HEALTHCARE ANALYSIS FINAL

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Healthcare Case Analysis

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Introduction

Scenario

The case involves a seventy-two-year-old woman who presented to the neurological intensive care unit after she experienced a cerebral hemorrhage that led to severe brain damage and rendered her ventilator-dependent. The patient and her husband put down a living will one year before the incident, and the will suggests that the patient denied being on a ventilator or artificial life support after experiencing a terminal condition. The physician diagnosed her condition as permanent; her husband was the legal next of kin and the one to decide for the patient. After discussing with the husband, the husband argued that the patient's living will should not be used in the current situation, and proclaimed that the patient is not permanently unconscious. The couple has adult children who disagree with their father's decision to refuse to withdraw their mother from the life support machine. They were given one week to allow the father to grieve and accept his wife's health condition, but after one week, the husband refuse to allow his wife to be withdrawn from the ventilator machine as she had expressed in her living will.

Three legal/ethical issues

1. Legal/Ethical Issue #1 Effects on Family at the end of life

2. Legal/Ethical Issue #1 Designation of surrogate decision-makers

3. Legal/Ethical Issue #1 Effects on care at the end of life

Discussion of Three Legal/Ethical Issues

1. Discussion of Legal/Ethical Issue#1 Effects on Family at the end of life

The role of the loved ones in the decision-making process is critical. The death of a loved one is a traumatic event for the family. Little is known about emotional reactions or the process by which family members decide to deny the request to die (Hendriks, 2019). Rationalization and obfuscation are two common forms of denial at the end of life. Rationalizations are explanations that defend an action that the patient had stated in their living will. Obfuscation is the use of rationalizations to make it seem impossible to accept that the family member is dying. For example, the husband's case suggests that the wife's living will have a note stating her current condition should not make her withdraw from the life support machine despite knowing that the wife will not survive regardless of the treatment to be used.

2. Discussion of Legal/Ethical Issue#2 disagreeing Decision Maker

Decision-making continues to be an issue in end-of-life decision-making. Physicians, families, and health care providers are often faced with decisions regarding the end of life that are difficult to make. The frequent goal is to achieve a good death for the patient. Some of these decisions concerning medical decisions include life-sustaining treatment, withdrawal of life support, and time of death (Oh, 2020). The decision to withdraw life support is challenging since it requires consensus between the family and physicians. Because the family often influences this decision, it can be challenging to make and is not one health care providers usually make quickly. The decision to withdraw life support is typically a family decision. Still, health care providers, patients, and their families must carefully consider the decision, and the family must make sure it is informed. In the scenario, the patient's husband and her children disagree since the father does not want the wife to be withdrawn from the life support, but the children have agreed to follow their mother's living will.

3. Discussion of Legal/Ethical Issue#3 Effect on care at the end of life

Care at the end-of-life decision-making is at the heart of the palliative care situation. It is a decision that requires ethical deliberation and sensitivity to the moral issues raised by the patient, including religious, ethical, social, and legal matters. The best is to consider the patient's wishes and not to interfere with the patient's decision-making (Pozgar, 2019). However, the patient is entitled to ask for certain decisions incompatible with her wishes. From the scenario, the patient is unconscious with a permanent health condition that has put her in a vegetative state. In the patient's living will, she stated that she did not want to be placed on a ventilator or a life support machine in case she was in such a state.

How I would handle Each Issue

1. Handling of Legal/Ethical Issue #1

In end-of-life planning, physicians are legally obliged to act in their patients' best interest, but they must be realistic about what the person's best interests may mean for others. From the case scenario, the seventy-two-year-old patient left a living will, explaining that she did not want to be put on a ventilator. Still, the husband suggests that his wife's living will does not apply to her current condition. One of the best ways to deal with this issue is to make the husband understand that it is his wife's best interest not to be ventilated when she is in such a condition. However, this can be challenging since the husband believes the patient's living will not apply to her current situation. Nevertheless, it can be resolved by making the husband understand the seriousness of her wife's current condition. Comment by Busayo Oyewole: There should be a law that supports following the patient's wish. Example: the patient's self-determination act and the year to support why the husband should honor her wish

2. Handling Legal/Ethical Issue#2

Based on the scenario, the patient's husband is the next of kin and the one to make decisions for the patient health care. Based on this information, the best way for the husband is to decide for his wife. Since his adult children disagree with his decisions, the children must understand that their father is the next of kin and the decision-maker for the patient health care process. Therefore, the healthcare providers should follow the husband's decision to deal with the issue. Comment by Busayo Oyewole: You need to specify if this is legal or ethical and

3. Handling Legal/Ethical Issue #3

In the case of unconsciousness, a healthcare professional should obtain permission from the unconscious person's family or legal representatives, if possible, before suggesting withdrawal of life-sustaining treatment in an unconscious patient and provide them with the information that they required to make an informed decision about their end-of-life care and have their wishes considered. Then, the health care provider has to discuss with the family and agree on the next decision that should be taken for the patient.

Conclusion

One of the most important end of life decisions we make is to designate someone to decide if we should become incapacitated or die. It is a critical decision we should take seriously at some point in our lives. Making the decision involves thinking about our goals and values and our own and other people's interests. From the case scenario, the patient health care decision should be left to the husband since he is his wife's next kin and the decision-maker.

References

Oh, T. (2020). An Extraordinary Journey: What matters at the end of life. Elsevier Health Sciences.

Pozgar, G. D. (2019). Legal and ethical issues for health professionals. Jones & Bartlett Learning.

Hendriks, A. C. (2019, April). End-of-life decisions. Recent jurisprudence of the European Court of Human Rights. In Era Forum (Vol. 19, No. 4, pp. 561-570). Springer Berlin Heidelberg.