Introduction
Ethics is a branch of philosophy that deals with what is right and wrong, within the health context ethics can broadly be defined by four accepted principles of: Autonomy, beneficence, non-maleficence and justice. These principles act as a guide when dealing with the broader Ethical and Legal issues that all health care workers deal with throughout their career. Although these four above mentioned principles of ethical standards have remained unchanged, the ethical standards of today have begun to change in favor of a utilitarian approach to health that the “greatest good for the greatest number” which comes from John Stuart Mill a philosopher on utilitarian ethics.
Although ethics and legal standards are still dealt with on a case by case basis and in times where no law exists for a case then different depending on the context including the type of profession, (Doctor, Nurse, Social worker), where you are working and if you are working with a public or private practice. However, the broader ethical and legal standards will not differ greatly. This paper aims to thoroughly explain a series of Ethical dilemmas that face health practitioners and how they can be solved within the Legal boundaries put in place by the national Government of Queensland and Common law of Australia.
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Ethical Issues
Rachel believes that because of Ross’s character he would not want to continue living in a state where he cannot be independent in his actions, and since the health care team believe there is little chance of full recovery from the damage he sustained from the accident, and that they should end his treatment as he had previously clarified that he did not want to live in an incapacitated state. Rachel’s ethical views fall in line with Consequentialism. Consequentialism is an ethical theory that is focused on the outcome or consequence of actions. Consequentialist ethics is broken down into two parts defining what is “good” and how one can approach the defined “good”. The form of consequentialist ethics that Rachel believes is best known as Utilitarianism. Utilitarian’s believe that the right actions or “good” actions are the ones that produce the greatest amount of happiness and the reverse of this would be an outcome that does not produce the greatest happiness. In Ross’s case, he is happier dying then remaining in an immobile state having to rely on machines to live so the best option is to allow him to pass away peacefully, therefore, maximizing the overall happiness.
Chandler views on Ross’s condition in a more positive light believing that given time Ross would be able to recover and showed some signs of being aware of his surroundings and based on research he had down on patients suffering from coma’s or brain injuries he was adamant that Ross’s was to remain on life support. Chandler believes that despite Ross current condition and his character of not wanting to be looked after were less important for health and wellbeing if in the long term there was potential for a recovery and that it was in Ross’s best interest to stay on treatment. Despite the healthcare team and Rachel believing that Ross’s recovery was bleak. This view of Ethics falls more in line with the Kantian view of ethics that the end does not justify the means. The idea proposed by Immanuel Kant is known as Deontology and it focuses more on protecting
the individuals need as opposed to utilitarianism which focuses on the greater good for society. In the medical context deontology focuses on what are the duties that a healthcare professional is to withhold regardless of the outcome. They focus on what the benefits of the person are in this case that Ross could potentially recover and can be there for his children, and more importantly he gets to keep living his life.
Rachel believes that since there is no chance of recovery for Ross based on the severity of the injury and the advice of the medical team. As the ex-wife of Ross, she knows him well enough to justify terminating his treatment as it’s what he would have wanted.
The challenge lies in Ross being unable to agree to procedure and in face of death individuals often change their opinion on things including being on life support. There is also some bias in Rachel’s beliefs as she would gain full custody of her and Ross’s children. Ross’s Boss Chandler feels guilty that he was not able to do more to prevent Ross’s accident and even though when Ross was conscious, he resisted medical treatment Chandler still feels like even the slightest chance of Ross surviving overalls even Ross’s own will to not continue living on treatment. Chandler had also been doing some research on patients who had recovered from brain injuries or woken up from coma, so this influenced his decision to continue treatment.
The United Nations Educational, Scientific and Cultural organization (UNESCO), made a stance of Bioethics by publishing a paper in 2005 outlining principles that could internationally be agreed on. This publication is known as the Universal Declaration on Bioethics and Human Rights. In this publication one of the principles that relates to Autonomy and individual responsibility which is about the capacity of an individual to make their own decisions on something and to responsible for those actions as well as respecting the autonomy of others except in circumstances where someone is not able to capable of exercising autonomy. In Ross’s case this is an ethical dilemma is determining whether these circumstances constitute an exception and whether they are in Ross’s best interest which is difficult as Ross was unable to consent to treatment therefore the decision must be made on his behalf either by his Ex-wife or friend Chandler, unless there was a living will be indicating how to proceed. Another principal outlined is Consent which is challenging as before the coma Ross very strongly refused treatment by paramedics but due to his life being threatened the healthcare team decided to intervene medically despite the lack of consensus.
Legal Issues
Consent in healthcare is defined as an agreement between a patient and healthcare professional to provide treatment and care including testing, medicines treatment and procedures. For consent to be given the patient must also meet other criteria including: A doctor or healthcare professional explain the different options for treatment, the potential risks associated with each operation and how likely those risks are, ensure you understand the benefits of the procedure, and the purpose of your consent. (healthdirect, 2018).
However the laws regarding valid consent in Australia require that “A mentally competent patient has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own death” (Royal Courts of Justice, 2004). After Ross’s first accident at the Emergency department he refused to cooperate with nursing staff so the healthcare practitioners were unable to operate and fully assess Ross’s condition if the healthcare practitioners had decided to proceed they would be liable for failing to uphold their duty of care, negligence and be liable for a medical malpractice suit.
However consent does not to be given in an emergency, if the patient is not in a condition to consent. Since Ross was unconscious and in a life threatening condition the health care practitioners were able to provide treatment for Ross’s injuries without being liable for a malpractice suit. Queensland law states that “A life-sustaining measure may be withheld or withdrawn for an adult without consent if the adult’s health provider reasonably considers the adult has impaired capacity for the health matter concerned”. (Guardianship and Administration Act, 2000). This means that the decision for Ross’s treatment is to be decided by the healthcare team who believed it was in Ross’s best interest to receive treatment while he sustained injuries preventing consent.
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