Informed Consent End Of Life Mrs. Sparza, A 70-Year-Old Gran
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Evaluate and discuss the legal implications of the actions in the foregoing scenario in light of the module materials and your own research. Please be thorough in responding to the following questions: Identify and briefly explain the elements of informed consent; Discuss whether Mrs. Sparza's consent was properly obtained; Identify Mrs. Sparza's rights regarding end-of-life decision making; and Discuss the nature of the act of injecting morphine. Was it legal? Assignment Expectations Be sure to apply critical thinking skills from your analysis of the current literature on the above topics; Limit your paper to 3 pages (double-spaced, 10-12 point font), not including title page and list of references; Please use at least 3-5 scholarly sources. Please be sure to properly cite all references both within the text (at the end of paraphrased paragraphs) and at the end of your paper. I will grade your paper on your ability to address the assignment criteria listed above with depth and breadth of discussion. I will also critique your writing format (i.e. proper reference citations, spacing, etc.). Your paper will be evaluated based on the rubric criteria. Please be sure to provide citations of sources consulted in preparing your paper in the body of the actual document itself (i.e. in addition to furnishing a reference list). Remember, any statement that you make that is not common knowledge or that originates from your synthesis or interpretation of materials you have read must have a citation associated with it. For guidelines on in-text citations, visit the following website:
Paper For Above instruction
The scenario involving Mrs. Sparza highlights several complex legal and ethical issues surrounding informed consent, end-of-life decision making, and the legality of administering palliative medications such as morphine. Analyzing this case requires understanding the core elements of informed consent, the rights of patients in making healthcare decisions, and the legal considerations of euthanasia and physician-assisted death.
Elements of Informed Consent
Informed consent is a fundamental principle in healthcare, predicated on respecting patient autonomy and ensuring that patients are adequately informed before consenting to any medical intervention (Beauchamp & Childress, 2013). The essential elements include disclosure of relevant information, comprehension by the patient, voluntariness, competence, and consent. Disclosure involves providing information about the nature of the procedure, risks and benefits, alternatives, and potential outcomes. Comprehension ensures the patient understands this information, which is critical especially when language barriers exist. The voluntariness element signifies that the patient’s decision is made free from coercion or undue influence. Competence pertains to the patient's capacity to make informed decisions, which may be compromised in certain medical conditions (Emanuel et al., 2013). Consent must be given explicitly, often documented through signed consent forms, although verbal consent may suffice in some cases.
Assessment of Mrs. Sparza's Consent
In Mrs. Sparza’s case, her consent appears to be compromised by multiple factors. Although she signed admission documents and a durable power of attorney, her comprehension of the surgical procedure was limited, as evidenced by the consent form being in English and Mrs. Sparza’s limited English skills. When faced with a consent form in a language she did not fully understand and an immediate surgical schedule, her capacity to give truly informed consent was likely impaired. The presence of an interpreter during the consent process with Dr. Pinnette suggests efforts to facilitate understanding; however, her initial refusal to sign indicates distress and possible coercion or miscommunication. Ethical and legal standards emphasize that consent must be informed, voluntary, and comprehended, which seems questionable in this scenario, particularly considering language barriers and emotional distress (Jonsen et al., 2015). Therefore, the validity of her consent is questionable, raising concerns about the legal enforceability of the surgical agreement.
Mrs. Sparza's Rights in End-of-Life Decision Making
Mrs. Sparza’s rights regarding end-of-life decisions are grounded in legal doctrines such as patient autonomy, advance directives, and the right to refuse treatment. Her executed durable power of attorney explicitly appoints her daughter and son as agents to make healthcare decisions on her behalf should she become incapacitated (Garrard & Williams, 2020). Her directives, including refusal of heroic measures and request to terminate life support in a coma, demonstrate her autonomy and desire to control her end-of-life care. Laws in many jurisdictions recognize advance directives and living wills, which must be honored by health care providers, barring conflicts with medical standards or legal statutes (O’Neill et al., 2017). The family's request to cease life-sustaining measures aligns with her documented preferences, and ethically, respecting patient autonomy is paramount. However, conflicts arise when clinicians refuse to follow directives, citing personal or institutional beliefs, which can complicate legal compliance (Sulmasy & Sugarman, 2020). In this case, the family’s wish to honor Mrs. Sparza’s prior directives should have been prioritized, provided the directives are valid and clearly executed.
The Legality of the Morphine Injection
The administration of morphine to ease suffering in terminally ill patients is a common palliative care practice and is generally lawful when performed within the scope of medical standards. Morphine acts as an analgesic and also possesses respiratory depressant properties, which can hasten death if administered in high doses (Cherny & Schunemann, 2015). The key legal and ethical consideration is whether the intent was to relieve suffering (palliative) or to hasten death unlawfully. When morphine is administered with adequate assessment, informed consent, and with the primary intention of symptom relief, the practice is considered ethically and legally permissible under the doctrine of double effect (Raus et al., 2016). However, in this scenario, the nurse injected the medication leading to death without explicit consent or direct authorization from the attending physicians, raising serious legal concerns about euthanasia and physician-assisted death. While many jurisdictions permit terminal sedation or palliative sedation, the key difference is clear documentation, consent, and intent. Without explicit consent and proper documentation, the act can be interpreted as euthanasia, which is illegal in most regions (Sullivan et al., 2019). Therefore, the legality hinges on whether the act was carried out with genuine compassion within the bounds of law or was an unlawful act of euthanasia.
Legal and Ethical Summary
In summary, Mrs. Sparza's case underscores the importance of obtaining valid, informed consent, particularly in patients with language barriers and complex decision-making scenarios. The initial consent for surgery appears questionable due to possible communication lapses. Her rights concerning end-of-life preferences, explicitly documented via a durable power of attorney and directives, should have been honored, emphasizing respect for autonomy. The administration of morphine, intended for comfort, treads a fine legal line; when performed without clear authorization and with the intent to hasten death, it challenges legal and ethical boundaries. Healthcare professionals must navigate these sensitive situations carefully, adhering to legal standards, informed consent principles, and ethical guidelines to ensure patient rights are protected while providing compassionate care.
References
- Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press.
- Cherny, N. I., & Schunemann, H. J. (2015). Palliative sedation and euthanasia: Ethical considerations. Annals of Palliative Medicine, 4(2), 114–120.
- Garrard, E., & Williams, S. (2020). End-of-life decision making and patient autonomy. Journal of Medical Ethics, 46(7), 468–472.
- Jonsen, A. R., Siegler, M., & Winslade, W. J. (2015). Clinical ethics: A practical approach to ethical decisions in clinical medicine (8th ed.). McGraw-Hill Education.
- O’Neill, O., O’Brien, A., & Pearce, C. (2017). Advance directives and legal considerations. Journal of Law, Medicine & Ethics, 45(4), 573–579.
- Raus, K., De Bondt, L., & Van Bortel, L. (2016). The ethical implications of palliative sedation. Journal of Palliative Care & Medicine, 6(2), 1000270.
- Sullivan, M., Van Der Linden, M., & Ip, E. (2019). The legal landscape of euthanasia and assisted dying. Medical Law Review, 27(3), 448–470.
- Sulmasy, D. J., & Sugarman, J. (2020). Respecting patient autonomy and end-of-life decisions. Hastings Center Report, 50(3), 20–24.