NSG 426 - Legal and Ethical Responsibilities: A Detailed Case Analysis

This report analyzes a case study titled 'Our Pregnant Daughter Didn’t Want This,' focusing on the legal and ethical dilemmas surrounding a pregnant woman in a vegetative state. The case involves Janet, who is nine weeks pregnant and in a vegetative state after a car accident. The report examines the legal aspects, particularly the Kansas law regarding advanced directives and pregnancy exclusions, which invalidate Janet's wishes. It explores ethical principles such as autonomy, non-maleficence, and beneficence, highlighting the conflict between Janet's wishes and the legal requirement to protect the fetus. The report discusses the alignment of legal and ethical considerations, the challenges faced by healthcare professionals, and recommends a resolution that balances patient autonomy, legal requirements, and the well-being of both the mother and the fetus, including communication with the parents, maintaining life support, and exploring options to save the unborn baby. The report references peer-reviewed sources to support its analysis and recommendations.

Running head: LEGAL AND ETHICAL RESPONSIBILITIES 1
Legal and Ethical Responsibilities
NSG 426
December 24, 2019

LEGAL AND ETHICAL RESPONSIBILITIES 2
Legal and Ethical Responsibilities
Introduction
This paper looks at the case study ‘Our Pregnant Daughter Didn’t Want This.’ and seeks
to analyze the legal and ethical principles about the case. The case is about 29 year old Janet and
her husband Jack, who sustained severe injuries after collision with another car while driving
home. Jack died on the way to the hospital and Janet survived. However, her injury was the
worst-case scenario as her best prognosis is a vegetative state because of her head injury.
According to her advanced directive, her husband was given the durable power of attorney for
health decisions and her parents were secondary agents. Since her husband died, Janet’s parents
were responsible for all the decisions regarding her (Rosell, 2019). There are many ethical and
legal challenges linked to the case as the law is considering her advanced directives null and void
because she is pregnant. This report will explore the issues in detail.
Legal aspects pertaining to the case
The issue in the case study was that Janet is in a vegetative state, and the central dilemma
for her parents while taking decisions on their daughter’s behalf was that Janet was nine weeks
pregnant. The parents made the decision to initiate palliative care for her. However, the dilemma
was that the physician noticed Janet is not immediately dying, and since she is pregnant, the
decision of holding or withholding treatment does not apply to her parents but to the Kansas law.
According to the law of Kansas by Marcuccio & McCollum (2015), related to advanced care
directive, part two of the Kansas declaration is not valid for pregnant women. Part two of
directive allows the patient to state decision about life-sustaining procedures. Hence, adhering to

LEGAL AND ETHICAL RESPONSIBILITIES 3
Janet’s decision was a legally challenging issue and the medical team suggested that Janet’s
transfer of care will have to be postponed. This controversy happened because the law in Kansas
makes advanced directive or last wishes of pregnant women null and void.
Pregnancy exclusion is seen in thirty-one states and this is the main reason behind legal
challenges in proceeding with advanced directive if the patient is pregnant.
Ethical principles pertaining to the case
According to the law related to the advanced directive for Kansas, Janet’s will about
withholding life-sustaining treatment can be completed by the health care professionals as
pregnant women are allowed to have a say on their treatment. Instead, there are many other
ethical challenges in making treatment decisions for Janet. For example, one of the options is
that her hospice care is postponed, and that her parents have the right to give their opinion
regarding her treatment, which can be life support or nutrition and hydration through PEG tube.
This application is based on ethical principle of non-maleficence as this principle mandates that
health care providers should avoid causing any harm to patients intentionally and they must
ensure that patient safety is maintained (Karnik & Kanekar, 2016). Hence, providing life support
will be suggested because the main initiative of Kansas law is to save the life of the foetus and if
life support is against Janet’s wish then it will not be obeyed because the foetus needs to be
saved. It will also be likely for physicians to know if Janet’s child can survive or not. Another
issue seen in this case study is the violation of ethical principles in regards to the medical
professionals because they are in an ethical dilemma due to Janet’s decision and the steps to be
taken in such cases irrespective of the person’s will.

LEGAL AND ETHICAL RESPONSIBILITIES 4
However, as Janet’s parent has a power of attorney, the law must respect Janet’s living
will. If this is not done, it will violate the patient’s right to autonomy. It ensures that patients are
given treatment that is consistent with their end-of-life care preferences. Hence, the idea that the
decisions will be taken by her parents of the medical experts violates Janet’s right to autonomy.
There is a chance of a conflict of interest too because Janet’s parents strongly advocate that their
daughter’s will is respected. To avoid conflict of interest, Janet’s parents should seek counsellors
and legal experts that will advise them about the law of Kansas related to the exclusion of
pregnant women in advanced care planning. They will also have to communicate with them
regarding the benefits, drawbacks, and limitations of each of the treatment options, which is not
acceptable by Janet because she does not want a life support or a gestational environment for the
foetus (Dzeng et al., 2015). The decision is more difficult because any decision will effect Janet
as well as the foetus. According to Hester, Eisenberg and Guidry-Grimes (2019), withholding
treatment is not preferred for a pregnant women because the question is about the fetus’s survival
according to the Kansas law. Hence, this possibility should be considered and appropriately
communicated to the health care staff too.
Alignment of legal and ethical in the case
The legal aspects and ethical aspects are not aligned in the case. Because the legal status
of Kansas prohibits the application of Janet’s will related to end of life treatment, whereas the
ethical principle of autonomy conflicts with the legal aspects of the case, besides going with
Janet’s decision can also violate the ethical law of beneficence and non-maleficence as this limits

LEGAL AND ETHICAL RESPONSIBILITIES 5
any chances of survival of both Janet as well as the fetus. This shows another aspect of using one
human for the survival of another, which is one of the ethical dilemmas.
Recommendation to resolve the issue
The following recommendation is suggested to resolve the issue and ensure respect of patient’s
wish as well as patient autonomy, which includes the health care professionals to engage in
communication with her parents to explain why going by Janet’s decision is not legally valid.
The health care professionals will help her parents to rethink why the issue may create legal
challenges (Menezes & Luna, 2017). The next action is to keep Janet on life support based on the
State Statute as this will prevent any legal issues, and it will ensure that the patient’s chances of
survival are increased. It is also recommended to make attempts to save the unborn baby by
considering options like IVF. New possibilities or new medical advances can be considered to
manage the life limits of Janet so that new life is given. The above recommendation is based on
the deontological approach as it pays emphasis on the relationship between duty and morality of
human actions (Baron, 2017). Hence, honesty and a fetus’s right to life has been considered
while making this decision because it is taken in consideration to Janet’s deontology, which is
the act of decision making according to what is right or wrong irrespective of the consequences.

LEGAL AND ETHICAL RESPONSIBILITIES 6
References
Baron, J. (2017). Utilitarian vs. deontological reasoning: method, results, and theory. In Moral
inferences (pp. 145-160). Psychology Press.
Dzeng, E., Colaianni, A., Roland, M., Chander, G., Smith, T. J., Kelly, M. P., ... & Levine, D.
(2015). Influence of institutional culture and policies on do-not-resuscitate decision
making at the end of life. JAMA internal medicine, 175(5), 812-819.
Hester, D. M., Eisenberg, L., & Guidry-Grimes, L. (2019). Regulating Decisions for
Incapacitated Pregnant Women. Jama, 322(9), 894-895.
Karnik, S., & Kanekar, A. (2016). Ethical Issues Surrounding End-of-Life Care: A Narrative
Review. Healthcare (Basel, Switzerland), 4(2), 24. doi:10.3390/healthcare4020024

LEGAL AND ETHICAL RESPONSIBILITIES 7
Marcuccio, E. A., & McCollum, J. P. (2015). Advance Directives Containing Pregnancy
Exclusions: Are They Constitutional. Ne. J. Legal Stud., 34, 22.
Menezes, R. A., & Luna, N. (2017). Pregnancy and maternal brain death: decisions on the fetal
life. Interface-Comunicação, Saúde, Educação, 21(62), 629-639.
Rosell, T. (2019). Case Studies - Our Pregnant Daughter Didn’t Want This. [online]
Practicalbioethics.org. Available at: https://practicalbioethics.org/case-studies-our-
pregnant-daughter-didn-t-want-this [Accessed 14 Jan. 2020].
Criteria Level Met
Case Summary (5% of grade) Exceeds expectations
Research/explanation of pertaining laws
(17% of total grade)
Approaches expectations – there is
confusing re what the law is directing re
Janet’s wishes and what, exactly, Janet’s
wishes are.
Definition of ethical principles
(23% of total grade)
Meets expectations
Legal and Ethical responsibility alignment
(17% of total grade)
Meets expectations
Resolution recommendation
(23% of total grade)
Meets expectations
Communication (5% of total grade) Meets expectations
Information utilization: ability to incorporate
research/evidence that supports ideas;
quality of research (5% of total grade)
Approaches expectations
APA Format (5% of total grade) Approaches expectations

LEGAL AND ETHICAL RESPONSIBILITIES 8
Total (100% of grade – 180 points) 132.8