In The Matter Of Earle N. Spring Introduction End of life decision making can be an easy procedure. It can also become a hard decision that in some cases, ends up being up to a court of law to decide. In order for such choice to be a smooth process, understanding of appropriate considerations and cooperation from each individual is needed. Ideally each individual, while competent, will have a plan in place that stipulates what they want done as far as medical treatment goes in the event they were no longer competent and a decision concerning their health needed to be made, a living will is a good example. When no action like mentioned above had been taken while an individual is capable, and a situation presents where a decision regarding end of life treatment needs to be made, there could be conflicts between families or guardians and the medical team (Spring. V. Hennessey, 1980) The situation can turn into an ethical problem; there are many protocols to be follow before making a final decision that will coincide with the family or guardians and other parties involve in the best patient’s interest. In the case of Earle N. Spring that came before a judge in nineteen seventy eight, end of life treatment or wishes had not been specified in any written form; consequently, a conflict arose between the family and medical team when it came to making a decision regarding Mr. Spring’s health (Spring. V. Hennessey, 1980) Plaintiff’s cause of action Mr. Spring became critically ill.
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Secondly, the patient should be capable of making and communicating health care decisions for him or herself. Thirdly, the patient must be diagnosed with a terminal illness that will lead to death within six months. Interested patients must also provide the request for termination in writing to the physician. In addition, physicians are expected to inform patients to alternative means of care including hospice care and other medications. Only after precautions evaluation, the laws then permit patients to make the ultimate life ending decision.
.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).
The law effectively covers situations in which a patient can personally consider the effects of terminated treatments, but does not provide for situations in which the patient is incompetent to inform agents of their desires. Conflict occurs when the court requires evidence for consent to end lifesaving medical treatment, which could be otherwise avoided should the Act be amended to accommodate the needs of the patient (for example, conversations held in passing being held as evidence). The Act should be amended to allow families to make the judgment rather than the patient themselves (such as in Re BWV, Ex Parte Gardner (2003) 7 VR 487, 491). Although it is possible to make decisions on a patient’s behalf, clarification by the Victorian state is needed. The legislation fails to make distinctions between the patient’s desires and what is in their best
The topic of end-of-life care may seem daunting and uncomfortable, and yet most individuals do have unique desires and concerns regarding their provision for the future. Providing the opportunity for that communication, the advance directive and POLST forms allow an individual to explicitly state their wishes before the future. Developed to lessen the apprehensions concerning patients undergoing any extensive and unwanted measures to preserve life at any cost, these medical directives lighten the decision-making burden for physicians and families alike and help comply with the patient’s utmost end-of-life wishes.
The importance of end of life issues and decisions are now being discussed at the time of admission to most acute care and long term acute care facilities. More attention is being placed on these specific decisions to ensure that the patient's
It is very important that each individual, if possible has a say in his or her own dying and death. Facing death is hard for everyone and there are specific issues to be talked about in advance. A living will or a Physician Order for Life-Sustaining Treatment (POLST) is extremely useful. The POLST is designed for people with serious or life-threatening illnesses. “This is a standardized form that describes a patient’s wishes and is signed by his or her physician, providing both summary of an individual’s advance directive decision and the physician’s order. It can be used to inform emergency personnel about a patient’s wishes for life sustaining procedures, such as CPR. “
This film explains the legal role of advance directives in end of life issues. An advance directive is “a written document directing how medical decisions are to be made in the future when the patient lacks decisional capacity and is unable to decide and choose” (Hanlon, End of Life Issues, Slide 28, Bullet 1). All three of the cases demonstrate the importance in filling out some form of directive. When there is nothing to go off of, it makes decisions extremely tough for families and medical providers. Having legal documentation of patient wishes helps understand what treatments they would or would not consent to. In cases like
There are some ethical dilemmas evident in this scenario, starting with an End of life dilemma, refusal of care and informed consent.“End of
They were the subjects of public disputes with family members, court systems, medical professionals, the media, and society at large. Terri Schiavo, Nancy Cruzan and Karen Ann Quinlan; their names are synonymous with permanent vegetative state (PVS). The amazing technological advancements in modern medicine has been credited with keeping persons alive who in times past would have died, therefore this is remarkable for countless families. In the cases of the Quinlan’s, the Cruzan’s and many like them, families members find it unbearable to witness loved ones who linger indefinitely in PVS with little or no chance for recovery. There are many like Terri Schiavo’s parents, who value the lives of their love ones no matter how limited their
Ethical dilemma may also arise in cases where a patient may feel their right to DNR should be carried out when giving direct order. The DNR process, however, is required to be documented by a physician. Andrew Putnam (2003) presents a case where an eighty-eight year old patient’s code status was DNR; “However, the patient has never signed formal advance directive statement or assigned durable power of attorney for her health care to anyone.” (Putnam, 2003, 2025) Ethics can be simply stated as doing the right thing (Roberts, 2002, 242); but in this case ethics is questioned because the physician was faced with the decision to carry out the wishes of the patient or to make a decision based on legality. In this case, it may have been morally right to carry out the wishes of the patient who wanted DNR orders carried out, but it may have been the right choice to do the legal thing and not carried out due to lack of signed documentation.
In end-of-life scenarios, where the patient may not be able to communicate their wishes, decisions must be made either by the healthcare professional(s) or family member(s). However, who gets to decide or where the line should be drawn are not always clear. Consequently, not all decisions may be ethically permissible. To illustrate, I will discuss a scenario in which physicians and family are not in agreement. Upon proving a brief summary and explaining the ethical dilemma, I will provide moral reasons for two ethically permissible choices from which, by referencing the principle of autonomy and Utilitarianism, will determine which course of action ought to be carried out.
With major advancement in medical treatments, it is now possible to keep a patient alive, which would not have been possible in former times. This has made end of life issue one of the most controversial issues in healthcare. Medical improvements have set the stage for ethical and legal controversies about not only the patient’s rights but also the family’s rights and the medical profession’s proper role. It is critical that any decision made in such situation is ethical and legal to preserve the rights of the patient and also protect the healthcare institution involved. It is very important when making decisions to discontinue treatments to make sure all other alternatives have been explored.
I agree having the conversation of that include decision with regards to advance directives and end of life decision are difficult. Many times these conversation begin when the patient is unable to make sounds decision and physician turn to the family to proceed with the medical intervention needed. Physicians should be required to have these conversations with yearly visits in the office. Patients may not full understand the content but can use this to begin a conversation with their own family. A physician should provide the patient with information and paperwork to begin the process if they wish to do so. As a health care worker, I discussed this with my own parent to become more informed as to her wishes.
Death and life threatening illnesses is not a subject that one likes to talk about. It is more complex, when the subject of wills and end of life desires arise. In this paper, I will be discussing ethical situations that arise when dealing with this specific problem.