The End Of Life Decisions Law Medical Essay

Published Date: 02 Nov 2017

The medical and health care environment is one of the biggest areas where ethics are of great consequence. Unlike many other professions, those in health care face various ethical issues every day. Healthcare ethics involves making calculated and considerate decisions about treatment, while taking into account the patient's beliefs/wishes. Many laws have to be considered alongside a patients choices and the future risks should also be given some thought before going ahead with a particular decision.

Four principles

Four basic ethical principles exist that medical professionals should follow; Beneficence, Non-maleficence, Autonomy and Justice1. Beneficence is a doctor’s duty to do good where possible, alongside this, non-maleficence is a doctor’s duty to do no harm1. The third principle – patient autonomy or respect for autonomy is the duty to respect patient’s decisions1. This principle allows the individual to make responsible decisions about their own life without obstruction by medical professionals2. The final principle is known as "Justice"1 this refers to a duty to be as fair as possible to all parties concerned2. Although it is the duty to carry out all these principles, sometimes one principle can conflict with another. For example beneficence and autonomy tend to clash, such as when a patient refuses a treatment that a HP believes is in the patients best interests2. If the patient is mentally competent then the medical team has to abide by the patient’s wishes even if it leads to negative consequences1. A reason for a patient refusing treatment is due to their religion, such as a Jehovah’s Witness refusing blood transfusion. The principle of autonomy can be revoked in certain instances, under the Mental Health Act 20073. The purpose of the act is to ensure those with serious mental disorders that pose a risk to their own or the public’s health and safety, can be detained and their disorder treated irrespective of consent, to prevent them from harming others or themselves4.

Confidentiality

Confidentiality plays a huge role within health care and its importance is always being highlighted. It refers to the promise not to share information inappropriately3. This code is fundamental to a strong patient – clinician relationship. Legally it provides the patient with the right to; be left alone, patient autonomy and to control their private information4. Only on very rare occasions can a clinician break the code of confidentiality. Within P3 an issue with confidentiality was raised, one of the patients had, had their licence revoked on medical grounds. As he was being assessed he informed the nurse carrying out the assessment that he was still driving. This information was provided in the assumption that it would be confidential. The nurse explained that although this man, continuing to drive, could be a risk to others, they still couldn’t inform police or his local council. Doing so would break the patient-clinician confidentiality. Yet, she did say there was a way around this issue, they could explain everything to the patient’s GP. The GP was allowed to inform the local council, which could then send on a letter of warning to the patient. As well as this, the nurse herself could also emphasise how important it is for the patient not to drive.

Consent

Two types of consent were encountered at placement, Informed consent and consent to share information. Informed consent involves the patient having all the information necessary to allow them to make an educated decision on treatment3. Sometimes this is not always possible, for example in the case of unconscious patients in which case family members may be asked to make the decision. If no family members are available, the procedure may be carried out anyway if it will save the patient’s life3. The only case where this will not happen is if the patient has requested a Do Not Resuscitate (DNR) form. This is a legal order written on a legal form to respect a patient’s wishes not to undergo CPR if their heart was to stop beating3. Doctors must respect this decision or they will face serious consequences. The latter type of consent is known as consent to share, this also relates to a patient’s confidentiality. This was encountered at P2, it involved the HP asking the patient who they would be happy to share the information E.g. If a family member rang P2, would the patient be happy to let the HP give out their information. In some circumstances, family members did not know about a patient’s mental health problems or the extent of them and patients wanted the information to stay confidential. However, due to the nature of mental health, some patient’s would be considered at risk to themselves or others. If a patient did not turn up to appointment and could not be contacted, the HP at P2 was allowed to break the confidentiality agreement. They were permitted to contact family and friends to enquire after their wellbeing and to find an alternative method of contact with the patient.

End of life decisions

Traditionally health care and medicine has been about doing everything in ones power to keep patients alive. In today’s society this attitude is being continually questioned and debated. End of life decisions are becoming publicly recognised, and often reported in the media. Frequently the term used to justify these decisions is "Quality of Life"5. Euthanasia is an immensely debated topic within end of life decisions, it is debated whether or not it should be legal in the UK. There are many different "forms" of euthanasia and not all of them are illegal. Active euthanasia (AE) and assisted suicide (AS) are probably the best known forms. AE involves directly and deliberately causing the patient’s death and AS is providing help to those unable to carry out their own death, possibly by providing them with drugs5. Even if patients request these or help with them, doctors legally are not allowed to carry out the wishes in the UK6. Euthanasia is only legal in the three Benelux countries and assisted suicide is legal in Switzerland and the US state of Washington3. Those that wish to carry out assisted suicide can travel to Switzerland to a group known as Dignitas that will provide assisted suicide. A legal alternative within the UK is known as passive euthanasia, this involves the withdrawal or withholding of treatments, similar to DNR, that are keeping a patient alive7. Many see this as a morally unsatisfactory distinction, as the person withdrawing or withholding treatment is still aware the patient will die. Traditionally passive euthanasia is thought of as "less bad", yet some see it as morally worse as active euthanasia can be quicker, cleaner and less painful7. Another argument could be that there is no difference between the two, if a patient comes into hospital having been stabbed and the only available doctor does nothing, technically he did not kill the patient but merely "allowed him to die"6. In this case the doctor’s excuse would not be accepted by most people thus many argue why should passive euthanasia be acceptable?

Abortion

Abortion is largely accepted and legal within the UK, excluding Northern Ireland, reasons for abortion aren’t always to do with the health of the foetus. Usually the foetus’ "right to life" is powerfully opinionated and there are a wide variety of opinions. Often the principles of beneficence and non-maleficence come into play in these situations. Many see abortion as the termination of possible life or actual life, this would breach the principle of non-maleficence8. That foetus also does not have control over their own lives, is this then a breach of respect for autonomy to take its life?9 Usually the only completely accepted justification for abortion is if the birth of the baby would result in the death of the mother8. In that situation the mother is the doctor’s patient and they must do what they can to save her life.

Medical research

Genetics and research within medicine tend to divide opinions on what is ethical and morally correct. "The New Genetics" is surrounded by social and ethical implications, for example, Three-person IVF. This type of procedure can allow children to be born without the risk of inheriting mitochondrial disorders. As of yet this procedure is not legal4. Certain groups see this and genetic testing as going against what God would want and find it unnatural – "designer babies"4. Technically that child will have three parents, it is impossible to guess how that foetus will eventually feel about this and how they were created. Genetic testing can also be seen as a type of discrimination against groups like the disabled4.

Conclusion

Ethical, social and moral disputes are encountered regularly within health care, usually there is no perfect answers for those situations. Regardless of the decision made, there will still be those who disagree with the choice and unfortunately this is impossible to avoid. Yet, the correct education, and a full understanding of the repercussions of ones decisions, will assist with the ability to carry out the right option.