NSG2HEL - Mr. B Case: Legal and Ethical Dimensions of End-of-Life

This assignment delves into the legal and ethical complexities surrounding end-of-life care, focusing on the case of Mr. B, a quadriplegic patient requesting the withdrawal of life-sustaining nutrition. The analysis explores the legality of refusing treatment in Singapore and Australia, differentiates betw...Read More

Running head: LEGAL AND PROFESSIONAL ISSUES IN NURSING
Legal and professional issues in nursing
Name of the student:
Name of the university:
Author note:

1LEGAL AND PROFESSIONAL ISSUES IN NURSING
Table of Contents
Introduction: 2
Case description: 3
Case questions: 4
Question 1: 4
Question 2: 5
Question 3: 6
Question 4: 7
Question 5: 8
Conclusion: 9
References: 11

2LEGAL AND PROFESSIONAL ISSUES IN NURSING
Introduction:
Health Care is now providing us with a lot of options and benefits which had been
unimaginable a few decades ago. The most important necessity of human civilization has
evolved drastically in the past few decades by the virtue of technological innovations and the
implementation of different evidence-based practices in the healthcare scenario. One of the most
important benefits that the healthcare service now provide is a person centred and specialized
end of life residential care which has eased the restrictions of many critically ill palliative
patients. End of Life Care usually into supporting and caring for a patient that is critically ill for
a prolonged period of time and is completely dependent on the care provider for basic necessities
of everyday life. The improvements of healthcare has Incorporated marriage has made end of life
care easy and effective while integrating holistic nursing care to the concept in an attempt to
reduce the restrictions and difficulties that a palliative patient goes through every minute of every
day (Parsons et al., 2010).
However despite all the innovations and advancements, there are still a few issues that an end
of life care receiving patient faces. A very significant and frequently observed challenge that a
palliative patient goes through while in a comprehensive end of life care is the dependency and
restrictions. It has to be understood that are critically ill or disabled palliative patient has to
depend on the care provider for each and every aspect of daily life starting from eating bathing to
even moving if possible at all (Phua et al., 2015). The dependency on the care provider for the
purpose of living every day often is a huge psychological burden on the patient, and most of
them often lose the will to live any longer. This assignment will attempt to discover the end of

3LEGAL AND PROFESSIONAL ISSUES IN NURSING
life issues faced by a patient and voluntary elective death requests with respect to health care
ethics and laws.
Case description:
This case study represents the 48 year old patient Mr B, who had went through a spinal cord
injury I had to suffer from quadriplegia. Now it has to be mentioned in this context that
quadriplegia is a paralysis of all four limbs which is generally brought about by a severe injury to
the spinal cord. This type of paralysis is mostly irreversible and restricts any movement by the
patient suffering from it without assistance. It has to be understood that a quadriplegic patient is
cognitively intact, capable of all normal brain functions although the patient is capable of any
activity. The patient in the case study as well had been capable of cognitive functions es but was
completely dependent on the end of life care he was receiving in the nursing home for everything
else. Now it has to be mentioned here that prior to the accident, the patient had been a lively
young energetic man with a profession in the industry of adventure tourism. The accident and the
mobility restriction therefore can be considered a huge burden on the consciousness and psych of
the patient. However, the patient had been very courageously went through the quadriplegia for a
prolonged period. However recently the condition of the patient had deteriorated significantly
and he had been unable to receive nutrition in his own and has to be fed through feeding tubes. In
fact even his respiration needed to be assisted by a diaphragmatic pacing. All the added
complexities had been facilitating extreme stress and had been a contributing factor behind the
patient losing his will to live any longer. That is the reason the patient requested that his tube
feeding should be cased and he requested to die peacefully. However, there are various different
laws and health care policies that define the use of assisted death or the broader concept of
euthanasia.

4LEGAL AND PROFESSIONAL ISSUES IN NURSING
Case questions:
Question 1:
The end of life medical decision is a very delicate subject and different nations have
differential policies and protocols regarding the end of life medical decisions that a patient can
take. In the most of the developed nations the right to die is an operational health law. However
in order to be able to exercise the right to die, the patients will need to be in a competent
cognitive health. In case of rightfully competent patient the option to refuse life sustaining
treatment and nutrition is legal in many of the developed Nations (Bloomer et al., 2010).
Considering the Healthcare law and practices of Singapore, the concept of Euthanasia and
assisted suicide is illegal and is considered a criminal offence. Hence the concept of assisted
suicide or providing the means to the patient to directly end their life the targeted measure is
completely illegal in Singapore and health law. According to the authors by the virtue of s 309 of
the Singapore Penal Code any abetting direct Euthanasia and attempted suicide is considered a
criminal offence and any person any person assisting the procedure will be punished with
imprisonment for even leading up to 10 years and will also have to submit a monetary fine.
Hence, considering the engaging indirect active Euthanasia for assisted suicide will cost the
Healthcare professionals associated with it criminal offence with respect to the s309 and s107
codes.
However it has to be mentioned that under the AMD act, the patients going to incurable
critical illness of disability with no hope of recovery can legally refuse the continuation of life
sustaining mediation (Moh.gov.sg., 2018). Similarly in case of Australian law, an adult patient
with optimal cognitive health and competency has the right to refuse any life sustaining
treatment as well. Hence, according to the health care laws and regulations of both Singapore

5LEGAL AND PROFESSIONAL ISSUES IN NURSING
and Australia, the patient in the case study had complete rights to refuse the life sustaining
treatment.
Question 2:
Euthanasia can be considered a considerably controversial topic in terms of the health care
and there are numerous laws and protocols regarding the practice of euthanasia in the different
nations. According to the Bloomer et al. (2010), Euthanasia can be defined as intentionally
causing the death of the patient with the underlying motive of benefiting the patient and
protecting the patient from any further suffering. The different forms of euthanasia, it can be
voluntary where the patient will give competent and complete consent to the action that will
eventually cause his or her death. The second type is non voluntary where the patient involved
will not provide competent consent on where is regarding the euthanasia. The last type of
euthanasia is involuntary will inevitably die due to it. Now each of the type mentioned can be
further subdivided into active and passive form of euthanasia. In the active form of euthanasia
the actual act that will cause the patient's death will be a direct and it will not depend on any
other confounding factor rather than the normal metabolic processes of the patient's body
(Martin, 2010).
On the other hand the passive form of euthanasia generally involves the natural causes of
death. In this case, the healthcare professionals are the family of the patient usually takes the
resistance of discontinuing or withdrawing medical treatment or life-sustaining methods so that
the patient will eventually die (Ebrahimi, 2012). This type of euthanasia is considered to be the
most merciful to the patient as the patient will be released from the suffering of the treatment
methods and the critical illness that he is going through. Hence, it can be mentioned that if the
life sustaining nutrition is discontinued are withdrawn from the patient Mr B then the healthcare

6LEGAL AND PROFESSIONAL ISSUES IN NURSING
professionals will not constitute euthanasia. This verdict is justifiable as patient himself has
requested to the withdrawal of life-sustaining nutrition so that he can eventually the die, hence
due to the withdrawal when the patient eventually dies, the death of the patient is considered as a
direct result of the wishes of the patients and not due to the act of any other individual ( White &
Willmott, 2012).
Question 3:
Euthanasia according to many authors is very different from withdrawing any life-sustaining
treatment from a patient, when considering the point of view of a medical practitioner. It can be
mentioned that euthanasia is constituted only when the patient is provided a direct means of
death. Along with that euthanasia can be carried out with or without detect consent from the
patient as well in case of involuntary euthanasia (Goldney, 2012).
In case of withdrawing or discontinuing a life sustaining treatment on nutrition is not a direct
at that could lead to instantaneous death of a patient. It has to be understood that in this case the
patient and his cognitively completed decision to see any treatment and eventually face death is
considered to be autonomous decision of the patient entirely. According to the Medical
Treatment Act of Australia patient on his legal guardian can refuse continuation of any medical
treatment or life sustaining care procedure if it is of no beneficial use of the patient or is not
adding to any possibility of recovery. In this provision the main contribute in fact behind the
withdrawal of the medical therapy or treatment is to relieve the pain suffering and discomfort
that the patient is going through and letting the nature take the cause of death with the patient
providing him ultimate relief (Alberthsen et al., 2013).
According to the author the most important difference between kids drawing treatment and
carrying out euthanasia is the fact that in case of euthanasia the patient is given a direct method

7LEGAL AND PROFESSIONAL ISSUES IN NURSING
of instantaneous death with or without competent consent of the patient. Whereas withdrawing
treatment is considered as Justice by mercy as the patient is given the opportunity to attend
natural death by discontinuing any complicated treatment procedure (Bartels & Otlowski, 2010).
And the eventual death of the patient is considered to be the consequence of the autonomous and
valid decision of the patient himself. According to the law of good medical practice, withholding
treatment is classified as the patient's own underlying conditions leading to death rather than a
direct act by a medical care provider. Hence withholding treatment is completely different from
Euthanasia in accordance with the good medical practice of any medical practitioner (Krishna,
2014).
Question 4:
Although the consent for withdrawing the life sustaining treatment comes directly from a
cognitively components patient. There are a few legal issues and restrictions that Healthcare
professional may face while listening to the request of the patient. In case of both Singapore and
Australia the withdrawal of life support treatment or facility is lawfully justified in case that
informed consent and inform if you still has been taken from the patient. Good medical practice
constitutes of the medical practitioner engaging in a filthy practice that is based on school
principals of Healthcare integrity truthfulness Fidelity compassion and confidentiality (Toh &
Yeo, 2010).
The most important consequence of adhering to the request that the patient has made for a
natural death following withdrawal of life-sustaining fluids can be considered the moral distress
and deletion of professional ethics when it comes to providing care and support to the patients
(Murugam, 2016). Along with that another very important risk that the health practitioners can
be faced with is the account of negligence to the care needed by the patient despite the patient

8LEGAL AND PROFESSIONAL ISSUES IN NURSING
refusing it. It has to be understood that there is a fine line between passive voluntary euthanasia
and withdrawal of life sustaining treatment. Hence the medical practitioners associated with
complying with the request of the patient must have thorough documentation and follow the
legal protocol for the entire procedure so that there is no confusion regarding this activity being
practice of euthanasia in any circumstances (Pereira, 2011).
Question 5:
According to the provisions of patient centred care, adhering to each and every wish and
Desire expressed by the patient or his family members is the most important area of practice
standard in case of health care delivery both in Australian and Singapore and context. However
when a patient willfully decides to discontinue any medical therapy that can potentially lead to
the consequences of the patient there are certain professional provisions which can allow how
medical practitioner to refuse engaging in such an activity. Conscientious objection can be
considered a professional provision in the healthcare delivery that provides the opportunity to the
healthcare professionals to consciously refuse to participate in any medical practice on
organizational procedure that clash with the moral obligation and professional ethics of that
particular individual (Fletcher, 2015).
However it has to be mentioned in this context that conscientious objection is only valid
when there is a distinctly model motivation behind the objection of a healthcare professional. It
should never be based on personal convenience or prejudice and it has to be performed on the
basis of autonomous informed and critically reflective choice at all circumstances (Dworkin,
2011). In this case, as the patient has been going through condition that was a reversible and no
amount of therapy or treatment could provide any potential possibility of recovery of the patient,
the conscientious objection can be very difficult to establish. It has to be understood that the

9LEGAL AND PROFESSIONAL ISSUES IN NURSING
condition of the patient has been deteriorating everyday and the existing treatment procedures for
only increasing the difficulties and complications of the patient. Hence the most ethical and
morally correct decision at this stage should be relieving the patient of any pain or suffering that
he might be going through and providing him the opportunity to embrace at its most natural
course. Hence, it can be mentioned that under as the treatment procedure or the life sustaining
fluids in this case were only prolonging the inevitable death of the patient (Caresearch.com.au.
2018). Hence the moral justification of continuing the service despite the competent consent of
the patient and his family members to withdraw the LST is not valid. Hence, personally I cannot
refuse the desire expressed by a mentally healthy and competent patient.
Conclusion:
On a concluding note it can be mentioned that the importance of the end of life care is
optimal to the health care industry. Although the continuation of the end of Life Care should
always depend on the needs and desires of the patient who is receiving the palliative care. It has
to be understood that the will to live is very important for any human being to continue to sustain
a complex and difficult treatment procedure which only leads to more suffering, and in cases
where the patient has no hopes of recovery at any circumstances the patient has a right to refuse
to the complicated treatment procedure and embrace death in peace. It also has to be mentioned
that euthanasia can be brutal while the patient is being given I did it means to end his or her life
and the moral stress of ending a life consciously can also be a huge psychological burden on the
healthcare professionals associated. That is the reason many healthcare professionals exercise
their rights to conscientious objection when they have to undergo a procedure that can lead to
direct or indirect euthanasia.

10LEGAL AND PROFESSIONAL ISSUES IN NURSING
Although the case study utilized for this assignment represents a patient who has wished to
discontinue life-sustaining fluids and let nature take its own course for eventual death which is
not necessarily a practice that can be considered as euthanasia. The moral distress in this case is
also much lower as the patient is not being provided a direct means two and his life but is being
given an opportunity to see any suffering that the medical treatment is causing him and wait for
his eventual death in peace and with his loved ones. Hence the provision of conscientious
objection does not apply here and I would not have refused the patient of his last wish and would
have given the opportunity to die peacefully.

11LEGAL AND PROFESSIONAL ISSUES IN NURSING
References:
Advance Medical Directive Act | Ministry of Health. (2018). Moh.gov.sg. Retrieved 22
February2018,fromhttps://www.moh.gov.sg/content/moh_web/home/legislation/
legislation_and_guidelines/advance_medical_directiveact.html
Alberthsen, C., Rand, J. S., Bennett, P. C., Paterson, M., Lawrie, M., & Morton, J. M. (2013).
Cat admissions to RSPCA shelters in Queensland, Australia: description of cats and risk
factors for euthanasia after entry. Australian veterinary journal, 91(1-2), 35-42.
Bartels, L., & Otlowski, M. (2010). A right to die? Euthanasia and the law in Australia.
Bloomer, M. J., Tiruvoipati, R., Tsiripillis, M., & Botha, J. A. (2010). End of life management of
adult patients in an Australian metropolitan intensive care unit: a retrospective
observational study. Australian Critical Care, 23(1), 13-19.
Dworkin, R. (2011). Life's dominion: an argument about abortion, euthanasia, and individual
freedom. Vintage.
Ebrahimi, N. (2012). The ethics of euthanasia. Aust Med Stud J, 3, 73-5.
Ethical Issues. (2018). Caresearch.com.au. Retrieved 22 February 2018, from
http://www.caresearch.com.au/caresearch/ProfessionalGroups/NursesHubHome/Clinica
l/EthicalIssues/tabid/1473/Default.aspx
Fletcher, J. F. (2015). Morals and Medicine: the moral problems of the patient's right to know
the truth, contraception, artificial insemination, sterilization, euthanasia. Princeton
University Press.

12LEGAL AND PROFESSIONAL ISSUES IN NURSING
Goldney, R. D. (2012). Neither euthanasia nor suicide, but rather assisted death. Australian &
New Zealand Journal of Psychiatry, 46(3), 185-187.
Ho, Z. J. M., Krishna, L. K. R., & Yee, C. P. A. (2010). Chinese familial tradition and Western
influence: a case study in Singapore on decision making at the end of life. Journal of pain
and symptom management, 40(6), 932-937.
Krishna, L. K. R. (2013). Personhood within the context of sedation at the end of life in
Singapore. BMJ case reports, 2013, bcr2013009264.
Krishna, L. K. R. (2014). Is the encapsulation of local culture and mores within the practice of
palliative care liable to result in a slippery slope to euthanasia in Singapore?. Pall Med
and Care.
Martin, B. (2010). Techniques to pass on: technology and euthanasia. Bulletin of Science,
Technology & Society, 30(1), 54-59.
Murugam, V. (2016). Terminal Discharges and Passive Euthanasia—Two Fundamentally
Different Entities That Should Not Be Likened to Each Other. Asian Bioethics
Review, 8(4), 290-301.
Parsons, C., Hughes, C. M., Passmore, A. P., & Lapane, K. L. (2010). Withholding,
discontinuing and withdrawing medications in dementia patients at the end of life. Drugs
& aging, 27(6), 435-449.
Pereira, J. (2011). Legalizing euthanasia or assisted suicide: the illusion of safeguards and
controls. Current Oncology, 18(2), e38.

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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.
Soh, T. L. G. B., Krishna, L. K. R., Sim, S. W., & Yee, A. C. P. (2016). Distancing sedation in
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journal, 57(5), 220.
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assisted suicide?.