HEALTHCARE ANALYSIS FINAL

Running head: HEALTH CARE CASE ANALYSIS 1

Health Care Case Analysis

Name

Institution

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HEALTH CARE CASE ANALYSIS 2

Health Care Case Analysis

Introduction

Scenario

A woman in her early seventies was admitted to the Neurological Intensive Care Unit

after a severe cerebral hemorrhage that damaged her brain and left her dependant on a ventilator.

Before the admission, the woman and her husband had signed “living wills” with their attorney.

One of the provisions of the living will be that the patient did not want any artificial life support

including ventilator in case she got in a permanent unconscious condition. However, despite the

clear provisions, the husband argued that the living will could not be applied to the situation in

hand since his wife neither was in an imminently terminal condition nor was the unconsciousness

permanent. Although the couple’s children understood and supported the withdrawal of life

support, the husband could not agree even after being given sometimes to grief and comprehend

the magnitude of the situation.

Three legal/ethical issues

1. Legal/Ethical Issue #1 Determining futility 2. Legal/Ethical Issue #1 Competence and Consent 3. Legal/Ethical Issue #1 Right to privacy and ethics of justice

Discussion of Three Legal/Ethical Issues

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HEALTH CARE CASE ANALYSIS 3

1. Discussion of Legal/Ethical Issue #1 Determining futility

The main reason healthcare is given to achieve the goals of the patient, especially in a

patient-based healthcare system (Stewart, 2007). The treatment team has to pay attention to the

anticipated goal to be achieved if they take any action. Generally, the team is expected to work

form the point of view of the patient such that all the treatment interventions that could lead to

the achievement of the patient’s goals should be presented to her for consent, any other method

that will lead to different results that the patient wanted should be withdrawn or withheld

(Chima, 2008). The futility of treatment is not determined by whether the treatment will have

positive results but whether the outcomes will coincide with the wishes of the patient. However,

in this case, the patient is unconscious and therefore cannot give the consent on any possible

treatment. The dilemma in the scenario is that the treatment team can no longer speculate what is

in the patient’s best interest especially since the condition she is in has no possibility of

improving even with treatments.

2. Discussion of Legal/Ethical Issue #2 Competence and Consent

According to both legal provision in the constitutions and ethics of caregivers withdrawing a

life-sustaining intervention requires a competent consent of the patients or the surrogates (Welie

& Ten Have, 2014). Although a hospital might have a precise method of determining futility, it is

not the final step to the withdrawal of the treatment. If the patient’s surrogates are not available

and the patient cannot give a competent consent, the physician can make the decisions whether to

withhold or withdraw a life-supporting machine, but only if they argue as a formal surrogate

would, that is to the best interest of the patient. In the scenario at hand, different consents can be

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HEALTH CARE CASE ANALYSIS 4

said to be valid, and choosing which decision to make is hard. For instance, the patient had

indicated in the living will that if they would not want to be put in a life-sustaining treatment

plan. This clause is valid since the patient was in their right informed mind when agreeing to the

will. However, since she cannot consent or withdraw her prior consent, her competence and the

meaning of the clause is questioned. In the case of surrogates, the fact that both the adult children

of the couple and the patient’s husband cannot agree yet they are all arguing for the best interest

of the patient is contradicting.

3. Discussion of Legal/Ethical Issue #3 Right to privacy and ethics of justice

Generally, the right to privacy is said to cover the right of a patient to refuse medical or other

treatment intervention. In United States history, many cases have been held regarding the

question of withdrawing treatment and end of life intervention (Welie & Ten Have, 2014). The

New Jersey Supreme Court in 1976 during the case of Quinlan held that a patient could not be

forced to endure treatment they did not want that was not bound to make any changes to their

health (Supreme Court of New Jersey, 1976; in Munson, 1992, 173 as cited in Stewart, 2007).

On the same issue, the court stated that the right of privacy could be exercised by the patient or a

guardian if the patient could not b able to make a decision (Stewart, 2007. Precisely, the court

indicated that the right to refuse medication could not be discarded on the basis that the patient is

unconscious. However, the issue in the scenario is that the husband’s arguments are valid, the

clause in the living will that could be taken as the patient’s way of exercising her right to privacy

does not precisely fit the scenario and the family members cannot agree.

How I would Handle Each Issue

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HEALTH CARE CASE ANALYSIS 5

1. Handling of Legal/Ethical Issue #1

The treatment team should be able to evaluate the specific goals that are expected in offering

care (Welie & Ten Have, 2014). I would engage the team and launch a discussion on their moral

discomfort and their take on any available options. In the scenario, the condition of the patient is

critical such that it is already determined that her unconsciousness is permanent meaning she will

never wake up and hence will never be able to give a precise direction on what she wants. Since

withholding the treatment for a while cannot be said to be illegal, the treatment team can buy

time to weighing any options available that could improve her breathing and make her

independent to a ventilator (Chima, 2008). Regardless of the findings of the team, clear facts

should be presented to the family and perhaps will sway them to agree.

2. Handling of Legal/Ethical Issue #2

For consent to be referred to in treatment, it has to be determined that it is a competent and

informed decision. The scenario does not tell us whether the patient at the time of making a

living will be properly informed. It is possible the patient was already diagnosed and made the

decision based on psychological trauma related to such a diagnosis (Stewart, 2007). It cannot be

determined if the patient knew all the facts about the condition and life support systems and there

is no indication of what her decision was based on. For instance, if it was known that she knew

about the complications and benefits of the treatment, it could be determined that the consent

was informed and competent.

On the other hand, the husband could be deciding since he does not want to lose her but not

because it is the patient’s best interest. In this case, the husband should be informed about all the

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HEALTH CARE CASE ANALYSIS 6

risk factors, complications and expense of the method. Also, I would urge the treatment team to

refer to their personal and professional ethics and base their convincing comment to the family

based on what they think is right.

3. Handling of Legal/Ethical Issue #3

People are likely to be held liable for what they do and not what they fail to do. In this case,

the intervention under question determines if the patient lives or dies yet it does not bring any

improvement to the health of the patient (Chima, 2008). Putting aside the issue of the validity of

the clause in the living will, the treatment team should respect the choice of the patient and

should determine which action is bound to bring pleasure or ‘happiness’ to the patient and also

the family. I would explain to the family the facts surrounding the case and makes sure they are

all thinking about the well being of the patients and not their ‘selfish’ wants and wishes.

Conclusion

In cases of life-supporting treatments, the question shift from improving the health of the

patient to whether it is worth it for the patient to survive unconsciously until they die slowly. It is

a dilemma moment for both the family and the medication team since there is no way of

knowing precisely what the patient would decide on the given situation. In the given scenario

unlike in cases where the questions are about adherence to medication, there are only two

options, either withdraw or withhold the intervention. Assuming the patient was in their right

mind and understood the gravity of their statement while making a living will, I would

recommend her wishes be respected.

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HEALTH CARE CASE ANALYSIS 7

References

Chima, S. C. (2008). Overriding patient autonomy in medical practice: Best interests, necessity,

therapeutic privilege and public policy. Organized by the UNESCO Regional Centre for

Documentation and Research on Bioethics at Egerton University, 12-14 August 2008, 1.

http://erepository.uonbi.ac.ke/bitstream/handle/11295/40656/Bioethics.pdf?

sequence=1#page=9

Stewart, R. S. (2007). Withholding and withdrawing life support: Moral dilemmas, moral

distress, and moral residue. Online Journal of Health Ethics, 4(2), 4.

https://aquila.usm.edu/ojhe/vol4/iss2/4/

Welie, J. V., & Ten Have, H. A. (2014). The ethics of forgoing life-sustaining treatment:

theoretical considerations and clinical decision making. Multidisciplinary respiratory

medicine, 9(1), 14. https://mrmjournal.biomedcentral.com/articles/10.1186/2049-6958-9-

14

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