2805NRS Trimester 1: Legal and Ethical Issues in Healthcare Report

This report provides a comprehensive analysis of legal and ethical principles in healthcare, utilizing a case study involving a patient named Doreen. The report examines key concepts such as autonomy, individual responsibility, and the application of the law of capacity in the context of advance health directives. It explores the ethical implications of medical decisions, including the denial of CPR, and the role of surrogate decision-makers. The report addresses legal issues surrounding consent, the authority of the prison governor, and the obligations of healthcare professionals in ensuring patient capacity. Through a detailed examination of the case, the report highlights the importance of ethical decision-making, respect for patient rights, and adherence to legal frameworks in healthcare practice. It emphasizes the need for healthcare professionals to balance patient autonomy with the complexities of medical interventions and end-of-life care.

Running Head: LEGAL AND ETHICAL ISSUES 1
Legal and Ethical Principles in Healthcare
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LEGAL AND ETHICAL ISSUES 2
Introduction
From the case study involving Doreen, there are several ethical and legal issues that can
be identified. Doreen does not like being a burden to people, and hence she can be described as
being autonomous. Bea is ready to do everything to help her friend Doreen get well. One of the
values that can be identified in Bea is caring and altruistic. This paper discusses whether the
decision made by Molly is in line with the ethical principle of autonomy and individual
responsibility. The article also discusses the application of the law of capacity to make consent
when Dorreen was signing the Advance Health Directive (ADH). The paper discusses the
rationale for the legal obligation of the doctors to obtain permission from Doreen tracheostomy
despite not being in a position to provide the consent. The other legal issues discussed is the
ability of the prison Governor to consent on behalf of Doreen and the role of the prison doctor in
ensuring that she had capacity when signing the AHD. Dr. Molly cannot rely on the AHD as a
valid refusal of Cardiopulmonary resuscitation (CPR) since her health had been improving
tremendously, and hence there was a chance that she could recover fully and would not be
dependent on anyone.
Making ethical decisions
Question 1
The value that can be identified by Doreen's hate for being dependent on others is
referred to as being autonomous. Autonomy can, therefore, be described as the capacity to be
one's person to live their own life according to the reasons and motives that are their own and not
manipulated (Arruda et al., 2020, p.19-31). It is also the ability to take care of oneself without

LEGAL AND ETHICAL ISSUES 3
depending on other people for help. The fact that Doreen does not like being dependent or a
burden to people shows that she is very independent on herself and that is why she does not want
to be in prison without having the ability to do things by herself. The value of autonomy may
affect Doreen's decision making in several ways. One of the ways in which it has affected her
decision making is that she completed and advance health directive requiring that incase her
health condition worsens to the extent that she is not capable of taking care of herself in prison,
she should not be allowed to live. This therefore shows that as a result of this value, Doreen will
make her decisions independently and based on her ability to take care of herself. Any indication
that her health condition might make it challenging to be autonomous means that she prefers to
end her life rather than live being entirely dependent on other people.
Question 2
From the concern and the kindness that Bea shows to Doreen, she can be described as
caring. Caring is the value of being kind to someone and being ready to do everything to assist a
person in need of help (Greaney & O'Mathúna, 2017, p.83-99). For Bea, she is prepared to do
anything so as Doreen gets better. This means that she does not want to see Doreen's situation get
worse, and she does not want her to die of the medical condition she is suffering from. This value
can affect her decision making about Doreen because it might go against her wishes and her
rights to make independent decisions. This value might go against Doreen's with that incase her
condition worsens, she should not be assisted to live, and she should be allowed to die. But for
Bae, she is willing to do anything to see Doreen and to spend time with her again since she is her
best friend. It, therefore, means most of the decisions made by Bae regarding Doreen will aim at
ensuring that she lives against all the odds, and this is not what Doreen wants.

LEGAL AND ETHICAL ISSUES 4
Question 3
The decision made by Molly is not consistent with article five in autonomy and
individual responsibility. This is because, when Doreen signed the AHD, she did not indicate
that she should not be treated when she gets ill. The condition on the AHD is that she should do
not want to be kept alive if she cannot take care of herself. Dr. Molly was not right to indicate
that Doreen should not be given CPR in case of cardiac arrest because there was a high
probability that she could have fully recovered and resumed her life as usual. From the case
study, it is clear that she had been improving well, even beyond the expectations of the doctor
until the mistake was made, which resulted in her getting into cardiac arrest. Therefore, the
wishes of Doreen have not interpreted appropriately, and this led to the fatal death of the patient.
Dr. Molly did not respect the autonomy of the patient since conducting a CPR could not mean
that the patient could lose the ability to care for herself; hence her decision to order that the
patient should not undergo CPR was unjustified (Osuji, 2018, p.101-111).
Question 4
The decision made by MET is consistent with article 7 on persons without the capacity to
consent. Article 7 requires that when a person lacks decision-making capacity, the physician
should identify an appropriate surrogate to decide on behalf of the patient (Inoue et al., 2019,
p.1746-1752). In this case, Doreen had not designated a surrogate. Therefore, the law requires
that if a patient had any preferences, they should be followed when deciding their health
(Ghafourian et al., 2018, p.43-51). In this case, Doreen had an AHD indicating that she does not
want which to live if the sickness could interfere with the ability to care for herself. Additionally,
when the Medical Emergency Team (MET) team was manually ventilating Doreen, it came to a

LEGAL AND ETHICAL ISSUES 5
point where she stopped making any effort to breathe. This was a clear indication that the patient
did not want to live anymore. It was enough indication for the MET team to follow the wishes of
Doreen, as stated in her AHD. Therefore, the MET team acted according to article seven since
they followed the wishes of the patient, which she had made earlier when she could make
decisions regarding her health (Wood et al., 2019, p.109-121).
Legal Issues
Question 5
The law requires that even when a medical condition or disorder impairs the ability of the
patient to make decision capacity, they still may be able to participate in some aspects of
decision making (Committee on Bioethics, 2016). The medical team is expected to engage a
patient with an impaired ability to decide the greatest extent possible even when a patient has
designated a surrogate to make decisions on their behalf. Therefore, when Doreen suffered from
cardiac dysrhythmia, the team led by doctor Rosie Bush had an obligation to do everything
possible to obtain consent from her regarding the use of tracheostomy.
Question 6
The prison Governor Vera Bennet does not have the legal authority to provide consent for
the insertion of Doreen tracheostomy. This is because, according to Queensland Authority, laws
require for a person who cannot make only the person with the enduring power of attorney or a
statutory health attorney can make a decision on behalf of the patient (Williams, 2017, p.27-38).
Since Doreen had not appointed enduring power of attorney, the statutory health attorney should

LEGAL AND ETHICAL ISSUES 6
be used to make the decision. In this case, the person who should have made this decision is Bea
because she is the close adult friend who was close to Doreen.
Question 7
Since Doreen did not appoint the power attorney and she is not in contact with any close
friend, the Queensland authority law indicates that a close adult friend or relative who is not paid
can decide on behalf of the patient (Menon et al., 2020, p.10-23),. In this case, that person is Bea,
and she is obliged by the law to choose the least intrusive treatment if options are available. She
is also expected to consider the views of Doreen when making the decision. In case Doreen did
not have a close adult friend, a public guardian would have decided on her behalf.
Question 8
To ensure that Doreen had decision-making capacity, the doctor has to ensure that the
patient understands their current medical condition and how it could affect them in the future
(Carter et al., 2016, p. 405-414). Regarding Doreen, she was aware that her chronic condition
was serious and could result in her losing the ability to care for herself. The law also requires the
patient to understand the decision they are making, including the risks, benefits. The doctor
should weigh the information by asking questions to establish the wishes of the patient (Slade,
2017, p.67-75). The patient should also be capable of remembering the decision long after she
completed the AHD.
Question 9
Dr. Molly cannot rely on the patients AHD to deny CPR. This is because the AHD does
not specify CPR as one of the conditions under which the patient stated that they should not be

LEGAL AND ETHICAL ISSUES 7
assisted. The AHD expressly stated that Doreen should not be assisted to live to incase her
condition could impair her ability to care for herself. In this case, there was no enough evidence
to suggest that once the patient underwent CPR and survived, they would have lost the ability to
care for themselves. The doctor, therefore, should not have assumed that by needing CPR, the
patient could have the ability to care for themselves. The law also requires that the doctor should
not follow the AHD if a direction is uncertain (Barnato, 2017, p. 1252-1257). They should
consult a substitute decision maker before going ahead to implement the AHD. Therefore,
instead of writing that the patient should not have received CPR, Dr. Molly should have
established further by what Doreen meant by losing the ability to care for herself since the
statement was quite vague and inconclusive.
Question 10
According to healthcare principles, a substitute decision-maker must decide on the best
interest of the patient (White et al., 2016, p.356-370). In the case of Doreen, the substitute
decision-maker should have made the best decision, which could have helped in improving the
health condition of Doreen. When making the decision, the substitute decision-maker should also
consider the decision that they believe the patient could have made by themselves.The other
consideration is that the substitute decision-maker should seek to understand the medical
condition and should be given information on how the condition might affect the patient in the
future (Kenny, 2017, p.10-17). This ensures that the substitute decision-maker makes an
informed decision so that they can weigh up the options for the patient before making the
decision.The other consideration is that the substitute decision-maker should consider the choices
and the wishes of the patient before they died (Fanelli, 2017, p.78-84). These include the goals,

LEGAL AND ETHICAL ISSUES 8
values as well as spiritual and personal beliefs of Doreen. This includes the views that Doreen
expressed in the AHD as well as other beliefs that she knew from the good friendship they had
developed over the years.
Conclusion
Ethical and legal principles are very critical in healthcare decision making. Healthcare
professionals have to be very careful when making decisions regarding the patient. One of the
most important ethical principles that should be considered is autonomy. Healthcare
professionals should respect the independent ability of a person to make their own decisions.
Healthcare professionals should not interfere with the ability of an adult to make a decision, but
they should only provide information to make it possible for a patient to make an informed
decision. It is also critical to consider a person capacity to decide on their care. The condition in
this is that the patient should be of sound mind, an adult, and should be in good health condition
to make the decision. The wishes of the patient stated in the ADH should be respected and
interpreted appropriately. In the case where there is no appointed power of attorney like in
Doreen's case, the law requires that a close adult friend or relative should be the substitute
decision-maker. When a substitute decision maker is making decisions on behalf of the patient, it
is very critical that they consider the wishes of the patient and that they should make a decision
that is in the best interest of the patient (Kwan & Ng, 2017, p.897.907).

LEGAL AND ETHICAL ISSUES 9
References
Arruda, L. M. A. D., Abreu, K. P. B., Santana, L. B. C., & Sales, M. V. D. C. (2020). Variables
that influence the medical decision regarding Advance Directives and their impact on
end-of-life care. Einstein (São Paulo), 18., 19-31
Barnato, A. E. (2017). Challenges in understanding and respecting patients' preferences. Health
Affairs, 36(7), 1252-1257.
Carter, R. Z., Detering, K. M., Silvester, W., & Sutton, E. (2016). Advance care planning in
Australia: what does the law say?. Australian Health Review, 40(4), 405-414.
Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice.
Pediatrics, 138(2), e20161484.
Fanelli, C. M. (2017). Respecting end of life wishes: development and implementation of an
evidence-based intervention to increase the completion of advance directives, 78-84
Ghafourian, M., Safaei, S., & Abbasi, M. (2018). Analyzing the Role of Patient Autonomy in
Informed Consent. Bioethics Journal, 8(29), 43-51.
Greaney, A. M., & O'Mathúna, D. P. (2017). Patient autonomy in nursing and healthcare
contexts. In Key Concepts and Issues in Nursing Ethics (pp. 83-99). Springer, Cham.
Inoue, M., Ihara, E., & Terrillion, A. (2019). Making your wishes known: Who completes an
advance directive and shares it with their health care team or loved ones?. Journal of
Applied Gerontology, 38(12), 1746-1762.
Kenny, B. J., & Hamilton-Foster, E. (2017). Autonomy & informed consent. hearsay, 10-17.

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Kwan, J., & Ng, Y. Y. (2017). Respecting death at the coal face. Resuscitation, 116, A7-A8.
MacKenzie, M. A., Smith-Howell, E., Bomba, P. A., & Meghani, S. H. (2018). Respecting
choices and related models of advance care planning: A systematic review of published
evidence. American Journal of Hospice and Palliative Medicine®, 35(6), 897-907.
Menon, S., Entwistle, V. A., Campbell, A. V., & van Delden, J. J. (2020). Some unresolved
ethical challenges in healthcare decision-making: navigating family involvement. Asian
Bioethics Review, 1-10.
Osuji, P. I. (2018). Relational autonomy in informed consent (RAIC) as an ethics of care
approach to the concept of informed consent. Medicine, Health Care, and Philosophy,
21(1), 101-111.
Slade, M. (2017). Implementing shared decision making in routine mental health care. World
Psychiatry, 16(2), 146-153.
White, B., Willmott, L., Cartwright, C., Parker, M., & Williams, G. (2016). The knowledge and
practice of doctors in relation to the law that governs withholding and withdrawing life-
sustaining treatment from adults who lack capacity. Journal of law and medicine, 24,
356-370.
Williams, K. (2017). Health law: Advance care directives in Queensland: Two sides of the coin.
Proctor, The, 37(6), 22., 27-38
Wood, C., Ivec, M., Job, J., & Braithwaite, V. (2019). Applications of responsive regulatory
theory in Australia and overseas., 109-121.