Group R Ethics Legal Debrief
Hey All.
I will post under comments what Jackie emailed me, as promised.
If anyone wants the word file, just drop me a line.
For non group R people, our theme 4 tutor wanted to give us these... could be fun.
much love,
Tim
I will post under comments what Jackie emailed me, as promised.
If anyone wants the word file, just drop me a line.
For non group R people, our theme 4 tutor wanted to give us these... could be fun.
much love,
Tim
posted by timfazio at
11:03 pm
1 Comments:
Ethics Debrief – from shorthand notes taken during presentation by visiting Ethics Tutor. It has been taken and typed verbatim – the odd word may be missing but mostly it makes sense! I haven’t edited the grammar in any way. What you get here is what the ethics tutor said. Hope it helps – Jacquie Wise
Case 1:
A man aged +/- 55 years – smoking pot every two to three months.
In hospital with heart condition for the first time since six years ago. He wanted to be released – hated being in hospital. Drs didn’t want to let him go – they thought he wanted out to smoke. Were the doctors prejudiced?
Duty of care: their personal beliefs about someone’s addictions should not enter into it.
However, if the patient is going out to support their addiction, should it be under the patient’s control, so are they minimising their own right to patient care?
Some people think they have no control, so it is looked at as a health issue. If you are taking something, it diminishes your ability to make good decisions. Addiction is still a health issue. It should not be looked at as a patient control issue.
In this case, patient was honest and open about it, so it’s a minimal habit. It would not be affecting his decision-making. The doctor was not letting him go – one thing influencing doctors is how often he goes in and out of hospital and leaving before his care is fulfilled. So the question is, if they have looked at that as part of his history, they may be keeping him in to protect him.
It’s an issue of patient autonomy, and when the patient has the right to refuse treatment and the right to leave the hospital.
If they try to stop him it’s a breach on his autonomy only. If there’s a severe risk to his health, does it override the ethical issue?
Guideline: they can’t force him to stay. If it’s a severe risk to his health if the patient leaves, the doctors may find a way to keep him eg sedative, otherwise it’s a legal issue of assault.
Case 2:
Patient has lung cancer – lost 25% lung capacity. Came in with rebound of cancer, still drinking and smoking.
When resources are finite, do you give him as much treatment as another person who is trying to get well?
Do you view smoking as part of their responsibility or do you see it as an addiction and an illness in itself? Did he try to give up and not been able to do so?
Issue: addiction versus finite resources.
If there are limited bed spaces do you overlook this guy and give the bed to someone “more deserving”?
Answer: You try to do what you can. If two people come in at the same time you may give priority to someone else but MORALLY, EACH INDIVIDUAL HAS AN EQUAL RIGHT TO TREATMENT. – Right to equal health care, no matter what they be doing to jeopardise themselves.
Q: If someone is doing something illegal do you have the responsibility to report it?
A: Depends: no legal requirements if they are putting themselves at risk. (It’s their right to personal autonomy.) BUT if they are putting someone else at risk, or if there is a severe risk to themselves, then their right to personal autonomy is overridden.
Case 3:
Pt with cognitive dementia = decision-making skills are impaired – in that case the pt has diminished autonomy because of his condition.
Right of decision making is passed on to the guardians. If there is no one, then VCAT is given guardianship over the person. (Victorian Civil Administrative Tribunal).
If treatment is urgent, then there is justification for the Dr to step in and override autonomy. Depends how high the risk is. Justifications have to relate to issues of self harm or harm to others.
Case 4:
If a minor disagrees with what the parents want to do – eg 15 year old wanting to keep a child but the parents want termination.
Mature minor: You defer to them. If minor is not aware of what is going on, then you sit and explain and convince. Not what they should be doing but what is involved. Morally you have a requirement to uphold autonomy of the person but you need to defer to the parents.
Ensure the person has good follow-up counselling.
Rights of the minor are the responsibility of the guardians.
Find the least problematic compromise possible.
Case 5:
Informed consent issues – woman – breast surgery – two options. She chose the first option, surgeon defended second option.
If it was clearly stated the Dr should have gone through the procedure she asked for; it was the Dr’s mistake. He coerced her into consenting to his choice.
If the pt changed her mind, then you can see sh’e still entitled to change but she may have to wait. Morally she has the right to the procedure she wants. If she has to wait six weeks and there is the risk of the cancer spreading then maybe she has to give in but it should be explained properly.
Case 6:
Pt requests transfer from private to public hospital. The records should be transferred. The hospital refused to transfer the records for privacy issues. But this is not valid, because it could compromise the pat’s care. Pt could have insisted to go to a different hospital. Dr has to justify why he wants to keep her there. Another issue of informed consent.
Case 7: Confidentiality issues
Aids Pt going to surgery – GP knows about AIDS but surgeon didn’t know. Should the GP tell the surgeon without the patient’s consent? Surgeon doesn’t have a right to know because they will be protected anyway.
Risk to the surgeon is minimal due to proper procedures, so it’s not enough of a risk to warrant breach of confidentiality.
GP could try to convince pt to tell the surgeon, explain benefits and harms, but it’s still up to the pt.
If it’s highly transmittable high mortality risk to the surgeon eg SARS, or MARBERG (related to eboli) then you could claim that the risk to third party is higher and it overrides confidentiality.
If a surgical team member cuts their hand and has been exposed to high risk, or if they are putting people at risk through sex, then you can breach confidentiality, you could try to give a de-identified warning.
Case 8: Valid justification issues:
HIV pt not taking meds to save his life – what can the Dr do? Can he tell his partner? Legally if they are having unprotected sex or sharing needles then they are putting others at high risk. There may be a legal requirement to tell the partner.
Re keeping pt alive and no risk to the partner, then you can’t do anything.
Conflict of interest: eg when pt care is jeopardised because the Dr has ulterior motives or Dr puts pt on a med because they get kickbacks from the druug company, not because it’s the best drug for the pt. If it is detrimental to the pt care then it’s conflict of interest.
Negligence issue:
Brace broke – is it negligence?
If something is wrong with the manufacture you can claim against the manufacturer. If the Dr put it on incorrectly then it’s negligence. If the pt was not properly instructed it’s negligence against the Dr or the technician. Find someone who has responsibility to pt – to make it properly, the instruct her properly, to put it on properly if permanent. If Dr knows he’s done the wrong thing then the Dr should express apologies and fix the problem at no expense to the pt; then she may not sue.
Vexatious litigant: trying to be annoying – they can be banned from the court.
While people may shoot off letters of demand, they may not follow through with proceedings.
Court proceedings need to satisfy two things:
1) fix at no cost
2) ensuring the same mistake is not made again so no one else will suffer
Capacity to give consent:
Depression can be considered as diminished capacity.
How do you work out capacity eg 3-year dementia?
Six steps to assessing capacity – there’s also a video available ask legal professor
Establish whether they have the ability to understand information, the benefits, downsides, possible complications.
If they have the ability to comprehend, assimilate and communicate their decision to you, and they are over 18 years, we assume they have the capacity.
Capacity for someone to make decisions isn’t necessarily static: they can make good decisions in one area and not in another, or one day yes and one day no.
Legal standing:
1) we assume they do have the capacity
2) trigger – we assess their capacity
3) we find someone else to make the decision on their behalf, maybe the Guardianship Board. Maybe Enduring Powers of Medical Attorney.
Dr must make sure they see a copy of the document or a family member can volunteer and sign a form which goes to the Public Advocate.
Order:
First available and willing person on the following list:
- spouse
- parent
- adult child
- sibling
If there is a conflict of interest – eg child wants the will so wants to “kill” the parent – the Dr can pass on information to the Guardianship Board. If there is a doubt and they won’t be able to fulfil their Guardianship duties the Guardianship Board won’t allow it.
If the family members are arguing as to treatment, there could be a serious risk of someone suing for action or inaction, you call the Guardianship Board.
Rights to refusal
Dr’s or nurse’s right to conscientious objection – eg termination of pregnancy - sometimes clashes with duty of care to patients.
Eg pt comes in bleeding because of backyard abortion, duty of care supersedes conscientious objection.
Right to treatment:
A lion tamer was mauled by lions in a circus. Nurses refused because they didn’t believe in animals in cages. They refused to treat him at night. As long as the hospital finds someone else to cover them, it doesn’t matter that other nurses refuse. Pt can make a complaint to the Nurses Board.
It’s only when you can establish that there is a Dr/pt relationship does the pt have a right to expect treatment (or if they can’t go anywhere else/have nowhere else to go.)
Eg in world organizations – everyone has a right to medical care but if no one is there to provide it, then if someone is in your catchment area then you have a duty of care to treat them.
Sued in Battery: means when you touch someone without valid legal consent.
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timfazio, at 11:10 pm
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