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Informed consent case study
Informed consent occurs when a healthcare provider explains the medical procedure or treatment plan to be followed, including the risks, benefits and alternatives. According to Lipshie-Williams (2017), this process enables a patient to inquire about specific treatment plan and decide whether to accept or reject it. From a critical analysis of Narcan’s case, it was evident that there was no informed consent for the patient’s medication. When the patient was presented at the facility with lower back pain, the physician explained that he would receive anesthesia the following day to numb his pain. At 8:15 AM the following day, the physicians explained to the patient the procedure followed. However, there was no formal written consent towards this aspect. The patient gave a verbal consent for the medication although there was no written disclosure form.
The patient’s permission warrants the determination of whether informed consent had been given for the MRI and the medications needed for sedation. From the case analysis, informed consent was not properly given to the patient for the MRI procedure. Although the patient had agreed to the initial MRI, the physicians failed to inform the patient of the process’s postponement. The patient only gave verbal consent related to the second dose of the same medication. As noted by Teo et al., (2017), the admissibility of an informed consent incorporates written agreement by the patient regarding the medical procedure to be administered. There was no such agreement from the case study, and the patient only gave a verbal agreement to the same. Therefore, there was no informed consent given to the patient for the MRI and medications needed for sedation.
For the second dose of medication, informed consent was deficient to the degree that there was an absolute lack of informed consent. The nurse postponed the MRI procedure on the second day but failed to inform the patient of these developments. The Committee on Bioethics (2016) submits that informed consent is a legal undertaking that indicated a patient’s willingness to proceed with a medical procedure or lack thereof. This implies that there must be a legal document towards this aspect that is admissible before a court of law. There was no such document for the second medication to indicate that the patient had given the authorization to warrant for the medical procedure. It’s the prerogative of health care professional to document the informed consent conversation and the patient’s decision or a surrogate decision-maker if the patient is unable to make sound decisions (Juliá‐Sanchis et al., 2019). As noted by the American Medical Association, a nurse must record written consent if the patient avails it. For the medication that was administered at 11.00AM, there was no evidence of informed consent. Therefore, it would be challenging for the nurses to determine if the patient understood the diagnosis and the implications of treatment unless they administered a written consent.
From legal and ethical perspectives, the nurses failed to provide informed consent to the patient. For the case study outlined herein, the patient was right in advancing litigation for the lack of informed consent. From my perspective, I would decide the case by giving the patient compensation, as it is evident that residual psychological symptoms were attributed to a lack of informed consent. Besides, there was no evidence of informed consent for the medication given at 11:30 AM.
Case 2: Jimmy
From Jimmy’s case study, it would be rational for the judge to inquire if the patient was aware of his medical condition and the interventions that are being advanced towards the same. One of the judge’s points of focus would be to determine if the patient had been given informed consent before administering the immune-depressants drugs. This would be an imperative inquiry as it would inform if the patient had given the nurses a go ahead with medication. Lack of informed consent would be attributed to the patient’s situation as he was not aware of the proposed medical procedure or its effectiveness in the current context. The judge would also have questioned the patient’s mental stability and if he was aware of the consequences and risks inherent to that. It would be vital for the judge to ask Jimmy what factors led him to discredit the effectiveness of medication administered to him and why he felt that it would not help his condition. I would also anticipate the judge to ask the patient if he understands the importance of adhering to medications and promoting self-health.
Concerning the mother, the judge should evaluate her response to her son’s request based on intentions to do no harm. It would be in the mother’s interest that the child recovers and attains good health. Legally, the judge is obliged to protect the accused’s life more, considering that he was a minor (Teo et al., 2017). Therefore, the judge would evaluate the mother’s feedback based on her intentions to improve her son’s overall health outcomes. The judge would also assess the emotions emanating from the mother due to her son’s suffering. The mother’s honesty and conviction would be a vital aspect of informing her position in the son’s medication procedure.
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The state or residency would not factor into the judge’s decision considering that the utmost goal of the determination was to improve the child’s health. As noted by Lustgarten et al., (2017), any decision made by a judge relating to children’s welfare must be anchored on the best interest principle. From this perspective, the residency factor would not be a critical factor of consideration. Other additional issues that would be addressed before deciding on the matter are the availability of a patient’s written will, which could be admissible in a legal proceeding. Considering that the patient was a minor, it would be essential to assess if there was a surrogate decision-maker regarding his will. From my position, I would decide the case in favour of the physicians considering that the patient was a minor and would, therefore, not make an informed decision regarding his health. This decision is anchored on the ….
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fact that there was no surrogate decision-maker to warrant deciding in favour of Jimmy. This decision is also informed by the need to uphold the patient’s rights and ensure that all decisions are made concerning his best interest.
Jimmy Chang’s case study
From Chang’s case, the informed consent form is vital to determine his will regarding the proposed medication (Lustgarten et al., 2017). This form would be critical to tell the primary decision maker and who the patient prefers as a surrogate if he is incapacitated. Analysis of the form is also imperative to determine the patient’s preferences towards his medication, the presence of powers of attorney, or a need to take advance directives. This form must be signed by the patient in case he is in a capacity to do so. A legally appointed decision-maker signs the consent form if the patient is incapacitated or a next of kin if no advance directives present (Baker & Marco, 2020). From moral code perspectives, the patient’s best course of action would be to continue with the treatment modalities. He has enjoyed 14 months of remission, and it’s evident that chemotherapy has played a crucial role in his recovery path. The ethical guidelines dictate the adoption of interventions that would increase the overall well-being of the patient. While it’s evident that the parents’ conflict regarding whether to continue with medication or not, the patient’s stability comes first in this perspective. As noted by Owens et al., (2019), healthcare executives must act in a way that instils confidence, trust and respect for their clients. Therefore, it’s the prerogative of medical executives to take actions that promote such rights, interests and needs.
From a legal perspective, the best course of action would be to continue with Jimmy’s chemotherapy process. The legal statutes compel the selected person to decide on behalf of the patient to determine the best decision such a patient would have made if he or she was competent. From Jimmy’s case, it’s evident that chemotherapy provided relief. The patient had seen improvements in his medication procedure, and therefore, it would be rational to uphold his decision. Thus, the mother’s submission to sign the form would be maintained, considering that her opinion is legally binding.
From both an ethical and legal approach, I came to a similar conclusion. Both legal and ethical perspective compels healthcare professionals to adopt interventions that would increase the patient’s overall well-being. In this aspect, it was critical to continue with the patient’s treatment procedures as it contributed to positive health outcomes in the past.
References
Baker, E. F., & Marco, C. A. (2020). Advance directives in the emergency department. Journal of the American College of Emergency Physicians Open, 1(3), 270-275.https://onlinelibrary.wiley.com/doi/full/10.1002/emp2.12021
Committee on Bioethics. (2016). Informed consent in decision-making in pediatric practice. Pediatrics, 138(2), e20161484.https://pediatrics.aappublications.org/content/138/2/e20161484?utm_source=TrendMD&utm_medium=TrendMD&utm_campaign=Pediatrics_TrendMD_1
https://link.springer.com/article/10.1007/s10728-019-00372-y
Juliá‐Sanchis, R., García‐Sanjuan, S., Zaragoza‐Martí, M. F., & Cabañero‐Martínez, M. J. (2019). Advance healthcare directives in mental health: A qualitative analysis from a Spanish healthcare professional’s viewpoint. Journal of Psychiatric and Mental Health Nursing, 26(7-8), 223-232.https://onlinelibrary.wiley.com/doi/full/10.1111/jpm.12539
Lipshie-Williams, M. (2020). The peculiar case of the standards of care: Ethical ramifications of deviating from informed consent in transgender-specific healthcare. Journal of Gay & Lesbian Mental Health, 24(4), 392-405.https://www.tandfonline.com/doi/abs/10.1080/19359705.2020.1798691?journalCode=wglm20
Lustgarten, S. D., Elchert, D. M., Cederberg, C., Garrison, Y. L., & Ho, Y. C. S. (2017). Readability of informed consent documents at university counseling centers. Journal of College Student Psychotherapy, 31(4), 281-296.https://doi.org/10.1080/87568225.2017.1343108
Owens, J., Singh, G., & Cribb, A. (2019). Austerity and Professionalism: Being a Good Healthcare Professional in Bad Conditions. Health Care Analysis, 27(3), 157-170.
Teo, W. Z., Brenner, L. H., & Bal, B. S. (2017). Medicolegal Sidebar:(Mis) Informed Consent in Medical Negligence Lawsuits. Clinical Orthopaedics and Related Research®, 475(11), 2643-2646.https://link.springer.com/article/10.1007/s11999-017-5493-4