medical ethical dilemma cases

First, patients who have capacity. Stevenson C. L. (1944): Ethics and Language: New Haven, Connecticut. There however remain some debate of what constitutes “common” or “serious”. Then, within the band of those who lack capacity, there are two further concepts of the patient: those who once had relevant capacity but are deemed now to lack it; and those whose values cannot be (satisfactorily) ascertained. The case did however establish in English common law that a doctor has a duty to provide patients with sufficient information for them to reach a balanced judgement. A question into whether or not the staff took time to change her bedding regularly when soiled. Physicians should not provide ineffective treatments to patients as these offer risk with no possibility of benefit. For treatment to be lawful it is requisite that: In the UK, our human rights are protected by law. They were not informed of possible side effects, i.e., rectal tearing and impotence. An ethical dilemma found in a case study. Was she offered the necessary alternative to be served in her room and encourage to eat or even be fed by the staff or were trays of food left and cleared up with food untouched? The emphasis was placed on pain and symptom management by promptly changing Dina’s care level to palliative care. Kant, Immanuel. Two days later, after discussions with the ICU staff and Dina’s brother, it was agreed that she is moved from the ICU, and the care level was changed to palliative care status. Disclaimer: This work has been submitted by a student. (1910-1987), Perception and identify, ed. But patients’ classification into competent and incompetent helps to establish their level of capacity. Click on each Case Study to view. One patient's tragic, and telling, story", "A referenced summary of the Dan Markingson case", "Doctors tread ethical minefield, 21 years on", Schloendorff v. Society of New York Hospital, Medical Experimentation on Black Americans,, Creative Commons Attribution-ShareAlike License, Psychosurgery (also called neurosurgery for, German medical doctors went on criminal trial for, The syphilis experiments in Guatemala were. What was your biggest ethical dilemma? Constructing the ‘Vulnerable Adult’ in English Law and Public Policy’ (2008) 28(2) LS 234. This is because the consequences of an action are often without our control and cannot be easily predicted. Medical laws on dental malpractice states that failure to tell a patient about a post-operative condition that calls for monitoring is negligence and fraudulent concealment. He also notes a reference to a complete listing: Edmund Pincoffs, Quandaries and virtues, University Press of Kansas, 1986. This is one example of a difficult situation … Words: 632. In nursing ethics there are many theories and moral principles that help with ethical decision making such as the theories of deontology and utilitarianism as well as the four fundamental principles, also referred to as principlism. On the contrary, one could argue that an appeal to justice would compel cessation of further intervention so that expensive resources would not be used on Dina who was later seen to be benefiting less from the treatment. The doctor can still be found to be negligent if common practice is thought to be unreasonable by the court. Capacity, as is widely observed, is decision-specific, and invites examination of a patient’s practical reasoning. A mother euthanizes her adult sons to relieve their suffering from. GMC. Case and Commentary Nov 2020 How Should Risk Managers Respond to Cases for Which No Risk Profile Exists? Dina) can be grouped with the latter two. The principle of beneficence is often seen as the overriding duty in healthcare. An example of this was the Winterbourne Inquiry which led to series of investigations into the failings of the care system. The above questions are answered by previous cases considered to be landmarks in the medical and legal community. The parents of a child born with horrible birth defects request the right to refuse treatment and keep the child off life support. Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of A sister is charged with euthanizing her brother after he has medical problems. The amount of information provided is at the discretion of the doctor, as demonstrated by Sidaway v. the Board of Governors of Bethlhem Royal Hospital (1984). A 20-year-old, pregnant, Black Hispanic female presented to the Emergency Department (ED) in critical condition following a single-vehicle car accident. As such, at any given time (depending on the circumstances under issue), section 4(6) of the Mental capacity law presents three sorts of patients. VAT Registration No: 842417633. As in the case of Dina whose request to be allowed a cigarette was continuously ignored because she was attached to IV Fluids. An example of possible breaches of this Article in my scenario can be linked to allegations of abuse. He should also have taken the time to examine the patient in order to diagnose her correctly. 1785. Deontologists like Kant believe that the moral worth of an action has nothing to do with any consequences that the act might have. I will never forget my biggest ethical dilemma. The conflict is between the duty of the medical team to respect the instructions of the patient’s next of kin, who have explicitly given consent to firstly medical intervention and (perhaps) a duty owed to Dina to pay attention to her wishes. It is for this reason that the adjective ‘informed’ has been used to clarify its meaning. Mr Leslie Burke v GMC [2005], Case Analysis using the Mental Capacity Act (MCA), 2005. Prison officials question whether to force-feed inmates who are on hunger strike. Jeff McMahan, The Ethics of Killing–Problems at the Margins of Life (OUP 2002). They create a mechanism within which issues of moral uncertainty may be questioned and resolved (P. Jones, Human Rights, Macmillan 1994). It is generally recognised that the more closer the relationship the more likely the law will impose a duty (French Penal Code Article 63). Richard Huxtable, ‘Autonomy, Best Interests and the Public Interest: Treatment, Non-treatment and the Values of Medical Law’ (2014) 22(4) Med LR 459. (Hasman, A., Mcintosh, E. and Hope, T. 2008), Jackson however has argued that doctors do not consciously apply rationing to decisions, in day to day practice; at the most ‘If a patient is suffering from symptoms which are very likely to be caused by a minor illness but there is a remote chance that there is something much more serious wrong with them the doctors will adopt a wait and see approach. Reasons such as religious beliefs, medical concerns are easily resolved by reason and need. Ngaire Naffine: Law’s Meaning of Life (Hart 2009), Nursing & Midwifery Council Code of Professional Conduct, 2006, P. Jones, Human Rights, Macmillan 1994: pg 237, Philip Bielby, ‘The Conflation of Competence and Capacity in English Medical Law: A Philosophical Critique’ (2005) 8(3) Med Health Care Philos 357, Principles of Morals and Legislation, 1789, Rawl J.: ‘A Theory of Justice’, (Belknap Press of Harvard University, 1971), Re Y (Mental Patient: Bone Marrow Donation) [1997] 2 WLR 556. Mental Capacity Act 2005: post-legislative scrutiny (HL 2013-14, 139); United Nations Convention on the Rights of Persons with Disabilities. When a paternalistic stance is taken the principle of respect for autonomy comes into conflict with other ethical considerations like beneficence and non-maleficence. The ban on smoking in hospitals is not discrimination because it does not breach Article 8. Article 2: Right to Life – is an absolute right and states that public authorities have a reasonable duty to protect your life. This group can still present thornier conceptual, legal, and ethical problems. Home > Health & Medicine > Medical Ethics Dilemma. In its simplest terms, consent may be defined as giving permission: “… in current usage consent is defined as a voluntary compliance, or as a permission. It’s been noted lately that Dina has been spending more time in her room, communicating with very few words. For deontologists there will be certain actions that are always wrong and should never be carried out, such as lying or murder, and it is our duty to abstain from such actions whether they produce good consequences or not. Further into my assessment, I will be conceptually examining ‘adult patients’ in mental capacity law and the human rights law. A couple request the legal right to commit suicide together, although only the husband was ill. A man who suffered severe burns requests the right to die. The Act ‘gives further effect’ to rights and freedoms guaranteed under the European Convention. General Medical Council, Consent: Patients and Doctors Making Decisions Together (GMC 2008), General Medical Council (UK). A sister is charged with euthanizing her brother after he has medical problems. It is best conceived as being about respecting a patient’s determination of her interests by reference to her reflectively endorsed values, rather than non-substantive reverence for bare choice in itself. 1785), Kant also believes in the motive of duty which is merely a prudent one and not moral one. Experiments were designed to test the “safety and tolerance” of AIDS medications, some of which have potentially dangerous side effects. She exhibited signs and symptoms of internal … He spent his life outlining the implications of Utilitarianism for a variety of social and political institutions. Health care provision is increasingly becoming complicated. In simple terms, there is generally no liability for failing to act, however there are six exceptions and if a person fails to act then they will be committing a criminal law offence. This paper presents a clinical case study, identifies the ethical-legal dilemma, and discusses the ethical and legal principle that applies in this case. In a nut shell, the more people we can make happy the better. Jeremy Bentham famously stated, ‘… nature has placed mankind under the governance of two sovereign masters, pain and pleasure’. He did not want his donation to generate commercial profit for private entities. A abstains from doing so in order that B may be drowned, A will have committed no offence (S Fitzjames, Digest of Criminal Law1887).This example clearly shows that there is no positive duty for B to act, even though B holding his hand out may have saved A’s life. Euthanasia violates codes of medical ethics which have existed since antiquity. A 40-year experiment conducted by the U.S. Public Health Service withheld standard medical advice and treatment from a poor minority population with an easily treatable disease. This contrasts sharply Utilitarianism’s view that any action could in principle be justified, however seemingly vile it is, provided it generated good consequences on that occasion. After retirement, Dina, who has never married and never had children, sold her home, and moved into a Nursing Home. doi: 10.1001/amajethics.2020.1004. For Kant, to deny that lying is wrong is the same as denying that 2+2=4. (M. Komrad 1988). … She is not allowed to leave the hospital grounds. Dina’s later life in the nursing home during which she was unable to get out of bed. The Milgram experiment on obedience to authority figures was a series of notable. Thesis for leadership essay writing a reflective essay at masters level: does music help you write essays essay on life during lockdown for students. Informed consent and involuntary sex reassignment in the case of an adult intersex woman. In addition, physicians must not do anything that would purposely harm patients without the action being balanced by proportional benefit. (Rumbold 2000) is often used by doctors as an argument against informed consent. Disney world essay topics aim in life essay for class 10. She appeared to be initially very happy at this home. Hale, B. MacIntyre, op cit, p 57. I will aim at analyzing the central claim that the mental capacity law has been devised with a commitment to achieving patient-centered care; care that honors where possible a patient’s own, reflectively endorsed values as well as whether or not that patient has decision-making capacity. There are many reasons as to why abortion poses an ethical dilemma for most women. Section III of the MCA goes on to consider patient values in relation to the concept of the medical decision, which requires to be understood by reference to the multiple ‘stakeholders’ involved in it: the patient herself (Dina), the authority responsible for resource allocation (the nursing home and hospital) as well as the person making the clinical determination (the doctors / hospital). (In reality, there is no quid pro quo: medicines not used on her would have no obvious intended recipient. Section 1(1) MCA stipulates that we should assume that adults have capacity, and the tests in sections 2 and 3 provide the means by which that assumption might be displaced. Below is a resource with multiple ethical case studies that involved patients, their families, and members of the interdisciplinary team. He did so in part by imputing specific values to the patient, holding that because Ms Y’s family could be said collectively to espouse the sort of values that would support a decision to donate, Ms Y herself could be said to do so. It must be noted that virtues exist to show one’s caring nature for the well-being of others and an unwillingness to cause harm. Therefore, if one is to judge morality by examining the nature of one’s actions rather than by the goals that those actions ultimately achieve, the outcome relative to medical professionals should be that they are praised or blamed only for those actions within their immediate control. In total, there are 16 rights set out in the Human Rights Act. But the progression of her condition has been relentless, and Dina has become more withdrawn. To break a moral rule is like committing some sort of logical error. However, as far as moral assessments go, they are irrelevant in calculating the moral worth of an act; only good intentions or motives matter. On other occasions, medical consultants who are in possession of all the facts may take the form of ‘the doctor who knows best’ view. There is always a dilemma in applying treatment decisions, in that, doctors often consider what course of action to take in order to promote a patient’s best interests. [35], Termination of mechanical ventilation and life support, Withholding life-prolonging medical treatment, "Tuskegee Study – Timeline". These he believed were the twin motivators and goals of all human action. He holds that actions are right in proportion as they tend to promote happiness: and wrong as they tend to produce the reverse of happiness. Laws are a familiar concept, and provide a basic social framework of right and wrong to which the majority adhere. The right of minors to request contraception from their doctor without parental consent. Airedale NHS Trust v Bland, CA 1992.142 NL.J 17, Ambrosino N. and Goldstein, R: Ventilatory Support for Chronic Respiratory Failure ed: illustrated & Published by Informa Healthcare 2008, (Application no.2346/02) (2002) 35 E.H.R.R 1 ). He also showed a positive attitude towards the whole medical process to benefit his sister. Her parents wish her to remain on life support. Sometimes they must also take positive steps to protect your rights when your life is in danger or you’re threatened by other people. Was there negligence in the hospital setting? (2007) The Human Rights Act and Mental Health Law: has it helped? Report of the Committee of Inquiry into Allegations of Ill – Treatment of Patients and other irregularities at the Ely Hospital, Cardiff", "Some Thoughts on Ethics of Research: After Reading Milgram's "Behavioral Study of Obedience", "Political Abuse of Psychiatry—An Historical Overview", The Stanford Prison Experiment – A Simulation Study of the Psychology of Imprisonment Conducted at Stanford University, "New look at antidepressant suicide risks from infamous trial", "Paxil Maker Held Liable in Murder/Suicide", Tobin v. SmithKline Verdict, June 6, 2001, Tobin v. SmithKline Judgment, June 6, 2001, "Jury Awards $6.4 Million in Killings Tied to Drug", GSK fined over vaccine trials; 14 babies reported dead, "The deadly corruption of clinical trials. The nursing home staff displayed serious sensitivity and warmth towards Dina’s withdrawal from living her normal life in the home she has spent her retirement years. by J. Bowring. (Kant, Immanuel. However, if his actions were not a generally accepted practice within the hospital setting then it would generate far more pain for society as a whole. Parents and doctors agreed to withhold life-prolonging measures of severely disabled newborn baby, including surgeries and medication, while Right to Life activists claimed the baby was murdered. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior). Dina has always been a chain smoker. Hasman, A., Mcintosh, E. and Hope, T. 2008: Journal of Medical Ethics. The Human Rights Act may be used by every person resident in the United Kingdom regardless of whether or not they are a British citizen or a foreign national, a child or an adult, a prisoner or a member of the public. Ethical theories may also be applied to all issues of uncertainty, including those not covered by laws or professional guidelines. Doctors at this hospital diagnosed African Americans with schizophrenia because of their civil rights ideas. As indicated, the MCA gives little help in adjudicating between the patient’s own inconsistent views. For Hume, the wrongness lies not in the object but in us. Instead Rule Utilitarian believe that we should stick to general rules of conduct such as ‘Don’t lie’ or ‘Always keep your promises’ because these rules in turn tend to produce good consequences overall.

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