Essay on "Ethical Decision 'Not to Resuscitate"

Essay 8 pages (2702 words) Sources: 10

[EXCERPT] . . . .

It should be remembered that there is not a single kind of consent but many. Therefore, the doctors must see what sort of consent is applicable in a specific situation and then act accordingly (J., 2005).

First of all, the doctors and nurses should remember that the consent should always be in form of a typed paper. However, most of the times because of common practice and to save time many consultants just the verbal consent. Either way, consent should be proper and the doctor must only proceed if the patient agrees (Nandimath, 2009).

The kind of consent that the doctors are required to take from the patient in most of the cases is the informed consent. In this type of consent, the doctors tell the patient everything about the procedure or examination that they are about to perform on the patient (Zafar et. al, 2011). The doctors are required to tell the patient what he will be doing as a part of the treatment and the procedure that he is about to perform. The doctor is required to tell the patient why he or she is doing what he or she is doing and what are the possible outcomes of the examination or the procedure. Moreover, the doctors also have to tell the patient about the potential complications of the procedure that the doctor will be performing on the patient. If the patient agrees to whatever the doctors have told him or her, only then the doctor should proceed with the treatment. Same is the case with CPR or NRT. The patient should be told why there might arise a need where the doctors would have to perform a CPR on the patient. Moreover, the doctors also need to tell the patient why they would make a decision of NRT.

Then the second kind of co

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nsent is the blanket consent. This is the kind of consent in which the doctors tell some part of the procedure to the patient and withholds some of the information in good will. This is mostly done in the cases where the patient is not agreeing to a specific procedure but the doctors think that it is necessary to perform it on them, for example if the life of the patient is at risk (O'Neill, 2003).

Another kind of consent that would be talked about in this paper is the implied consent. This means that when a person walks in the emergency of a clinic or a hospital, he has come there because of some serious problem which he wants to get treated. In this case, the doctor is allowed to start the treatment without taking consent of the patient since it is implied. However, when a life changing decision has to be made about the patient while he is being treated in the emergency then it is important for the doctors to take consent from the patient.

Apart from the types of consent that have been mentioned above, there are many other sorts of consent that have been mentioned in the Laws of Clinical Practice and the doctors should always refer to the code of conduct that has been devised for them. It should be remembered that if the patient has given consent then the burden of negligence lies with the patient (in case any negligence takes place during any procedure that has adverse effects on the health of the patient). This implies that in case of any negligence, the patient will have to prove that negligence on the part of the doctor took place. This is only possible when the doctor had taken consent from the patient. On the other hand, if the doctors do not take consent from the patient then the burden of proof lies with the doctor. This means that the doctor will have to prove that he was not negligent while performing the procedure.

The doctors should take consent from the family of the patient if the patient is not in the state to give consent him or herself. In any case, however, the doctors are required to take consent from the patient or the family (Miler and Wertheimer, 2009). In this case, Mrs. Lily was not told that a decision for an NTR was taken for her. The consent for this decision was not taken from her family either. Therefore, this clearly means that the code of conduct was violated by the doctors.

Use of Health Resources

The use of health resources that are involved with a decision of NTR are only those of the stay at the hospital. It should be noted that most of the people about whom the patient, family or the consultant has to take an NTR decision are admitted to the ICU. The amount of health resources that are spent in the ICU are more than in any ward or department of the hospital. Therefore, the patient and the family should be informed about the charges and use of health resources regarding NTR as a part of the informed consent taken from the patient and/or the family.

Conclusion

Basically, from this case one has many lessons to learn pertaining to the medical practice or as a professional nurse. It should always be remembered that when the patient is in the state of giving the consent, the consent should always be taken by the patient (Salinset, al, 2010). The whole procedure should be explained to the patient and in the end the wishes of the patient should be honored. In this case Mrs. Lily had absolutely no idea why a decision for NTR was added to her medical notes. Even if the doctors think that it is for her own good, she should have been told about it from before.

The next main thing that we can infer from this paper is that making a decision for NTR is not an easy one. The doctors should involve the patient and the family of the patient before taking any such decision for the patient.

Bibliography:

Miller, Franklin and Wertheimer, Alan (2009). "The Ethics of Consent: Theory and Practice." Oxford Scholarship Online, Print.

Nandimath, Omaprakash V. (2009). Consent and medical treatment: The legal paradigm in India. Indian J. Urol. 25(3): 343-347.

O' Neill, O (2003).Some limits of informed consent. J Med Ethics.

Salins, Naveen S.; Pai, Sachin G.; Vidyasagar, MS; Sobhana, Manikkath (2010).Ethics and Medico Legal Aspects of "Not for Resuscitation." Indian J. Palliat Care.

Soar, J.; Mancini, ME., Bhanji, F., Billi, JE., Dennett, J., Finn, J., Ma MHM, Perkins, GD.,

Rodgers, DL., Hazinski, MF., Jacobs, I., Morley, P.T. (2010).Education, implementation, and teams: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010;81:e288e330.

Skene, L. (2008). Law and Medical Practice, Rights, duties, Claims and Defenses. 3rd edition, Australia, LexisNexus.

Tibballs, J. (2005). Legal liabilities for assistance and lack of assistance rendered by Good Samaritans, Volunteers and their organizations.Insurance Law Journal 2005.

Zafar, Shamsa; Malik, Rizwan H.; Sami, Ahmed N.; Avais, Ayesha R.; Avais, Ahsan and Malik, Fatima N. (2011). The Awareness of 'Informed Consent', Among Medical Students and the Current… READ MORE

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Quoted Instructions for "Ethical Decision 'Not to Resuscitate" Assignment:

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Task description Discuss relevant ethical and legal issues that pertain to the following scenario Please note, you are not being asked to take a particular viewpoint/position here, but rather to discuss key issues relevant to the scenario. This is not a discussion about pathophysiology, nor about euthanasia. Scenario background: Mrs Lily is a 63 year old female with a mixed presentation of emphysema and chronic bronchitis. She has marked shortness of breath and her abilities to carry out activities of daily living independently (for example, showering and cooking for herself) are becoming increasingly limited. The intervals between her hospital admissions are now much shorter. She requires home oxygen which she uses according to her level of exercise tolerance. Mrs Lily's family members are dismayed to find that on the last two hospital admissions, without discussion with Mrs Lily or her family, a Not for Resuscitation (NFR) order had been placed on her medical notes.

Using appropriate ethical principles from the four principles framework, discuss key issues relevant to the above scenario. You should consider:

1. professional communication and truth telling 2. the role of advance directives in health care 3. the requirements of consent 4.use of health resources

Presentation: Your arguments/discussion points should be logical and objective, and address relevant issues. To achieve this, avoid “I feel” or “I believe” statements. This is different to the journal. Write in the third person using formal academic writing.

Referencing: The CDU Harvard or in-text referencing system should be used as per the referencing guidelines on the CDU Library Website; peer reviewed journal articles are your best sources. Avoid non-refereed sources such as editorials, monthly columns or non-refereed journals. It is useful to include your set text (Kerridge, Lowe and Stewart) as a reference but otherwise keep the number of books to a minimum. Your reference list should contain a minimum of 8-10 quality references that are no older than 5-10 years. This does not include Wikipedia or dictionaries. Information gained from Internet sites varies greatly in depth and quality of content. Internet sites must be relevant and reputable, for example, the NHMRC website. Writing Write in the third person; avoid personal pronouns such as ‘I’ and ‘you’. Avoid long, confusing sentences and check that your tenses (past, present and future) are consistent within the same sentence. Avoid posing questions; work the information into the paragraph. Use plain English. It is essential your meaning is clear and that you demonstrate your understanding of the nature of the topic.

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