Written assignment: Case Study Essay
Due Date: Monday 24 April 2017 @ 5 pm
In your future role as a health care professional you will be faced with complex and challenging situations. There will at times be a legal solution that can be applied to the situation. It is important that you are aware of what this might be so that you can confidently practice within these legal boundaries. Almost always there will be differing ethical positions that need to be considered. The purpose of this case study is to enable you to practice identifying a legal issue and possible outcomes, and consider why an ethical conflict arises.
The case study will assess all of the learning outcomes in 2805NRS. Instructions:
You are required to write an essay. In your essay you must identify and discuss the legal and ethical issues presented in the case study that follows. In your discussion you must address the questions posed at the end of the case study.
You are expected to submit your essay with appropriate grammar, spelling, sentences, paragraphs and references. It should be structured using the following ‘APA Level 2’ headings:
Formatting the Case Study: Please refer to the Health Group Writing & Referencing Guide that describes how your case study is to be formatted.
Submitting the Case Study: You must submit your case study via Turnitin by 5pm on Monday 24th April. It must include an assignment cover sheet.
Case Study Scenario
Edward is a 37 year-old-man and aspiring musician. He has been married to Genevieve for 8 years, and together they have two young children. Edward and Genevieve live three doors down from Edward’s mother, Una. This turned out to be quite a convenient arrangement because, after Edward’s father passed away, Una would regularly spend time at Edward and Genevieve’s house minding the children.
Edward was diagnosed with Type 1 diabetes when he was 14, and since that time he has managed to maintain relatively stable blood glucose levels with a combination of diet, regular insulin and routine blood glucose monitoring.
Edward had recently been unwell, complaining to Genevieve of a sore throat and fever. He was treating this symptomatically with regular paracetamol and warm honey and lemon drinks. This was a pretty unfortunate time for Edward to be unwell because he had recently been offered some work out of town that he hoped would kick start his musical career. Genevieve thought it best if Edward went to see a doctor before he set off for these performances. However, Edward was never keen on visiting the doctor and refused to go. Instead, he reassured her that it was just a viral infection, and that in a few days things would start to improve.
While Edward was out of town, his viral infection began to be get worse. He developed muscle aches, and the pain in his throat meant that he could not eat or drink – let alone perform on stage. When he did not turn up at the agreed time for his first performance, the venue manager tried to contact Edward by phone. Receiving no response, he went to the hotel where Edward was staying, discovering him unconscious in the bathroom. The ambulance was immediately called, and upon arrival the paramedics assessed Edward as being in a diabetic coma. Despite instigating the appropriate life-preserving treatment, Edward suffered a cardiopulmonary arrest en route to
hospital. Resuscitation was commenced and after several minutes, Edward’s spontaneous circulation returned. On arrival at the hospital, Edward was intubated and ventilated. After a short stay in the emergency department, Edward was transferred to the intensive care unit.
Unfortunately, after several days of treatment it became apparent that Edward had suffered a serious hypoxic brain injury. Subsequently, although he was successfully weaned from the artificial ventilation and able to breathe spontaneously, he needed to be fed through a percutaneous endoscopic gastrostomy (PEG) tube. He had an indwelling urinary catheter, and continued to receive regular subcutaneous insulin. Edward no longer moved spontaneously, although Una believed that he did make eye contact with her and blink appropriately in response to her questions.
Understandably, this was a devastating turn of events for Genevieve, both children and Una. Although they initially tried to remain optimistic about Edward’s potential for full recovery, as weeks turned into months, is became increasingly apparent that this would not happen. The healthcare team, caring for Edward formed the opinion that Edward was in a minimally conscious state. They believed that because of the extensive hypoxic brain injury Edward has no awareness of his surroundings, and no possibility of recovery.
Genevieve agreed with the assessment made by the healthcare team, believing that Edward displays no sign of recognition of her, or the children. She described Edward’s condition, saying that, ‘initially you could think that he was looking at you, but it was really like he was looking through you’. Genevieve was also very mindful of conversations that she and Edward previously had where he expressed views about what he would want to occur were he to ever experience such a catastrophe. Edward had made it very plain that he would not want to be left in a situation where he could not care for himself and would want Genevieve to ‘turn the bloody machines off’.
Una’s perception of Edward’s situation was not quite as grim. She had undertaken some research and found several cases where people had ‘woken up’ after being in comas for prolonged periods. Una did not agree that Edward had no awareness of his surroundings, and thought that from time to time he would track movements around the room – not always, but sometimes. She also knew that Edward would not want to remain in this minimally conscious state permanently, but was hopeful that given adequate time and support, Edward would once again be able to communicate with his family.
Genevieve and the healthcare team caring for Edward believed that continuing treatment was not in his best interests. They reached the conclusion that this treatment should stop. Una, however, is opposed to stopping treatment and wishes for Edward to be given every opportunity to recover; even if this means that he needs to remain highly dependent in hospital for many more months. Una wants to do whatever is necessary to ensure that the life-sustaining measures Edward is currently receiving continue.
Full Details of the Task
You are required to answer the following legal and ethical questions. Your case study is to be structured in essay style with the following headings.
A short introductory paragraph that outlines what you will be presenting in your case report.
You do not need to include a detailed account of the facts in the scenario; the markers are aware of the facts and this is an unnecessary use of words.
Using structured sentences and paragraphs, answer the following questions in relation to legal issues raised by the case.
1. As Edward had previously refused medical treatment for his viral infection, do the paramedics have any legal authority to institute treatment for his diabetic coma? What legal authority can you rely upon to support your answer?
2. What elements must be present for this consent to be valid? What legal authority can you rely upon to support your answer? What potential legal consequences may flow if healthcare practitioners provide treatment without first obtaining consent?
3. As Edward is unresponsive he will not have decision-making capacity. Provide a rationale that supports the legal obligation to obtain consent in these circumstances.
4. List the potential options available for the healthcare practitioners to obtain consent for Edward’s ongoing care in these circumstances. What legal authority can you rely upon to support your answer?
5. In circumstances where there are two or more substitute decisions-makers who could potentially provide consent, and they disagree, describe the legal options available to provide a definitive answer as to what course of action the healthcare practitioners should take.
6. What factors will be taken into account when making a decision as to whether Edward’s life-sustaining measures can be withdrawn?
Referring to the Universal Declaration on Bioethics and Human Rights, and using structured sentences and paragraphs:
1. Identify two principles that are relevant in this scenario and describe how the selected principles apply to the facts in the scenario.
2. Describe where a conflict between these principles may arise by considering the different values of each of the stakeholders in the scenario.
3. Apply the modified Kerridge et al. (2013) model for ethical problem solving to address the conflict.
A short concluding paragraph that brings it all together.
NB* you are not required to decide the outcome of this case – in relation to the legal issues this would be a role for the courts. In relation to the ethical issues, there will not be one “right” answer, it is the process that you are being asked to apply.
CRITERIA POSSIBLE MARK
Correctly identifies whether the paramedics have authority to treat Edward in light of his earlier refusal and provides correct legal authority to support the answer 5
Correctly describes the elements of a valid consent and the potential legal consequences may flow if healthcare practitioners provide treatment without first obtain consent. 5
Provides a rationale to support the legal requirement to obtain consent in circumstances where a patient lacks decision-making capacity. 5
Correctly lists that potential options available for the healthcare practitioners to obtain consent, and provides correct legal authority to support your answer. 10
Correctly describes the legal options that are available to provide a definitive answer as to what course of action the healthcare practitioners should take if there is disagreement between substitute decision makers. 5
Correctly describes the factors that will be taken into account when making a decision as to whether Edward’s life-sustaining measures can be withdrawn.
Using the Universal Declaration on Bioethics and Human Rights, accurately identifies two relevant principles and describes how the selected principles apply to the facts in scenario. 10
Accurately describes where a conflict between these principles may arise by considering the different values of each of the stakeholders in the scenario. 10
Appropriately applies the modified Kerridge et al. (2013) model for ethical problem solving to address the conflict. 20
PRESENTATION and STRUCTURE
The case study essay is appropriately structured with a succinct introduction and conclusion. Coherent organisation of ideas presented under appropriate headings and formatted according to the Health Group Assignment Presentation Formatting Guidelines.
Essay is well presented, with correct spelling, grammar, and wellconstructed sentence and paragraph structure.
Evidence of extensive reading and use of relevant materials (case law, legislation, academic journals and text books) to support key points and argument.
Correct in-text referencing and reference list consistent with the Health
Group Writing and Referencing guidelines (APA 6th Edition)
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