A 72 year old woman was admitted to the Neurological Intensive Care Unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up “living wills” with an attorney. She was diagnosed by her treating physician as being in a permanent unconscious condition.
The final project for this course is an analysis of the legal and or ethical issues involved in the below health care scenario. See questions to be answered at end of this factual scenario below. I have also provided, after the formatting requirements for the paper, two articles that will aid you in your analyzing the scenario and writing your paper.
The two articles to base the analysis of your paper are entitled:
Clinical Ethics Issues and Discussion and
A Framework for Thinking Ethically
This is the final paper for the class and must be double spaced and be approximately 4-5 pages in 12 point New Times Roman font. Include a cover page [not counted as a page] which should have student name and title of your paper. See more formatting requirements later in these paper instructions.
NOTE: For this paper it is unnecessary to do any research beyond the two articles I furnished with this assignment. Both are after the specific paper requirements. You may use all the articles in the class also. To do internet research would only be wasting your valuable time.
Case Scenario
A 72 year old woman was admitted to the Neurological Intensive Care Unit following a cerebral hemorrhage which left her with severe brain damage and ventilator dependent. One year before this event, the patient and her husband had drawn up “living wills” with an attorney. She was diagnosed by her treating physician as being in a permanent unconscious condition. The patient’s living will specified that the patient did not want ventilator support or other artificial life support in the event of a permanent unconscious condition or terminal condition.
The patient’s husband is her legal next of kin and the person with surrogate decision-making authority. When the living will was discussed with him, he insisted that the patient had not intended for the document to be used in a situation like the present one. Further discussion with him revealed that he understood that the patient would not be able to recover any meaningful brain function but he argued that the living will did not apply because her condition was not imminently terminal. He further indicated that he did not consider his wife to be in a permanent unconscious condition. The immediate family members (the couple’s adult children) disagreed with their father’s refusal to withdraw life support.
The treatment team allowed a week to pass to allow the husband more time to be supported in his grief and to appreciate the gravity of his wife’s situation. Nevertheless, at the end of this time, the husband was unwilling to authorize withdrawal of life support measures consistent with the patient’s wishes as expressed in her living will. End of scenario.
You paper should have 3 major sections. Each is numbered 1, 2 and 3. Questions to be discussed based on the facts above. You must weave into your discussion the relevant facts from above scenario to support your discussion in discussion areas 2 and 3 below. And for discussion area 3 you must weave into your discussion the ethics philosophy you pick for each issue from the article A Framework for Thinking Ethically. A penalty will be deducted if you fail to use appropriate headings in your paper.
1. Three Legal/Ethical Issues. Just list the three most important legal/ethics issues in this scenario that you will discuss. They must be three separate, different and distinct issues. Pay particular attention to the article I furnished with this assignment. No explanation needed, just state them 1, 2, 3.
2. Discussion of Three Legal/Ethical Issues. Discuss the three most important ethical/legal issues you listed above. Must use the relevant facts in the scenario to support your discussion of the legal/ethical issues.
Must use headings below. Headings will be:
Legal/Ethical Issue 1 [state the issue] then discussion
Legal/Ethical Issue 2 [state the issue] then discussion
Legal/Ethical Issue 3 [state the issue] then discussion
For each legal/ethical issue above discuss
a. Why each is a legal /ethical issue?
b. Discuss each issue in the context of the scenario facts and
c. Define the concepts you use
3. How I would Handle Each Issue. First, in this section and for each issue, as a health care provider, how would you handle each of the three issues discussed above and why? Must use the relevant facts in the scenario to support your positions. Secondly for each issue, using the article in these requirements, entitled “A Framework of Thinking Ethically” fully discuss the specific ethics philosophy that would epitomize your handling of each issue. Fully define the specific ethics philosophy used and weave the ethics philosophy into your discussion. See article below entitled A Framework for Thinking Ethically.
Must use headings below. Headings will be:
Handling of Legal/Ethical Issue #1 (followed by the discussion)
Handling of Legal/Ethical Issue #2 (followed by the discussion)
Handling of Legal/Ethical Issue #3 (followed by the discussion)
[A penalty will be deducted if you fail to use appropriate headings in your paper. ]
This is an independent paper and you are on the honor system not to discuss or consult with any students or other individuals about this paper. You may use the information we have discussed in the class, the articles in the class, and the two articles I have furnished below. Just so you know, all you need to read to analyze the questions for your paper are the two articles I have furnished with this assignment and information in the class.
All you need to read to analyze the questions for this paper are the two articles below entitled:
Clinical Ethics Issues and Discussion & A Framework for Thinking Ethically
The paper must be:
Late submission – No late assignment 4 papers will be accepted. Paper is due Saturday in the last week of class no later than 11:59pm EST..
Paper must be in narrative format not outline or bullets.
Double spaced and be 4-5 pages in 12 point New Times Roman font. [No deduction if paper exceeds a page or so. Thus 3 and half page paper will be penalized.]
Must cite to source of all your facts in the text of your paper in APA format.
You can cite directly to the original source. Here are the links to the sources where the University received copyright permissions for the materials:
Clinical Ethics and Law:http://depts.washington.edu/bioethx/topics/law.html
A Framework for Ethical Decision Making:https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/a-framework-for-ethical-decision-making/
Include a cover page [not counted as a page] which should have student name and title of your paper [Provide a short name for the legal responsibility the specific health care organization has for one type of patient right in a specific setting ]
A the end of the paper a list of references [not counted as a page]
Be prepared using word-processing software and saved with a .doc, .docx, or .rtf extension. No pdf.
Be uploaded to your Assignments Folder by 11:59 p.m. EST on the due date.
The paper is to be posted in Assignment #4 drop box.
Background articles to support the issues you will discuss in the paper.
Article One of Two
Clinical Ethics Issues and Discussion Article
Relationships: I. clinical ethics, law & risk management
Definitions and sources of authority
In the course of practicing medicine, a range of issues may arise that lead to consultation with a medical ethicist, a lawyer, and/or a risk manager. The following discussion will outline key distinctions between these roles.
Clinical ethics may be defined as: a discipline or methodology for considering the ethical implications of medical technologies, policies, and treatments, with special attention to determining what ought to be done (or not done) in the delivery of health care.
Law may be defined as: established and enforceable social rules for conduct or non-conduct; a violation of a legal standard may create criminal or civil liability.
Risk Management may be defined as: a method of reducing risk of liability through institutional policies/practices.
Many health care facilities have in-house or on-call trained ethicists to assist health care practitioners, caregivers and patients with difficult issues arising in medical care, and some facilities have formally constituted institutional ethics committees. In the hospital setting, this ethics consultation or review process dates back to at least 1992 with the formulation of accreditation requirements that mandated that hospitals establish a “mechanism” to consider clinical ethics issues.
Ethics has been described as beginning where the law ends. The moral conscience is a precursor to the development of legal rules for social order. Ethics and law thus share the goal of creating and maintaining social good and have a symbiotic relationship as expressed in this quote:
[C]onscience is the guardian in the individual of the rules which the community has evolved for its own preservation. William Somerset Maugham
The role of lawyers and risk managers are closely linked in many health care facilities. Indeed, in some hospitals, the administrator with the title of Risk Manager is an attorney with a clinical background. There are, however, important distinctions between law and risk management. Risk management is guided by legal parameters but has a broader institution-specific mission to reduce liability risks. It is not uncommon for a hospital policy to go beyond the minimum requirements set by a legal standard. When legal and risk management issues arise in the delivery of health care, ethics issues may also exist. Similarly, an issue originally identified as falling within the clinical ethics domain may also raise legal and risk management concerns.
To better understand the significant overlap among these disciplines in the health care setting, consider the sources of authority and expression for each.
Ethical norms may be derived from:
Law
Institutional policies/practices
Policies of professional organizations
Professional standards of care, fiduciary obligations
Note: If a health care facility is also a religious facility, it may adhere to religious tenets. In general, however, clinical ethics is predominantly a secular professional analytic approach to clinical issues and choices.
Law may be derived from:
Federal and state constitutions (fundamental laws of a nation or state establishing the role of government in relation to the governed)
Federal and state statutes (laws written or enacted by elected officials in legislative bodies, and in some states, such as Washington and California, laws created by a majority of voters through an initiative process)
Federal and state regulations (written by government agencies as permitted by statutory delegation, having the force and effect of law consistent with the enabling legislation)
Federal and state case law (written published opinions of appellate-level courts regarding decisions in individual lawsuits)
City or town ordinances, when relevant
Risk Management may be derived from law, professional standards and individual institution’s mission and public relations strategies and is expressed through institutional policies and practices.
Conceptual Models
Another way to consider the relationship among the three disciplines is through conceptual models:
Linear
Distinctions
Interconnectedness
Orientation to law for non-lawyers
Potential legal actions against health care providers
There are two primary types of potential civil actions against health care providers for injuries resulting from health care: (1) lack of informed consent, and (2) violation of the standard of care. Medical treatment and malpractice laws are specific to each state.
