Patients have the right to express their free will in their medical treatment. Integrity is protected by informed consent, where a competent adult can refuse medical treatment. An authorized person is required to give consent to minors or patients with insufficient mental capacity before medical procedures. Patient consent is governed by federal law, which acts to protect children and public health and preserve life (Pozgar, 2020). The essay outlines three medical cases where patients have the right to self-determination by deciding on procedures for their bodies.
Objectives
This essay aims to provide patients with autonomy in making decisions about their healthcare, present the benefits of patient-informed consent and the self-determination rights that govern their choices, and assess the legal and ethical framework that guides patient and physician relationships and improves treatment and care outcomes.
Case Study 1: A Case for a Patient Suing the Hospital for Lack of Informed Consent
Scheduling a patient with severe lower back pain to undergo an MRI procedure in five days was the care plan for this patient. The physician recommended medication for pain relief and to relax the patient despite the possibility of respiratory depression as a side effect. The patient consented to taking the prescribed medication, understanding the potential risks. They rescheduled the MRI, so administering the medication at 8:15 AM the following day was pointless. However, the patient required a second dose at 11:30 AM and, later that same day, at 5:00 PM, became lethargic and needed resuscitation. The patient was discharged and subsequently sued the hospital for not obtaining informed consent regarding the second dose and the potential mental effects of the medication (Guido, 2020).
The physician obtained informed consent from the patient regarding the initial medications. As per the necessary protocol, the physician provided detailed information about the benefits and potential risks associated with the medication. The patient was made aware that, due to the high dosage of opiates, respiratory depression was a likely side effect. After understanding the risks, the patient voluntarily agreed to the medication (Millum & Bromwich, 2021).
Before administering sedation medications, it is crucial to ensure that the patient has given informed consent. This protocol analyzes whether the patient has been provided with complete information about the medication’s potential and side effects and fully comprehends the associated risks. It is equally essential that the patient is mentally capable of making informed decisions and has willingly consented. (Millum & Bromwich, 2021). Following the postponement of the initial MRI and verbal consent from the patient, the physician penned new orders. The validity of the consent, however, hinges on the presence of a witness, given that it was not a written agreement. Additionally, the patient’s mental state will be considered to ascertain if they fully comprehended the potential risks and granted informed consent. Based on the available evidence, it appears unlikely that the second consent was sufficient due to the absence of a formal written agreement and a witness. As a result, the patient may be eligible for compensation for any psychological distress they experienced.
Case Study 2: A Case for Juvenile Refusing Medication
Jimmy is a 15-year-old Floridian and the only child of a single mother. He had undergone a liver transplant twice and was under immunosuppressant medication, which has severe, debilitating side effects. The prescribed medication was to stop his body from rejecting the second liver. However, Jimmy stopped taking the medication even with the knowledge of the outcome of his decisions. The healthcare institution obtained a court proceeding instructing the mother and Jimmy to continue with the medication. In separate juvenile court, the judge, Jimmy, his mother, and the healthcare team held a discussion. Jimmy outlined that he understood the consequences of his actions, and he was tired of taking the medication since it increased his pain. His mother supported his sentiments, but the healthcare team could not prove that the medication could increase Jimmy’s life (Guido, 2020).
The judge has to evaluate Jimmy to determine his level of maturity and understand the consequences of stopping immunosuppressive medications. The evaluation question criterion should be based on whether Jimmy understands the nature of his medical condition, how he feels about the pain and suffering, and if there are other interventions he is receiving to overcome pain. Moreover, the judge would need to evaluate Jimmy’s reason for refusing medications and the extent of consultation when making the decision. Furthermore, the judge will have to determine the repercussions of not taking his prescribed medication. Additionally, the possible alternative reasons Jimmy may cite to make his medical decisions include the availability of convenient medical alternatives and other sacrifices he intends to make to improve his health conditions.
The judge should evaluate Jimmy’s mother’s response to understand her position in supporting Jimmy’s decision not to take medication, which could speed up his son’s death. She should be evaluated on her understanding of her son’s condition, her capacity to provide necessary medical support, and her willingness to accept working with the healthcare team to improve her son’s condition. She should also be evaluated to see if she agrees to support Jimmy’s choices based on self-interest or if they are based on her son’s needs.
Jimmy’s state of residency influences the judge’s decision since specific state laws govern minors’ medical care decisions. Jimmy resides in Florida, and thus, decisions should be based on the state’s law. Under the Minor Consent Law, Florida requires minors under 16 to obtain parental consent for medical treatment (Sharko et al., 2022). The mature minor doctrine is applied when minors attain maturity to understand the consequences of their medical decisions. The minor can make medical decisions (Sharko et al., 2022).
The judge should address the experts’ opinions before making final case decisions. The judge needs to be assured of the benefits of immunosuppressive medication, increasing Jimmy’s life and the pain he is experiencing. The experts’ opinions include liver specialists, children’s psychologists, ethicists, and child welfare officers. Also, the judge should ensure that all the stakeholders are informed of Jimmy’s choices and that they are willing to respect them. Lastly, the judge should consider Jimmy’s right to autonomy in medical choices based on his maturity level.
The case should be decided by respecting Jimmy’s choices, provided that he demonstrates maturity to understand the consequences of his decisions and is given all the support he needs to make informed decisions. The outcome should be based on his maturity and understanding of the medical condition. He has the right to self-determination on his health by determining what is best for him.
Case Study 3: A Division Between Parents on their Adult Son’s Medical Care
Jimmy Chang, a 20-year-old student, was diagnosed with leukemia five years ago. He had undergone several chemotherapy procedures and was admitted while in the acute phase of leukemia. Jimmy has 14 months of remission, but his parents have different opinions on the best action. The mother is willing to sign informed consent to let her son continue with therapy, while the father rejects signing since he feels that his son has suffered a lot (Guido, 2020).
The parents cannot determine Jimmy’s medical choices since he is 20 years old and is considered an adult. However, the parents’ division on the course of action for Jimmy’s medical decision must be solved. The parents’ differences require negotiation to ensure they do not interfere and are willing to respect their son’s decisions.
Jimmy should sign the informed consent since he is an adult and can make medical choices. Jimmy is 20 years old and has the legal capacity to make decisions on his medical outcome, and thus, his self-determination and autonomy should be respected (Childress & Quante, 2021).
The MORAL model for ethical decision-making is crucial for determining the best course of action for Jimmy (Guido, 2020). The first step of the MORAL model is to massage the dilemma where the differences between the parents’ views on Jimmy’s medical pathway and who should sign the informed consent are identified. The next step is to outline the options, which reviews the possible actions for Jimmy and his parents. These actions include either Jimmy or his parent signing the informed consent for the course therapy and the parents’ mediation to ensure they reach an agreement.
The third step is to review criteria and resolve, which entails parents’ mediation to ensure they agree to let Jimmy practice his autonomy. The parents should let Jimmy sign the informed consent, thus practicing his independence (Guido, 2020). The fourth step is to affirm the position and act, achieved through consultative meetings for the parents, where they can share their opinions and allow Jimmy to express his desires. The last step is to look back by assessing the decision-making process to ensure that Jimmy’s self-determination rights are respected and that the parents are mediated for the patient’s best interest.
From the legal perspective, Jimmy is 20 years old and has autonomy in deciding the course of action for his health. He is legally capable of signing or not signing the informed consent for the course of therapy. However, he should be evaluated mentally to ensure he understands the risks and benefits of his choices.
The ethical and legal approaches promote the patient’s autonomy, where he is responsible for making medical care decisions. The ethical approach encourages parents’ reconciliation to give the patients a neutral environment for making decisions. On the other hand, the legal perspective focuses on the patient’s self-determination in making his decisions. The patient is responsible for determining his future, provided he is mentally stable.
Conclusion
Patients require informed consent, which outlines the benefits, risks, and consequences of all the possible treatment alternatives and are given room to decide willingly. The informed consent allows the patient to make decisions on their health matters and can be used for legal help in case of hospital negligence. In many states, including Florida, minors under 16 years of medical treatment require parental consent. When minors mature enough to understand the consequences of their medical decisions, they can make their own medical decisions. Additionally, when there is a division between the patient’s parents on signing informed consent, it is appropriate to consider ethical and legal approaches to find the best course of action for the patient’s interests. The patients’ autonomy has to be respected by giving them self-determination in making their decisions.
References
Childress, J. F., & Quante, M. (Eds.). (2021). Thick (concepts of) autonomy: Personal autonomy in ethics and bioethics, 146. Springer Nature. https://doi.org/10.1007/978-3-030-80991-1
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.
Millum, J., & Bromwich, D. (2021). Informed consent: What must be disclosed and what must be understood? The American Journal of Bioethics, 21(5), 46-58. https://doi.org/10.1080/15265161.2020.1863511
Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Jones & Bartlett Learning.
Sharko, M., Jameson, R., Ancker, J. S., Krams, L., Webber, E. C., & Rosenbloom, S. T. (2022). State-by-state variability in adolescent privacy laws. Pediatrics, 149(6). https://doi.org/10.1542/peds.2021-053458
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