2805NRS Case Study Essay

Aim:

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:

Introduction Legal Issues Ethical Issues Conclusion

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.

https://sites.google.com/a/griffith.edu.au/griffith-health-writing-and-referencing-guide/apa-referencing-guidelines
https://www.griffith.edu.au/students/exams-assessment/submitting-assignments
2805NRS Assignment Trimester 1, 2017

Case Study Scenario

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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. 2805NRS Case Study Essay

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. 2805NRS Case Study Essay

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

2805NRS Assignment Trimester 1, 2017

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. 2805NRS Case Study Essay

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

2805NRS Assignment Trimester 1, 2017

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.

2805NRS Assignment Trimester 1, 2017

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. Introduction 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.

Legal Issues 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?