Abiding by law and Risk Management
- Three Legal/Ethical Issues
- Abiding by law (legal issue)
- Clinical ethical reasoning (ethics issue)
- Management of risk (legal issue)
- Discussion of Three Legal/Ethical Issues
Abiding by law
Law is defined as an enforceable or established rule in a social context with a primary focus on either conduct or non-conduct. Laws are also legal standards, and in most cases, a violation of these rules results in what may be referred to as civil or criminal liability (“Clinical Ethics and Law,” n.d.). Whenever the term “law” is mentioned then “ethics” must also be mentioned because of the interdependence of the two. It is argued that ethics begins where law ends, which means that in a scenario in which the law is inapplicable then the former must be applied to determine whether an action is right or wrong. Their common goal is to ensure the creation and maintenance of social good (Warren, Justice, & Supreme, 2005). Ethical norms are derived from various perspectives including the law itself, policies of professional organizations, institutional practices or policies, as well as professional standards of care and fiduciary obligations. On the other hand, the term “law” can be derived from federal and state constitutions, statutes, regulations, and case law, as well as city or town ordinances, when deemed relevant (“Clinical Ethics and Law,” n.d.). Another avenue for coming up with a law is a voting process whereby the majority of voters take the decision. In essence, law enforcement is done in court or judicial systems, and the relationship between law enforcement and the scenario at hand can be viewed from the perspective of surrogate decision-making. Surrogate decision-making as witnessed in the situation is often used when a court order prompts the designation of a specific surrogate decision-maker for a patient incapacitated to provide informed consent. Additionally, the law in various countries states that a patient without the capacity to grant informed consent that may be attributed to circumstances such as the lack of consciousness should have a legally authorized decision-maker tasked with giving permission on their behalf (World Health Organization, 2013).
In the scenario at hand, the wife issued a living will. It is considered an advance directive that sees a person use different types of legal documents with the aim of recording future wishes in the event they lack a decision-making capacity. Laws that determine who qualifies as a legally authorized surrogate decision-maker for another a person in order of priority are in place in different countries. However, it is worth noting that the said laws may vary from country to country or from state to state. The conclusion made by these rules is based on the fact that relatives or close family members are the most qualified surrogate decision-makers. There are instances whereby a patient previously capable of granting consent chooses a person as her decision-maker. In the case of the lack of the capacity to make an informed consent on the side of the patient, then the person chosen previously is granted informed consent. Undoubtedly, this is in line with the scenario whereby the husband of the woman is the closest family member hence is tasked with making decisions on her behalf because she cannot provide informed consent. In essence, the husband derives his role of a surrogate from the living will that was drafted and signed by an attorney earlier. The law states that the role of a surrogate decision-maker is to take decisions that the incapacitated person would have made. In the scenario, acting as the surrogate decision maker, the husband declines permission to withdraw his wife’s life support machine arguing that the will’s contents are not applicable to the present situation. This scenario revolves around the law on surrogate decision-makers and what they ought to do or ought not to do.
Clinical Ethical Reasoning
Clinical ethics can be a methodology or discipline that helps in the consideration of the ethical implications of medical technologies, treatments, and policies, with a focus on the need to determine what ought to be done or not done when it comes to the delivery of healthcare services (“Clinical Ethics and Law,” n.d.). In the case of ethical issues that come up during medical care, several healthcare facilities have on-call or in-house ethicists with proper training on how to help caregivers, patients, and other healthcare practitioners with how to address the same. Undoubtedly, clinical ethics in hospital settings began in 1992 upon the introduction of accreditation requirements that pushed for the need for hospitals to come up with ways of addressing issues related to ethics that arise in the clinical sector. Clinical ethical reasoning might entail health care provider-patient communication as well as medical decision-making (Førde&Vandvik, 2005). Indeed, such problems affect various operations of healthcare organizations.
According to clinical ethics, considering the rights and expectations and satisfying the needs of a patient is mandatory (“Clinical Ethics and Law,” n.d.). For instance, health care providers must consider the choices made by a patient in a position to provide informed consent. However, a patient without the capacity to do so should have a suitable surrogate decision maker. In such a scenario, the surrogate decision-maker meets the requirements, guidelines, and provisions of clinical ethics. Other than availing a surrogate decision-maker as dictated by clinical ethics, the health professionals consider the expectations and needs of removing the life support machine as stated in her will signed with her lawyer. Even though the husband opposes the proposal, the fact that the healthcare professionals attempt to remove the life support machine as the woman desired is a demonstration of clinical ethics.
Management of Risk
Risk management can be defined as a strategy, method, or way of mitigating the risk of liability through practices and policies formulated by institutions (“Clinical Ethics and Law,” n.d.). The methods used by organizations to mitigate risks are often derived from professional standards, the law, and the mission and public relation plans of individual institutions. Moreover, it is mandatory that the methods of risk management be displayed through institutional policies and practices. Risk managers play an integral role in healthcare facilities, and this is evident in most hospitals where they are required to have clinical backgrounds. Like law, risk management also goes hand in hand with ethics. Hence, an issue revolving around clinical ethics may give rise to risk management concerns.
In the scenario, the aspect of risk management is evident when the husband is granted time to weigh possible risks that might arise from his decision to remove from the life support machine that kept his wife alive. It gives the husband time to recover from his grief and think from the viewpoint of his wife. On coming back, the husband, considering the possible risks involved, insists on retaining the life support machine. He firmly believes that his stand and decision on the contentious issue at hand are right. Undoubtedly, his opposition to the withdrawal of the life support machine highlights risk management that is part of operations in most healthcare facilities. Also, it is evident that decision-making in the scenario bases itself on the understanding of the patient’s intentions before succumbing to a severe brain damage. It means that they focus on reducing possible risks that might result from their action of withdrawing the patient’s life support machine.
- How I Would Handle Each Issue
Handling of “Abiding by Law”
From the perspective of law, as a healthcare provider, I would ensure that the final decision on the question of withdrawal of life support takes into account the will of the surrogate decision-maker. Also, I would make sure to adhere to the law by considering the will signed by the patient when she was in a position to provide informed consent (Koocher& Keith-Speigel, 2012). In this case, I would consider applying the utilitarian approach, which argues that an ethical action is the one that produces the most good and does not cause harm (Santa Clara University, n.d.). The approach believes that a moral action is one that keeps a balance between good and evil. In the scenario, I would have considered discussing the will of the patient with the surrogate decision maker, who is the husband. Through this, I would have done well and met everyone’s expectations rather than harm or jeopardize the process of discussion the next course of action when it comes to withdrawing the patient’s ventilator machine. With an objective of not causing damage, I would indulge the patient’s husband rather than making decisions from a personal point of view.
Handling of Clinical Ethical Reasoning
As already mentioned, clinical ethics dictates that healthcare providers must satisfy the expectations and needs of patients. Therefore, while handling clinical ethics in the scenario, I would allow the husband to decide on the withdrawal of the life support machine as he is the next kin to the wife meaning that he is entitled to provide informed consent on behalf of the wife. The best ethical approach to apply in this case would be the rights approach. This approach suggests that the ethical action is the one that ensures that the moral rights of those affected are best protected and respected (Santa Clara University, n.d.). Further, the approach suggests that humans have the right to be treated with dignity, which means that the purpose of treatment should a better life. In the scenario, my actions would be based on my respect for the patient’s right to life.
Handling of Management of Risk
As a healthcare provider in the scene, I would ensure that the husband has sufficient time to assess his wife’s situation and hence make a decision concerning the matter. With enough time to come up with the best choice, the husband would have fully exercised his role as the surrogate decision maker thereby coming up with the best suggestion to mitigate potential risks. Additionally, in this situation, I would prefer the virtue approach, which suggests that ethical actions must be consistent with some ideal virtues providing for the full development of humanity (Santa Clara University, n.d.). My decisions would aim to promote ideal virtues that allow the development of humanity such as truth, compassion, honesty, and love.
Clinical Ethics and Law. (n.d.). Retrieved from http://depts.washington.edu/bioethx/topics/law.html
Førde, R., &Vandvik, I. H. (2005). Clinical ethics, information, and communication: review of 31 cases from a clinical ethics committee. Journal of medical ethics, 31(2), 73-77.
Koocher, G. P., & Keith-Speigel, P. (2012). ” What Should I Do?”-Ethical Risks, Making Decisions and Taking Action. Retrieved from http://www.continuingedcourses.net/active/courses/course050.php
Santa Clara University. (n.d.). A Framework for Ethical Decision Making. Retrieved from https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/
Warren, E., Justice, C., & Supreme, U. (2005). Legal, Ethical, and Professional Issues in Information Security. Retrieved from http://www.cengage.com/resource_uploads/downloads/1111138214_259148.pdf
World Health Organization. (2013). Ethical issues in patient safety research: interpreting existing guidance. Retrieved from http://apps.who.int/iris/bitstream/10665/85371/1/9789241505475_eng.pdf