The main goal is always to provide the best healthcare possible to a patient given the physical state they are in. There weren’t any expectations of miracles or extraordinary risk to bear but thankfulness to the doctor for doing his very best. Even if the result was death, the thoughts were that the doctor did all he could by making the patient better and for most, the goal was always to prevent demise.
Our time’s have changed so has the preponderance of this paternalistic belief regarding the decision made concerning a persons care. Has a deterioration of trust in the provider tighten the reigns of control and switched the power to the hands of the consumer? Whatever the underlying cause may be, there has been an enormous shift in legislation since the days of old where its modifications are now holding physicians to an elevated level of responsibility when it comes to the degree of communication anticipated by the modern patient.
This “general principle of law” that charges the physician with the obligation of divulging the risks linked to a recommended sequence of care will enable the patient to take consideration of their own welfare when choosing to undergo treatment, selecting a substitution or foregoing care and is known as Informed Consent (Dabbagh, 1999). To put it simply, informed consent allows the patient to be trained in the details of their condition, purpose of treatment, dangers and alternatives to come to a more knowledgeable resolution. There are four elements of informed consent that signify sufficient admonition: •Adequate disclosure of information. Patient’s comprehension of information. •Patient’s freedom of choice. •Patient’s capacity for decision making (Ascension Health, 2007). The following are also some elements that a plaintiff must make evident in a court of law to prove liability of informed consent. •Failure to adequately inform. •If adequately informed, patient would not consent. •Adverse consequences occurred. •Plaintiff suffered injuries. An evaluation of the case study involving Mrs. Sparza, as the circumstances apply to these four components of informed consent, will build a greater understanding and relevance for legal action.
Mrs. Sparza seemed to have every thing in order as she and her son reviewed and signed her admissions paperwork on the day of her surgery, but things started to unravel quickly as she was being prepared and taken into the operating room. A key piece of information to point out is that Mrs. Sparza had prepared legal documentation, known as the Durable Power of Attorney for Healthcare, designating her son and daughter as the medical decision makers if she became incapacitated. After receiving muscle relaxants prior to surgery, Mrs.
Sparza was presented with a Surgical consent form which she was not able to understand because she did not speak English, could not comprehend under the influence of medication and was altered from the original parameters of surgery by including both eyes. In these facts lie the perpetrations of the first element to adequately disclose this new information before her capacity for decision was greatly disrupted. The doctor’s efforts to bring in an interpreter did not change the fact that her brain functions were altered due to the effects of the muscle relaxant, therefore it would have been illegal to ask her to make a decision based on he binding Durable Power of Attorney for Healthcare. Benak and Applegate supports that Mrs. Sparza’s distorted mental state took away her legal authority to give consent and immediately transferred this liability to her son and daughter (Journal for Forensic Nursing, 2006). Her initial refusal of the procedure reveals that if she were adequately informed there is a possibility she would not have consented to surgery on both eyes consequently establishing one of the four elements against the physician for failure to obey the statutes of informed consent.
In the article Grandmother’s Plea, the author states that the provider could have consulted the hospitals ethics committee in determining the competency of a patient in making a decision for or against treatment if he was unsure (Salladay, 2000). Instead, it is believed that Dr. Pinnette coaxed Mrs. Sparza into making the decision to proceed with the surgery. After the operation was completed and Mrs. Sparza was in an inpatient status, she had a heart attack, lost the use of her kidneys and went into a coma.
The addition of these three adverse outcomes along with all the improper acts committed thus far, confirm the third element that could be central in convicting Dr. Pinnette of medical malpractice. In the introduction of the case study, Mrs. Sparza made a declaration that life support be terminated and no heroic efforts be taken in the event she succumbs to a coma. During the notification of the children, the physician was duty-bound to consult them as agents to Mrs. Sparza before placing her on dialysis.
In the Journal of Medical Ethics it is stated that medical treatment allowed without consent is unlawful and could cause the defendant to be prosecuted for battery or a civil action for damages (Ferguson, 1997). When Dr. Lox refused to terminate life support he willfully disobeyed Mrs. Sparza’s end of life wishes and the decision made by her agents which implicated him for legal pursuit as well. The nurse’s compliance with the family’s request for comfort medicine in the form of morphine is legal given the order is validated through the physician.
According to the position statement provided by the Hospice and Palliative Nurses Association, the rule of double effect as it pertains to comfort medicines states: •The act must be good or morally neutral regardless of its consequence. •The clinician must intend to relieve pain although death may be foreseen but not intended. •The view must not be that the patient needs to die to relieve pain. •The benefit of achieving pain relief outweighs the risk of hastening death (Ersek et al, 2003). Contrary to this rule, Mrs.
Esparza’s nurse administered the lethal dose to ease pain and expedite death which is a direct defiance of the purpose of comfort medicine and could cause him/her to be implicated in the suit. It is apparent in the large scale insolence of medical judgment that each guilty party connected was thoroughly unaware of their limits and the rights of the patient set forth by law. It is also probable that the physicians and nurse involved fully understood their roles but wished to disregard those boundaries which can result in the surrender of their practices and the degradation of their current lifestyles.
Nonetheless, it is certain that the penalty each person faces will never prevail over the basic human right to have a choice.
References: 1. Ascension Health (2007). Healthcare Ethics: Principles of Informed Consent. Retrieved on January 18, 2010 from http://www. ascensionhealth. org/ethics/public/key_principles/informed_consent. asp. 2. Benak, L. D. and Applegate, S. (2006). Informed Consent and Issues Surrounding Lack of Capacity vs. Incompetence. Journal of Forensic Nursing 2 (1), pg. 48. Retrieved on 17 Aug 2009, from Proquest. 3. Dabbagh, N. (1999). Informed Consent Case Study. Retrieved on January 18, 2010 from http://itdev. gmu. edu/projects/ollbook/GallBladderUn/history3. htm. 4. Ersek, M. et al (2003). Providing Opioids at the End of Life. Hospice and Palliative Nurses Association. Retrieved on January 18, 2010 from http://www. hpna. org/filemaintenance_view. aspx? ID=27. 5. Ferguson, P. (December 1997). Causing death or allowing to die? Developments in the law. Journal of Medical Ethics 23 (6), 368. Retrieved on 17 Aug 2009, from Proquest. 6. Salladay, S. A. (August 2000). Grandmother’s plea. Nursing 30 (8), 66. Retrieved on 17 Aug 2009, from Proquest.