Justina Pelletier Case: Boston Children's Hospital

The case of Marci a 22-year-old female college student has several significant psychological, biological, social, and spiritual issues.

Middleboro Community Hospital is a non-profit hospital founded in 1890 with state licensure, The Joint Commission accreditation, and American College of Surgeons approval. Over 120+ year history, Middleboro has grown to be a respectable facility in the eyes of the medical community as well as its immediate population of patients in Middleboro. Still, Middleboro must continue to fight to remain relevant and up-to-date with the latest medical technology and changing patient demographics and needs. In order to this, Middleboro Community Hospital has set these three goals as part of their corporate strategy:

According to Beauchamp and Childress, the principle of autonomy asserts that a capable and competent individual is free to determine, and to act in accordance with, a self-chosen plan (Beauchamp and Childress as cited in Keating and Smith, 2010). Determining a patient's competence is critical in striking a proper balance between respecting the autonomy of patients who are capable of making informed decisions and protecting those who are not fully capable (Appelbaum, 2007). Tagging children incompetent solely on the basis of their age and not involving them in decision making regarding their health is violation of children's human right. Obtaining consent from parents, rather than children, negates one of the most important principles of medical ethics, which is patient autonomy. Nurses are obligated to promote the health of children by embracing children's right. Nurses' duties which stem out of respect for autonomy include both duties to ensure children's self determination is respected and to refrain from practices that interfere with the children's right of decision making (CARNA,

The following scenario explores the legal and ethical decisions involved with a pediatric patient. A six year old boy suffering from Sickle cell anemia is brought to the hospital with a crisis. During a sickle cell anemia crisis, red blood cells are damaged and they are unable to deliver oxygen to the body. The standard treatment is oxygen, hydration, blood replacements and exchange transfusion (Anita, 2006). The pediatric patient was admitted in critical condition and a blood transfusion is necessary. Parents stated they want to save their child and will accept any type of treatment except for blood products.

Although in most situations HIPAA takes precedence, the ruling falls in favor of the most protection of an individual’s rights. Three areas of comparisons are as follows: Both HIPPA and Montana law requires health care providers to release medical records to you within a ten day period after receiving your request. There are stipulations when it comes to mental health treatment. Mental health and psychotherapy are not governed in the same manner as medical treatment is under HIPPA. Therefore, states dictate how these particular records are handled. The Montana Codes allow for the release of medical records if seen by a psychiatrist but patients may not access records from treatment facilities for substance abuse. Lastly, HIPAA does not govern the release of records after death. Instead, they leave this up to the individual state to determine. Montana allows the release of records after death to the spouse, parent, adult children, adult siblings and lawyers.

whether the child is of sufficient age to independently consent to treatment. 2. How the release of information may impact the therapeutic treatment relationship. 3. Whether there are active concerns about abuse or neglect by the parent requesting the information. 4. Whether the child’s treatment was provided in individual sessions or conjointly with the custodial parent; and the purpose of the request. In the state of Florida, in most cases the non-custodial parent has the same right to visitation and shred custody as the custodial parent. The non-custodial parent has access to all the same information and documents pertaining to the child’s welfare. This happens unless the courts say otherwise. The ethical issues addressed in this case are the fathers trust that the medical records would not be released. The worker would be going against the fathers wish, but if they didn’t give the mother access to the records, they would be denying a worried mother the right to know about her child. Either way the worker could feel somewhat guilty (NASW,2006).

Under the US law, any kid under the age of 18 years old considered to be a child and need his parental consent form regarding any activity that involves the kid including a medical condition that is listed in this case (Byrne, Rapee & Sweller, 2017)So, parents have the right either to give or denies a consent. When parents faced with a medical procedure that they do not agree and believe in because of their religious background, they have a right to be present another treatment plan that doesn’t go against their beliefs (Byrne, Rapee & Sweller, 2017). From the case study above, it doesn’t say anything about an optional treatment plan being presented to the family, which might be a big problem that the doctor might be held accountable for. The other factors need to be seen is the doctor’s professional duty. Doctors have an ethical, professional,and constitutional duty to save life when they are faced with a situation that is called an emergency (Hashimoto, 2011) From the case study the kid was in a critical health situation because he has a meningitis. Meningitis is a medical emergency that is caused by an infection and can be a life-threatening situation ( Baldridge, 2013).Lastly, the kid has the legal right to be safe under his parents or any person who have a legal guardianship, however, if parents are putting kid’s life under a situation that might lead to fatality, it is called a child abuse. In this case, parents can lose the custody of the child and can not even able have any saying about the child

Canadian health care consent act, (1996) says that, there is no treatment without informed consent and it must be related to the proposed treatment, it must be given voluntarily and must not be obtained through misrepresentation or fraud. There is a different provision for a person who is deemed incapable to give consent. If a person is not competent to give consent, it may be given or refused on his/her behalf by a substitute decision maker. There is no specific age for children to give consent in Ontario but health care providers must assess the decision-making capacity of a child before proceeding with the treatment. There is exclusion too i.e. when informed consent is not mandatory. In an emergency situation informed consent could be withheld, where the person is experiencing severe suffering or he/she is at risk of life, if the treatment is not administered promptly and if there is no substitute decision maker to make decision on behalf of the patient. (HCCA,

The healthcare team will observe the legal statutes of the state of California when administering care to minor patients. Minor patients are any patients under the age of 18 at the time that services are rendered. In the state of California, minors of any age may consent to medical care related to pregnancy, contraception, abortion, emergency medical service, sexual assault and rape services (this office maintains that minors under 12 can not be expected to give consent to any sexual act* and the attending physician should notify the medical office manager immediately before the minor patient leaves) and skeletal X-ray to diagnose child for abuse or neglect (the physician doesn't need either the minor's or the parent's permission in this instance) without parental permission and the physician can not inform the parents without the minor's consent. Further, minors age 12 years and older may obtain outpatient mental health services, diagnosis and/or treatment for infectious, contagious communicable disease and sexually transmitted disease, HIV/AIDS testing and treatment, rape and alcohol and drug abuse treatment without parental/guardian consent. When

A toddler who is almost three years old died due to complications from cancer. Now, her mother wants justice as she claimed that the doctors failed to detect her daughter’s tumor despite visiting the northern nursing station at least 40 times.

On the same token, it’s recommended that adult children also have a living will, aka an advance care directive, which outlines a person’s wishes about life-extending medical treatment, as well as other intentions, such as organ donations. This document takes effect when the doctor declares that the patient lacks the capacity to make their own health care

According to Dictionary.com confidentiality is “the right of an individual to have personal, identifiable medical information kept private.” The definition for this term is widely known in health care, but when it is applied to adolescents many people do not understand the basics. Doctors are responsible for informing adolescent patients and their parents the privacy a minor is given according to federal and state laws, but in some cases doctors fail to do so. This results in the misunderstanding of minor’s privacy rights, which can lead to the adolescent patient not disclosing significant information, and the parents assuming they have the right to all of their child’s medical records. Because of this, it is important for adolescents and their parents to understand the nature of confidentiality in health care.

There are many legal and ethical situations that healthcare providers will be faced with when providing medical treatment to either a child or an elderly adult. While there is often much discussion regarding the elderly and do not resuscitate orders, there are often times when the decisions for health care of a child may be overlooked. Some of the legal issues that may be faced by healthcare professionals are informed consent, confidentiality, reproductive services and child abuse. Patients have the right to decide what is done to their own bodies, but for children under eighteen, their parents decide for them. A major issue faced by healthcare professionals is parental refusal for treatment. Healthcare providers will be faced with many conflicting ethical and legal situations regarding refusal of a minor’s healthcare and treatment. These issues

The popular belief among our society has always been “Parents know what's best”. While their kids are young, parents know how to make their medical decisions for them. Parents know what's best for their children, they know how to keep them safe and healthy. However, their children soon turn into teenagers who should be trusted to make their own choices regarding their health care. They’re no longer the children they once were; they can comprehend the extension of every decision they make. Services and treatments should not be restricted to them because of their age or need for parental consent. Teenagers should be given confidential health care and should be trusted to make the choices that regard themselves. They should be allowed the privacy from everyone, including their parents make those choices.

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