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Ethical Issues In The Field Of Medicine

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Ethical Issues In The Field Of Medicine

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Discuss the legal and ethical issues faced in the medical field in regard to the given case.


Every profession has certain legal and ethical standards, which, at times can tend to collide with each other. For example, in medicine, the legal standards often contradict the ethical norms and create dilemmas, making it very difficult to solve by choosing the right option. Ethical values followed by the medical practitioners are the standard rules of Bioethics, as set by the ‘Universal Declaration on Bioethics and Human Rights (UDBHR) (Plomer, 2013). This essay will discuss the legal and ethical issues faced in the medical field in regard to the given case, focussing on the principles of each that often contradict one another.
Legal issues:
The elements of a valid “informed consent” must be present in the given scenario for the paramedics to conduct the treatment of Richard’s heat shock (Lamont, Jeon, & Chiarella, 2013). Firstly, Richard must be let known about the pros and cons of treatment by the paramedics. Secondly, he must be made aware of the consequences of both having and not having the treatment done on him.  Lastly, he must be made aware of the necessity of such treatment, by the paramedics.The law on bioethics (UDBHR) for medicine states clearly that the elements of informed consent must be present before the treatment of any patient. In addition, the law states that in case of treatment without consent of the patient, the medical practitioners will be held legally liable (Wells & Kaptchuk, 2012).
The paramedics have the right to treat Richard for his head injury, even though he had refused their treatment for heat shock, previously. It is so, because according to the exceptions to the principle of informed consent, a medical practitioner need not obtain the consent of a patient for treatment in case of emergency when the patient is unable to consent. Therefore, in this given case, even though the medical crew did not obtain Richard’s informed consent for the heat shock treatment, they can provide treatment for his head injury, as after his head was injured, Richard was unable to give consent and it was an urgent and emergency situation (Flynn et al., 2012).
The law of bioethics(UDBHR)states that during a treatment, if another problem crops up which isresolved by doing the initial treatment, the medical practitioner need not require the consent of the patient(Kaye et al., 2015). Therefore, in this case, Richard was incapable of providingconsent because ofhis head injury andcranio-facial surgery was necessary(Garrino et al., 2015), therefore, the medical practitioners did not need consent for Richard’s cranio-facial surgery. This is clearly stated under the law of bioethics and is also an exception to the principle of informed consent.
Richard is a resident of Queensland, Australia, where his wife Meryl and children live. At the time of the head injury, Richard’s wife was not present, and Lucas took charge of Richard. He had called the paramedics after Richard suffered the head injury and at the same time informed Richard’s wife, Meryl. The paramedics decided toadmit Richard to a major hospital in Brisbane, which meant he was flown by air ambulance. Richard’s wife, after being informed by Lucas about Richard’s injury, straightaway went to the hospital.Lucas drove down to the hospital and by the time he reached to the hospital Meryl was already there.
In the circumstances, treatment decisions related to Richard depends on Meryl, as she has a legal relationship with Richard and has the right to make decisions for him. Lucas, who initially took responsibility for Richard, has no legal relationship with Richard and cannot make decisions regarding his health treatment (Bickenbach, 2012). Hence, Richard’s wife will be the one to take decisions regarding Richard’s treatment based on their legal relationship (Stewart, 2012). In case of any disagreement regarding any decision for Richard’s treatment, between Meryl and the medical practitioners, the only option that will be left is to obtain the decisions of the Queensland Civil Administrative Tribunal (QCAT), which decides these kinds of cases, brought before it by any medical practitioner regarding the treatment of patients’ requiring special medical care.
If the medical practitioners believe that Meryl’s decisions regarding Richard’s treatment are not the best course of action medically they will approach QCAT. In no condition, the decisions of Lucas will not prevail due to the presence of Meryl, as Lucas, being a friend of Richard, shares no legal relationship with Richard. Therefore, the issue is the difference between what Meryl wants and what is regarded as medically the best course of action.
In such cases, QCAT investigates the medical condition of the patient and after its investigation, gives a verdict based on the medical issue. QCAT is the only legal authority in Queensland that has the authority to decide the future treatment of Richard in this case, if the medical practitioners don’t agree with Meryl’s wishes regarding the same (Ries, Thompson & Lowe, 2017).
In order to withdraw the life sustaining measures Richard is surviving on, certain factors are required to beconsidered, including the current health condition of the patient and whether there is any chance of recovery if life sustaining measures are discontinued and whether there is any other feasible option available that can cure the patient (Alberthsen et al., 2013). The decisionof QCAT must be obeyed if the case has been referred to it, as once a case is referred to QCAT, the decision becomes legally binding.
Ethical issues
Two principles, which can be identified in this case, are those of autonomy and beneficence. The principle of autonomy deals with informed consent. According to theprinciple of autonomy under theUDBHR, a patient, or their legal representative,must be provided with information, by the medical practitioners, about the pros and cons of a particular treatment before the treatment is actually done. Disclosure must be madeabout the necessities of such treatment and the circumstances of avoiding it. However, the most important aspect of this principle is that the patient must give consent to go through a particular treatment, provided, they are competent to do so (Padulo et al., 2013). This principle also states that such a decision of the patient must be made without coercion or fraud. If the patient refuses to go through the treatment, then such treatment must not happen.No medical staff can refuse treatment if the patient wants it(Herring, 2014).
The principle of beneficence states that the medical practitioners are required to perform, keeping in mind the benefits to the patient, with all the knowledge and skill they possess (Page, 2012). Taking into consideration the facts of this scenario, the two abovementioned principles apply.
In the given case, the principle of autonomy, which states the rule of the self, that is free from controlling interferences by others and free from personal limitations that prevent meaningful choice of a person. An autonomous individual acts intentionally, without controlling influences and with understanding. It also includes the principle of informed consent,that applies in the given case because during Richard’s heat shock the paramedics could not conduct his treatment as Richard refused it. Later, the same paramedics took charge of Richard’s treatment and legally admitted him to the hospital without his consent. It is so because the principle of informed consent states that during an emergency situation, when a person is not able to consent and the situation requires immediate treatment, it is not required to obtain  informed consent in such situations. Both these incidents attract the principles of informed consent under the principle of autonomy (Hess et al., 2015).
On the other hand, the principle of beneficence applies in the given case as there was a clash between the opinions of Meryl and Lucas,and the medical practitioners regarding Richard’s treatment. It is the principle of beneficence under which the differences in opinion will get resolved and the medical practitioners will be able to act in accordance with the best treatment process for Richard ( Fisher, 2016).
The stakeholders in the given scenario are Meryl, Lucas and the medical practitioners. The ethical values of all three differ.Lucas, on the one hand, does not want his friend, Richard,to go through unnecessary pain and suffering, as he had once asked Lucas to turn life-support machines off if he ever suffered from any incurable disease or disability. The life-support machines keeping Richard alive were not improving Richard’s health.  Therefore, Lucas wanted Richard to be relieved of this unnecessary pain and suffering and have the life support-machines turned off, so that Richard could die peacefully. The opinion of the medical practitioners is that the life-support machines were not improving Richard’s health and were causing nothing but unnecessary pain and suffering to Richard.On the other hand, Meryl believes that Richard will get cured someday, as cures have happened in similar cases. In this situation, there will be conflict between the values of Meryl and the medical practitioners and the principles of autonomy and the principle of beneficence. The principle of autonomy will collide with the values of the medical practitioner because Richard’s or his representative’s consent is required for stopping the life-support measures. Lucas’s opinion or values won’t collide as he has no legal authority, being just a friend of Richard.The principle of beneficence will collide with the values of Meryl because according to the principle, the medical practitionershave an option to take such steps that are beneficial for the patient(Beauchamp, 2016). According to the medical staff, they also believed that further treatment will not be of any use for Richard and as there was a clash of opinion between the medical practitioners and Meryl, they can refer the case to the QCAT and the QCAT’s decision will prevail in this case. 
According to Kerridge’s et al (2013) modified model for solving ethical issues, there is no particular solution to the ethical issues or problems that arise in the medical field. Kerridge’s modified model for solving ethical issues can be called ‘ethical parameters’, which are required to be maintained by all medical practitioners, during any medical or nursing practices. The model suggests that, “this void needs to be filled with a conceptual understanding in accordance with the nature of the situationwhich is difficult to deal with and where there are two or more alternatives which are equally undesirable” (Degeling, 2015).
However, according to this modified model of Kerridge, along with the Australian courts, the focus must be on the patient. One way to solve the conflict between ethical values and other contradicting principles is to put the focus on the want and well-being of the patient. In this case, as there is a conflict between the principles of law and ethical values, focus should be on the patient. Lucas mentioned that Richard had asked him to end his life, if he ever suffers from an incurable medical condition. By saying so, Richard meant that he wanted Lucas not to prolong his life unnecessarily by any medical means, if he suffers from an incurable disease or incurable disability.In this case the choice that is better for the patient must be the area of importance, rather than remaining in a dilemma due to the conflicting values of the medical practitioners and Meryl.Kerridge’s et al. (2013) modified version states that medical advancement and ethics vary from country to country and hospital to hospital. It is very difficult to find the same clinical ethics everywhere. The type of practitioner and the technologies pertaining to medical science also differ in different places. In complicated medical cases where the values and the medical ethics collide, it can only be solved when the medical practitioners use the help of better medical practitioners and advanced technologies to determine the condition of the patient and to find out the suitable treatment for the patient. As stated earlier, the want of the patient is also to be considered. Therefore, according to the modified solutions for ethical problems in medicine, by Kerridge et al. (2013), as Richard’s health condition, even after treatment for a long period, was not improving and there is a clash between the values and decisions of the medical practitioners and Meryl regarding Richard’s treatment, the medical practitioners should first use the most advanced method to determine what is the best option regarding Richard’s health and then give importance to what Richard wants. It is also mentioned in the case that Richard would rather choose death than suffering from such a disease. The medical practitioners believed that the best option is to stop Richard’s treatment. Hence, the medical practitioners should consult QCAT.
From the above discussion it is clear that the medical profession is driven by various legal and ethical principles which often collide and create legal and ethical issues. It discusses these principles of ethics and laws, in relation to medicine, in the lights of a given case. It includes the principles of autonomy and beneficence. It states the steps a medical practitioner should follow under different situations and the steps they should take at times of ethical dilemmas. In addition, the above discussion also mentions the powers of QCAT, which is the legal authority in Queensland in relation to such complicated medical cases. Finally, the essay concludes by focusing on the modified model, by Kerridge, for solving ethical problems, especially in the field of medicine.
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Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer International Publishing.
Bickenbach, J. (2012). Argumentation and informed consent in the doctor–patient relationship. Journal of Argumentation in context, 1(1), 5-18.
Degeling, C., Johnson, J., Kerridge, I., Wilson, A., Ward, M., Stewart, C., & Gilbert, G. (2015). Implementing a One Health approach to emerging infectious disease: reflections on the socio-political, ethical and legal dimensions. BMC Public Health, 15(1), 1307.
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