Legal And Ethical Issues Case Study Cathy Smith An Eighty

Legal And Ethical Issues Case Studycathy Smith An Eighty

Cathy Smith, an eighty-eight-year-old woman with end-stage Alzheimer's disease and recent congestive heart failure, was admitted to the emergency room from her nursing facility with acute respiratory distress. She does not have a living will, but her daughter Rose, a healthcare professional, holds the power of attorney (POA) to make her mother's health decisions. The medical team considers placing her on life-support equipment, including a ventilator. Smith's son, Andrew, agrees with the doctors' decision, whereas Rose believes her mother would not want life-support to prolong her life. This scenario raises important legal and ethical questions regarding decision-making authority, patient autonomy, capacity, informed consent, and the conflicts that may arise among family members and healthcare providers.

Paper For Above instruction

The scenario presented involves complex legal and ethical issues centered around end-of-life care for Cathy Smith, an elderly woman with advanced Alzheimer's disease. The primary issues include the conflict between family members regarding treatment decisions, the identification of who has the authority to make decisions, the patient's decision-making capacity, and informed consent. These factors influence the delivery of appropriate, respectful, and lawful healthcare services in long-term care settings.

First, examining the autonomy-beneficial conflicts reveals a fundamental tension between respecting Cathy Smith's autonomy and promoting her well-being. Rose, acting as POA, argues that her mother would have chosen not to be kept alive artificially, aligning with the principle of respecting patient autonomy—the right of patients to make decisions about their own bodies and treatment options. Conversely, Andrew, who supports the decision to implement life support, might emphasize the principle of beneficence—acting in the best interest of the patient—assuming that prolonging life aligns with Smith's presumed wishes and well-being.

Determining who has the legal right to make healthcare decisions depends on the presence of legally designated authority. Since Cathy Smith lacks a current living will, her legal authority resides with Rose, as her designated healthcare power of attorney. The law generally grants the POA the right to make healthcare decisions based on the known preferences of the patient or, if unknown, in their best interest. Therefore, Rose's stance as POA generally positions her as the decision-maker unless her decisions are found to be contrary to the patient's wishes or against legal standards.

Ethical considerations extend beyond legal authority. Capacity and competency are critical in determining whether Cathy can participate in decision-making. While her advanced Alzheimer's disease affects her cognitive functioning, assessments should determine her decision-making capacity at the time of specific choices. In many cases, patients with dementia retain some capacity for preferences and values, even if they cannot understand complex medical information. But when a patient lacks the capacity to make informed decisions, surrogate decision-makers, such as the POA, step in to advocate for their wishes and best interests.

The competency of Cathy to make specific decisions about life support is likely compromised in her condition. This raises issues about interpreting her prior wishes versus current expressions. If Cathy expressed specific directives earlier, such as not wanting extraordinary measures, these should guide the decision unless her current condition indicates a different preference. The ethical challenge lies in balancing respecting her autonomy against beneficence and non-maleficence—avoiding harm even when the patient's decision-making capacity is impaired.

Informed consent is paramount when considering life-support measures. This process involves providing clear, comprehensive information about the patient's condition, the proposed treatments, potential outcomes, and possible alternatives. The surrogate decision-maker, in this case, Rose, has the legal responsibility to ensure that informed consent is obtained in line with her understanding of Cathy's wishes and best interests. The ethical principle here emphasizes honesty, transparency, and respect for the patient's dignity.

The critical issues related to informed consent involve ensuring that the surrogate has sufficient knowledge to make informed decisions and that these decisions align with the patient's values. Miscommunication, lack of understanding, or disagreement among family members can hinder this process. Healthcare providers must facilitate discussions, clarify misunderstandings, and document decisions carefully to uphold ethical standards and legal compliance.

In conclusion, managing end-of-life decisions in patients with advanced dementia involves navigating complex legal and ethical terrains. It requires balancing respect for patient autonomy, ensuring decisions are made based on informed consent, assessing patient capacity, and respecting legally designated surrogates' roles. Promoting clear communication, respecting the patient's prior wishes, and adhering to legal standards help guide healthcare providers in delivering ethical and lawful care in long-term care settings.

References

• Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics (8th ed.). Oxford University Press.
• Cherny, N. I., & Radbruch, L. (2015). European Association for Palliative Care position statement on strategies to improve palliative care for patients with advanced illness. European Journal of Palliative Care, 22(5), 258–262.
• Gorbaneva, N., et al. (2018). Advance care planning and end-of-life decision-making in dementia: A systematic review. Journal of Alzheimer's Disease, 63(4), 1023–1038.
• Katz, J. (2017). Ethical issues in end-of-life care. Crozer-Keystone Medical Journal, 44(2), 12–16.
• Meisel, A., & Crouch, C. (2021). Decision-making capacity in older adults with cognitive impairment: Ethical and legal considerations. Medical Clinics of North America, 105(3), 477–491.
• Ng, K. L., et al. (2019). Surrogate decision-making in dementia: A review of ethical and legal issues. Journal of Aging & Social Policy, 31(2), 137–151.
• Pollock, K., & Rimmerman, C. (2020). Ethical considerations in life-sustaining treatment decisions. Medical Ethics, 5(2), 45–52.
• Silberfeld, M. (2017). Ethical issues in palliative and end-of-life care. The Permanente Journal, 21, 17–103.
• Sternberg, T. (2020). Ethical challenges in caring for patients with dementia. AMA Journal of Ethics, 22(4), E344–E351.
• Wilson, K. G., et al. (2019). Decision-making capacity in patients with advanced dementia: Ethical and clinical considerations. Journal of Geriatric Psychiatry, 44(1), 117–123.