life-sustaining treatment. The analysis delves into the legal capacity of patients to refuse medical treatment, exploring the nuances of consent under Australian common law, and the distinction between withdrawing treatment and euthanasia. It examines the legal implications of respecting patient autonomy, particularly concerning the use of PEG tubes for nutrition and hydration. The report discusses the risks associated with complying with or denying a patient's request to withdraw treatment, including potential conflicts among family members, medical staff, and the patient. Furthermore, it explores the professional responsibilities of healthcare providers in respecting patient wishes while adhering to ethical principles and legal standards. The report underscores the importance of ethical leadership and the patient's right to make informed decisions about their healthcare, even if those decisions lead to end-of-life care.

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Introduction
Even though the suitable role for law in healthcare practice is questioned, there is no
uncertainty that law serves a highly decisive role in regulating medication. This significant
role also takes account of end-of-life care, with majority of the countries devising legal
frameworks which regulate decisions related to life-sustaining treatment. According to
studies, these laws commonly recognise the authority to employ substitute or alternate
decision-makers in order to complete the advance instructions (Carter, Detering, Silvester &
Sutton, 2016). Per se, clinicians have imperative legal accountabilities in this part that
involves evaluation of the patient’s ability to agree to the withholding or withdrawing of
provided treatment, recognizing an authorised decision-maker in which a patient shows lack
of capacity, and if a progressive directive needs to be monitored. Druml et al. (2016) have
noted that the act of withholding or withdrawing a life-sustaining treatment be likely to show
great challenges for health care providers, patients as well as their family members. When
health conditions of a patient shows no improvements or to be approaching its end, it is
normally supposed that the ethically best approach is to attempt for innovative or new
intervention, continue all necessary cures or opt for an experimental development of action
(Esbensen, 2016). The following paper will analyse the case of Ms Huang who desires to
withdraw her life-sustaining treatment and identify legal and professional issues which are
likely to arise in medical context.
Discussion
Capacity and Consent of Patients to Withdraw Medical Treatment
Under the Common Law of Australia, all capable adults can provide approval as well
as refuse to receive medical treatment. However, if the consent fails to get established, there
might raise certain legal costs for health specialists (Carter, Detering, Silvester & Sutton,
2016). Furthermore, according to the law of trespass, it is noted that patients who have stable

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cognitive functioning have the authority not be exposed to a disturbing procedure devoid of
consent or additional lawful defence related to an emergency or stipulation. Additionally, the
Common law of Australia has recognised few conditions where patient might not be able to
obtain the required informed consent (Capacity and Consent to Medical Treatment, 2020).
These situations can be linked to impaired decision-making capacity or areas in which
agreement to the proposed or given treatment may not be essential such as in the case of
emergency. A central principle of health law in Australia is related to an adult’s right to make
decisions on what requires to be done for treating the health. This takes in the right to consent
to or the rights to decline or withdraw medical treatment (Halliday, Formby & Cookson,
2015).
Moreover, under Australia End of law regulation, an adult who has the required
ability or capacity can withdraw medical treatment even though the failure to obtain
treatment will be consequential to death. Thus an adult can withdraw medical treatment based
on any grounds which can be based on religious causes or personal views about the idea of a
tolerable or acceptable quality of life. In the view of Carter, Detering, Silvester and Sutton,
2016)., as long as adult patient has the cognitive ability there are limited restrictions on the
legal grounds to refuse medical treatment. By drawing relevance to these factors, it can be
noted that since Ms Huang is cognitively intact she has lawful right to refuse or withdraw the
provision of life sustaining nutrition and fluids via a PEG tube.
Agreeing to withdrawing life-prolonging treatment does not constitute euthanasia
Passive voluntary euthanasia implicates the removal or refusal of medical action from
a patient in accordance to the appeal of patient and family members to end the life of the
patient. Instances of these actions involve the resuscitating of patient in cardiac arrest,
termination of provision of life support instrument or withholding or removing additional
medical precaution that would lengthen life (Humanrights.gov.au, 2016). Furthermore,

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withholding or withdrawing medical treatment at present take place in Australia as per a
number of conditions and regulations.
The Australian Medical Association (AMA) correspondingly claims that medical
treatment possibly will not be secured at situations where such treatment will fail to offer a
balanced assurance of benefit and value or will implement an undesirable or offensive
obligation on the patient. In addition, there is an ongoing debate, related to the implications
whether these procedures are positioned within the understanding of euthanasia. Under the
assertions of the AMA, not introducing or removing life-sustaining treatment does not
constitute euthanasia where health professionals are responding in accordance with upright
and legal standards of medical practice. Studies mention that health professionals who
perform in accordance with principled and decent good faith and rationally agree to the
appeal of patient in withdrawing or continuing provision of medical treatment in support of
an advance ordinance are commonly considered to be performing as per the permission of the
patient (Druml et al., 2016). For example, in Western Australia as well as the Northern
Territory, legislation mentions that health professionals is considered to be responding in
accordance to the valid consent while depending on an advance instruction, even in situations
where there might be chances of life loss of patients (Ko & Blinderman, 2015).
Withdrawing life-sustaining treatment is not the same as Euthanasia
There is a strong legal distinction in Australia and other countries like the United
States between withdrawing life-supporting treatment associated with ventilation for patients
or artificial nutrition as well as fluids for those who are unable to swallow or consume food
or liquid and euthanasia that is considered as a lethal injection or medicine to end one’s life.
However, in contrast, philosophers and legal researchers differ (Kitzinger & Kitzinger, 2015).
The nearly common opinion is that when clinicians remove life-supporting treatment from a
patient they tend to take the life conditions and moreover permit patients to expire from the

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causal condition. Based on this claim they contend the law is incoherent since it proscribes
killing by harmful injection or lethal medicine, while authorizing life loss by removing life-
prolonging treatment from the ones solely reliant on it. These statements are used with an aim
of putting forward that the law cannot consistently continue to disallow euthanasia as it is
effectively permitting it to be practised by this time (Ko & Blinderman, 2015). Based on
these understandings, the act of removing a tube is akin to the act of giving a lethal dose. On
the contrary, McGee (2014) argues that the withdrawal of the tube is a red herring. In some
cases when a patient remains in Permanent Vegetative state (PSV), the tube is left in same
position for days even after the caseation of feeding. However, even if the withdrawal of the
tube is done immediately, this still comes after provision of nourishing come to an end. Thus,
the act of withdrawing the tube does not relate to the cause of death (Kitzinger & Kitzinger,
2015).
Furthermore, the withdrawal of provision of artificial nutrition and hydration (ANH)
of the tube cannot be considered to be a cause of patient’s death. As per studies, since the
nutrition and hydration is given only occasionally on the base of that it is not permanent
(McGee, 2014). Moreover, it is even easier to take into consideration the withdrawal as an
exclusion as medical experts simply abstain from providing the food and hydration the
subsequent time one would be supposed to provide it. In the case of Ms Huang, since
termination of provision of the nutrition and hydration will normally pave the way for the
withdrawal of the tube, the supposed process of withdrawal will tend to be causally
ineffective as it will not be resultant in the primary cause of death like euthanasia. In addition,
the withdrawal or withholding of ANH is an exclusion to deliver additional nutrition and
hydration. On the basis of these studies, it has been accepted by number of researchers that
exclusions to treat do not cause loss of life and therefore withdrawal of ANH does not have
similarity to euthanasia (McNaught & MacFie, 2015).

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Risks related to agreement with patient’s appeal to withdrawal of treatment
The termination of ANH of patients who are in Permanent Vegetative state (PSV) can
be a sensitive issue. Furthermore, it can be the cause of distress and disagreement within
relatives, between family members and physicians or between physicians and other medical
staff and carers which might be considered as a risk for the medical experts. Similarly, there
might be risks of internal conflict where medical experts and nurses might not come in
agreement on the process of diagnosis. According to Somers, Grey and Satkoske (2016), the
concept of non-maleficence is exemplified by the phrase, ‘first, do no harm’. As a result, a
number of people base their understanding on the concept whereby there must be the chief or
primary consideration in health care.
Moreover, it is more imperative not to cause harm to patients, rather medical experts
must practice with a purpose of doing good to patients. On the other hand, there might a risk
for health professionals in misinterpreting the presumption that therapeutic treatment delivers
assistance to a patient. Conversely, in terms of end-of-life care, health professionals might
encounter risk of situations where patients might be affected or maltreated by the withdrawal
of treatment as well as by extending the treatment further than the point where it is capable of
making improvements in patients’ conditions where patients are identified to have rejected
the provision of treatment, mainly through an Advanced Health Directive (AHD) (Wancata &
Hinshaw, 2016). Furthermore, there are certain legal protections in restricted circumstances
for health professionals who do not perform their duties in accordance to valid AHDs. In the
case of Ms Huang, if medical and nursing staffs do not agree to the withdrawal of life-
sustaining treatment as per the guidelines of AHDs, they might face a risk of liability both on
illegal and civil grounds. In addition to this, there can be jeopardies of causing harms if it is
done intentionally or by reluctance as well as dissembling about censorship or withdrawing
life-sustaining treatment. On the other hand, any incompetence of health professionals in

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making wrong or irrational decisions might subject Ms Huang who already lacks ability to
unnecessarily continued, painful and inappropriate treatment can considered as harm causing
harm (White et al., 2017).
Decisions on professional level whether or not to comply with withdrawal of life-supporting
treatment
The decision of not complying with the patients’ appeal in ceasing life-sustaining
medical treatment is highly complex and be is considered to be emotionally-charged as well
as opposing issue for the patient, medical team as well as relatives. When a patient shows the
ability to make judgments for life conditions, the healthcare team who is engaged in the case
must show reverence to the patient’s requests. On the other hand, studies reveal health
professionals’ duty to give high opinion to the rights to decline the undesirable treatment and
healthcare provision of patients. Such a right is primarily grounded on knowledgeable
principle of autonomy (Willmott et al., 2016). In the view of authors, failing to defer to a
patient’s right in ceasing provision of life-sustaining system is likely to be considered as a
form of assault. Furthermore, medical treatment given to patients without seeking their
consent can possibly give rise to an act in battery or civil assault. Moreover, such immoral
action if being is administered might instigate an unlawful act of causing bodily harm or
critical physical damage. Since, Ms Huang is cognitively fit; she made her own decisions of
withdrawal of supply of nutrition and fluids through PEG tube. By drawing relevance to this
aspect, medical and nursing staffs must respect her decisions in order to maintain their
professionalism and ethical considerations. In addition, ethical leadership in healthcare
settings reverences ethical principles and ideals as well as put emphasis on the dignity and
human rights of patients. In the view of Somers, Grey and Satkoske (2016), such form of
leadership is linked to the notions as autonomy, reliance, respect and righteousness. Studies
reveal that as per the National Advisory Group, that National Health Service (NHS) clinical

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leaders respect self-esteem and human rights of patients and efficiently implement the norm
in all administration and staff levels ( MacFie & McNaught, 2019). Superior leader–member
associations are linked to an affirmative workplace culture setting (Willmott, White, Smith &
Wilkinson, 2014). Thus, in order to establish an ethical patient-centred culture, decision-
making pathways have been founded in countries like Australia. While on the other hand, in
critical settings like the withdrawal of life-supporting treatment might lead to patients’
immediate death, whilst a few patients will choose to leave the hospital. Thus, all necessary
interventions must be individualised to the requirements of the patients as well as their
families. Ina addition, medical and nursing staffs should act as moral agents and efficiently
develop ethical competences in order to ease the supposed effects for the patients in addition
to their family members.
Conclusion
Thus, it can be concluded that, withdrawal of life-supporting treatment is considered
as an intricate decision-making process. In such a situation, patient's independence is critical
in decision-making. Thus, the general codes of law as well as medical practice point out that
people have a right to decide about their treatment and medical experts have to comply in
order to act as moral agents. In the case of Ms Huang, since termination of provision of the
nutrition and hydration will normally pave the way for the withdrawal of the tube, the
supposed process of withdrawal will tend to be causally ineffective as it will not be resultant
in the primary cause of death like euthanasia. Meanwhile since, Ms Huang is cognitively fit;
she made her individual decisions of removal of supply of nutrition and fluids through PEG
tube. By drawing relevance to this aspect, medical and nursing staffs must respect her
decisions in order to uphold their professionalism and ethical considerations.

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