Healthcare Ethical and Legal Issues Research Assignment (Essay Sample)

Healthcare Ethical and Legal Issues.
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Terminating an individual’s life when there is no chance of improvement can be a matter of life and death. Such situations call for well-documented medical, legal and ethical laws that clearly outline what is to be done when faced with such issues. Life termination has raised the eyebrows of the public, politicians as well as religious and activist groups. Some are pro-life while others are against it. Some have substantial evidence while others base their argument on emotions and self-drive. The cases call for amicable agreements, well-stated laws, as well as advance directives on what should be carried out in case one is incapacitated
In February of 1990 at 26 years of age, Terri Schiavo collapsed in her home at St Petersburg, Florida. She had cardiac arrest and her tissues became hypoxic for several minutes. The oxygen supply to her brain was cut off for several minutes. The paramedics tried to resuscitate her, but massive brain damage had already occurred. She remained in comatose for about two and a half months only to proceed into a persistent vegetative state (PSV). PSV is the rarest form of disability in which most of the brain tissue is dead, but the patient loses cognition and can only perform a few involuntary action on his or her own. Terri was intubated for her hydration and nutrition because she couldn’t feed on normal food (Jones & Whitaker, 2009).
The cause of her collapse is disputed. Michael Schiavo said that it was induced by potassium imbalance that he associated it with bulimia, an eating disorder, while her parents, the Schindlers, suspected that her husband tried to strangle her. Their argument was based on a court testimony by a neurologist. The testimony stated that she suffered a neck injury on hospital admission (Lynne, 2005).
Due to unavailability of an advance directive, Mr. Schiavo was appointed as Terri’s formal guardian. The Schindlers didn’t object his appointment. Her optimistic husband received nursing training with the intention of taking care of her. It, however, proved too overwhelming, and she was returned to the chronic care facility after three weeks. Intense physical and occupational therapies were administered with the hope of rehabilitating her. She was taken to California by Mr. Schiavo to try experimental thalamic stimulator implantation in her brain to improve or restore her consciousness level but the treatment failed (Wolfson, 2006).
Mr. Schiavo continued to live with her for several more months until guardian ad litem was appointed by the court (Hook & Mueller, 2005). The Schindlers encouraged Mr. Schiavo to move on and start dating. After a while Michael’s belief about Terri’s recovery appeared to have changed. He had no hope that his wife’s health would improve. The Schindlers and Mr. Schiavo relationship deteriorated in 1992 after he and Terri were awarded a large amount of money for the damages in two malpractices suits regarding her infertility treatments and a possible association with the cardiac arrest (Hook & Mueller, 2005). In July 1993, a petition was filed by the Schindlers in court seeking to remove Michael as Terri’s guardian but later dismissed because the first guardian ad litem found that he had aggressively and attentively cared for her.
Four years later, May 1998, Michael filed a petition seeking authorization of the removal of her Percutaneous Endoscopic Gastrostomy tube, but the request was challenged by the Schindlers claiming that she would have wanted to be kept alive. A second guardian ad litem was appointed by the court to serve on behalf Mrs. Schiavo’s interests (Hook & Mueller, 2005). In December the same year, her guardian reported that Terri was in PSV and according to the physicians the chances of improvement were minimal, and Michael’s statement about Terri’s wishes not to be feed on tubes when incapacitated were genuine. Contrary Mr. Schiavo’s argument about Terri’s wishes had no evidence to support the claims (Hook & Mueller, 2005).
The trial to determine Terri’s wishes begun in January 2000 in Pinellas-Pasco County Circuit Court. The decision by Judge Greer to withdraw the nutrition and hydration tubes in order permit natural death raised a heated debate between right-to-die and pro-life advocates (Lynne, 2005). It was followed by a series of emergency motions, appeals and court orders to establish the trial’s jurisdiction but the physicians concurred with the earlier medical evaluations. It led to the public becoming increasingly interested in and vocal about the case. Several organizations were drawn into the case. Some claimed that the cessation of Artificial feeding tubes was an act of abuse and neglect. The tubes were removed but reintroduced after two days. In addition to the petitions, Florida House of Representatives passed Terri’s Law leading to reconnection of the tubes. The court battles went on, Michael, joined by the American Liberties Union to contest against Terri’s law as unconstitutional. The legal challenge culminated in the opinion of the judge declaring the law as unconstitutional. The series of events that occurred after became unique in the history of American politics, law, and bioethics (Lynne, 2005). The case progressed to involve the president. Consequently the tubes were disconnected in March 2005. She later died at age 41 ending the long legal, medical, and political struggle. The autopsy report was consistent with the initial report. She sustained severe and irreversible brain damage, and there was no hope of rehabilitation.
Practically Terri’s case raises a lot of questions. Whether her case was an act of euthanasia or natural death remains controversial. There were two different paths she could have taken. Her guardian would have chosen to allow her to die or continue living It wouldn’t have been considered as a case of euthanasia if the supportive treatment was utterly disconnected and she would have died later due to dehydration and starvation. Contrary, euthanasia would have involved the use of a drug or chemical by the medical physicians to terminate her life.
The end-life-decision making issues involved in Terri’s case
In Terri’s case, many decisions were made concerning her well-being and ability to stay alive. The initial end life decision being the succession responsibility. The physicians and the court selected her husband as the guardian based on the long relationship she had with him and Michael being her legitimate husband. Furthermore, the legislations defined the hierarchy of succession. In the absence of advance directive, Michael was the default guardian. He was expected to act on her behalf as she was not in a position to make a sound judgment after the accident. The Schindlers agreed with the decision, but they later filed a petition in court to remove Michael as Terri’s legal guardian (LANG & Quill, 2016).
Another end-of-life decision made was the substituted judgment and decisions in best interest of the patient. According to the physicians and guardian ad litem arguments, the decisions were issued to the best of Terri’s interest as opposed to the Schindlers who opposed. They clearly indicated that the decisions they made were not for themselves but based on the patient’s wishes, she wouldn’t have agreed to remain on feeding tubes for the rest of her life (LANG & Quill, 2016).
The clinicians were faced with situational and prognosis decisions concerning Terri’s end-life. As stated in the articles by several authors, Terri’s brain was severely damaged and there were no chances of her improving to her usual initial life. The prognosis of PSV patients was destitute and therefore the only decision that could be made was to terminate her life by disconnecting the feeding tubes. The Schindlers being optimistic about their daughter, however, contested against the decision which was finally effected after a series of court trials and laws being upheld. In addition to that, a range of decisions had to be made from Terri’s resuscitation and finally removal of the tubes. They include; initiation of feeding tubes, hydration and ultimately disconnection of life-sustaining devices. Others measures included supportive care initiation and life maintaining care through medical intervention to support Terri’s life (LANG & Quill, 2016).
Finally, the battle that arose in Terri’s case about the legality of methods of life termination. There were no clear laws about how such cases were handled and who was solely bestowed with the responsibility of decision making. It fueled a heated debate that was followed by several court hearings until a law was signed by the United States of America's president, which supported Mr. Schiavo’s argument to end Terri’s life. It was enacted to prevent prosecution of Mr. Schiavo and physicians from being accused of committing murder (LANG & Quill, 2016).
Over a long period, the role of Healthcare committees in hospitals has been controversial. Their participation has been clouded by conflicts with some arguing that they might be acting on their own best of interest and not the patient’s interest. It has led to most cases ending in courts particularly when two or more parties are involved. The committee has three primary functions: education, policy development and case consultation (Doyal, 2001).
The ethics committee’s role was to formulate hospital policies on the medical ethics and legal matters. Terri’s case would have been solved quickly based on the policies laid down by the hospital and the health care system. How the hospital would have terminated her life and to keep her on feeding tubes based on...