A Mature 12-Year-Old Who Refuses A Heart Transplant Analysis

As stated in Joseph A. Carrese’s article “Refusal of Care: Patient’s Well-Being and Physicians’ Ethical Obligations,” introduces the fundamental principles and responsibilities that physicians have in order to preserve the welfare of their patients in any circumstances. On the other hand, Debbie Dempsey, author of “Refusing Treatment: Practical, Legal, and Ethical Issues,” strongly supports the patient’s right to make their own medical choices, whether it be to accept or decline any help. W.D Ross solidifies the dependent yet incompetent patient to not refuse care and treatment because the physician has a duty of fidelity, beneficence and a duty to

In the case of Jani McMath, her parents, family, the court, as well as the medical staff, are all faced with the ethical dilemma of whether or not to pull the plug. Who has her best interest in mind? How do we know? We would assume her family because they are the closest ones to her, but the truth is that McMath is incapable of making the decision for herself; therefore, whether her life is preserved or not is left in the hands of others. She could have wanted the plugged pulled; then again, she could have wanted her family to be strong and continue to fight for her life.

“An ethical dilemma exists when a choice has to be made in which the consequences may have a potential positive or negative outcome.”("Topic 4: Contemporary Ethical Dilemmas (How do managers evaluate beginning-of-life dilemmas?). ", n.d.) The given scenario presents a patient named Jamilah Shah, who is of Turkish descent, 90 years old and collapsed at the side of her bed in the extended care facility in which she resides. The patient suffers from Chronic Pulmonary disease and diabetes mellitus. The patient was rushed to the ER were the EKG and lab tests revealed she suffered a heart attack and she was started on anticoagulants. The patient has no advance directives and a communication barrier exists, the ER department contacts the emergency contact, one of the patient 's sons Bashir. The patient 's family arrives at the hospital and her son states that he makes the decisions and the wants a do not resuscitate order for his mother and no medical intervention other than comfort care. The social worker handling Jamilahs case is concerned by her family 's lack of support and that the family 's wishes are at odds with the patient 's request for help and her expressed desire to live. Furthermore if the patient does not receive a cardiac catheterization or is considered for a coronary bypass, she will surely die.

Firstly, by looking at the first patient, whether she gets a kidney from her father or a “cadaver kidney” , there will be no difference because she needs a kidney nonetheless. The second patient however, cannot agree to give his kidney away because one of the main reasons is that he’s scared and lacks “the courage to make this donation”9. So right at this point, it can be seen that it would be better if the father didn’t give his kidney away because it wouldn’t cause him any happiness, whereas the daughter has two options to gIn everyday life, whether on a personal base or on a professional base, difficult scenarios, or also known as moral dilemmas, are present. Depending on whom the person is or what their belief and value systems are,

They got her a stable heart rhythm, so she never had a chance to consent to anything. The patient is currently in a state incapacity. There is not preference found or submitted to the hospital stating the patient treatment preferences. The appropriate surrogate to make decisions for the patient is her three adult children. The patient’s kids have the right to make the decision because she doesn’t have a living will or appointed anyone to make medical decision for her. I understand each state has guidelines to follow in a situation like this on who to consult in a situation like this. Some states may follow the same hierarchy plans as Washington State which are included in this order legal guardian, individual with power of attorney for health care decisions, spouse, adult children (all in agreement), parents of patient, and adult sibling (all in agreement). The patient cannot state whether she is unwilling or unable to cooperate with treatment (Clarence H. Braddock III, MD, MPH, 1998).

In case one, Mrs. G. has the competency and capacity to refuse treatment, therefore the hospital is not legally required to provide care. “Informed consent is an ethical and legal concept that relates to medical decision-making. It’s a generally accepted duty of the care provider, and right of the patient, to obtain informed consent. It can be defined as the process by which the care provider seeks the affirmative allowance of the patient to provide healthcare after apprising the patient of the benefits and risks of the proposed treatment. In this way, the provider respects the autonomy of the patient and their right to determine what happens to them in accordance with their personal values, health beliefs and goals”( Ridley 2001).

Yes, the right of an adult patient in receiving or not receiving medical treatment under the legal and ethical standards requires the patient to provide informed consent. If the patient cannot provide informed consent, a legally authorized surrogate can make decision. The same legal and ethical standards apply for the terminally ill adult patient in the case of withdrawal of life-sustaining treatments. In other ways, medical ethics does not involve the life of patient to be preserved in all circumstances at all costs.

As a doctor, to prepare myself to take on this case I would have to process a substantial amount of information and use my best judgment to conceive what the best plan of action regarding this case should be. Reviewing the four key principles in medical ethics: nonmaleficience, beneficence, respect for autonomy, and justice, would prove to be very helpful. After reviewing and consulting with my peers I would most likely conclude that the patient is the one receiving the service and is to be put first above all other factors contributing to the situation.

As an administrator I would need to take into consideration the patient’s autonomy, autonomy is recognizing an individual’s right to make his/her own decisions about what is best for them regarding their health care (Pozgar, 2012). The patient’s rights always should be considered before any decisions are made by any other family members. In this scenario it is clear that the patient is unable to make any decisions, the patient has suffered a serious brain damage, and although it is not complete brain death, we must determine how to proceed.

The best possible resolution for this case would be to, first, to identify what Andrea would want to do for her end of life care. When her condition was deteriorating but before the cardiac arrest, the parents, social workers, nurses, and the physician should assess Andrea’s pain and suffering, asking her to express what she thinks she would want in the end. Harrison et al. (1997) supports this argument, claiming, “Parents and physicians should not exclude children and adolescents from decision making without persuasive reasons.” “Physicians should ensure that good decisions are made on behalf of their child patients” (as in Boetzkes & Waluchow, 2000, p. 163). It was also argued that, children of primary-school age, like Andrea, can participate in medical decisions, indicating their

This Rights model, more specifically Ashley’s human rights is very present in the article. It could be argued that she doesn’t need or require the treatment to medically improve her life. The Equal and Human Rights Commission (2008) suggest that human rights are the freedoms that we are all entitled to as a result of our shared humanity. I understand that she is unable to speak and is unlikely to have the mental capacity to make that decision but does that automatically transfer that decision to her parents? The United Nations Convention on the Rights for a Child (1989) plays an important part of the Rights model for this text as I feel it both supports and opposes the parent’s actions. Article 23 concentrates on children’s disability by stating that ‘Children who have any kind of disability have the right to special care and support, as well as all the rights in the Convention, so that they can live full and independent lives.’ This could support Ashley’s parent’s’ motives. However, Article 3 states ‘The best interests of children must be the primary concern in making decisions that may affect them. All adults should do what is best for children. When adults make decisions, they should think about how their decisions will affect children.’ In this case are the parents doing what’s best for Ashley or themselves? This is a good example where the Rights model can get itself in a twist!

Today, teens face many struggles which include making decisions on, medical, social as well as academic matters. These are only a few decisions that teens need to face. Achieve3000’s article “New Heart, New Life” takes the reader on a journey of 16 year old Courtney Mescall who was faced with the important decision of whether or not to get a heart transplant. At first, Mescall refused the surgery thinking of her past medical history. After evaluating her options she finally agreed to have the medical procedure done. She tells readers how thankful she was that she did have the surgery done and how happy she is that she is alive and healthy. When looking at Mescall´s story one can easily see how she had help from her mother to guide her into

First, the relationship between a doctor and patient is a valuable asset in today’s medical environment. In this case, Merry didn’t understand that her diagnosis was worsening after refusing treatment, her autonomy was to have control of her own life decisions. As a result, Merry’s family chose to deny

Therefore, it is up to healthcare providers to be supportive of patient’s decisions and help them cope with whatever the outcome may be. According to the ANA Code of Ethics, “nurses establish relationships of trust and provide nursing services according to need setting aside any bias or prejudice” (http://nursingworld.org/DocumentVault/Ethics_1/Code-of-Ethics-for-Nurses.html). This means my role as a nurse is not to influence the individual’s decision, but to allow them to decide for themselves and respect their wishes. This quote from the Code of Ethics also supports the concepts of fidelity, autonomy, and beneficence. Fidelity is being loyal and supportive of our patients, while autonomy allows the patient to make their own decisions without fear of judgement from their nurse (http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf). Beneficence is what I believe to be of the utmost importance in ethical situations, because if my patients cannot believe that I will be their advocate and treat them with compassion, then they cannot trust me and no relationship can be

Michael H., a 68-year-old man, was admitted for exploratory surgery of his abdomen. He is frail, and his attending physician describes him as “emotionally labile.” Marcy R. is a social worker at BFL General Hospital, who is assigned to the unit that Michael H has been admitted. After Michael’s surgery, Marcy R. was approached by Michael H.’s daughter, Ellen B. in which Ellen has told Marcy that her father’s physician had just informed her that the lab report from the exploratory surgery shows that her father has terminal cancer. Ellen said that she and the family are in shock and they have decided that they not want the hospital staff to tell her father about the terminal nature of his cancer once he recovers from anesthesia. In this essay, I will discuss the ethical dilemma of “to tell Michael or not to tell him he has terminal cancer. He has the right to confidentiality by not withholding information from him when he has been diagnosed with terminal cancer, informed consent, and self-determination.