Introduction
Medical ethics can be described as general principles that govern if a practice is right or wrong. It applies to medical professions as stipulated in the code of ethics. Medical practitioners are expected to observe the regulations and rules surrounding them for proper and smooth running of their activities. The morals may be considered as autonomy, beneficence, non-maleficence and justice. As an important tool in health care, medical ethics should be followed to the later. To ensure it is affected, ethics as a part of course work has been integrated into the teaching curriculum to ensure that students learn them in their institutions. On the other hand, legal issues and considerations are matters that pertain a patient and are protected by the existing state laws. Patients, relatives, and other social bodies are bound to sue health care providers or the facility. With the increasing knowledge of patient’s rights and freedom, the physicians have to be careful when handling them to avoid the risk of facing charges in a court of law if malpractice is witnessed. Ethics may differ with the law. A physician is expected to reflect the idea of being right or wrong according to the society, though the behavior may not be enforced by the law (Luce, 2009). This paper seeks to evaluate the legal and ethical considerations surrounding the treatment of the elderly or terminally ill patients. Although, these categories of people may be at risk of suffering from malpractice due to their incompetence in many aspects, their rights should not be violated. All legal and ethical issues are significant and should be applied when treating them. Any failure should be considered as malpractice, and legal actions should be taken on the violator.
The Legal and Ethical Factors
There are several legal factors inherent in the treatment of the elderly and terminally ill. First, the law requires that these groups should have advance directives. It is the possession of a written will that outlines who should give informed consent as pertaining their treatment. The elderly may not be in a position of making decisions or may be incompetent. The terminally ill may suffer incapacitation and memory loss due to their prolonged illness rendering them incompetent (Emanuel, 1999). The laws require that they have a written will giving their relatives the mandate to give consent for the treatment they are going to receive. Advance directives allow the patients to avoid receiving unwanted medical intervention. The patient is allowed to appoint a relative who will handle decision making. The health facility may inquire about the presence of an advanced directive on an admission of a terminally ill or an elderly patient. It may also help the relatives and surrogates to obtain one in case they do not have (Luce, 2009).
Besides, the law does not allow for euthanasia and assisted suicide. According to the state law, life is sacred, and no one should take the life of another. The elderly may be sick and subjected to a lot of pain and suffering just like the terminally ill. The ultimate result of the terminally ill is to die. The best example of this is patients who suffer from HIV/AIDS. They may be only surviving in the intensive care units. This has a financial obligation and might be expensive for the family who may seek to have the life of the patient terminated. The doctors may also advice on mercy killing. The state laws consider this as murder because no one should end life (Enes, 2004). In the event of malpractice and negligence of duty where patients are left unattended, and they lose their lives, the relatives may sue the doctors in charge who may risk even losing their job.
The ethical factors involved are obtained from the Hippocratic Corpus (Luce, 2009). Firstly, it is the autonomy. The patient has the right to accept or refuse any treatment. As long as the patients are sober and competent, they can be allowed to make any decision concerning their treatment. They also give informed consent. Where they are incompetent, the relative can be called in to make the decision that should be evaluated to be in the best interest of the patient. The elderly are faced with many illnesses that may range from diabetes to kidney diseases (Frédéric, 2001). The family should be called in to make decisions relating to dialysis and kidney transplants. Autonomy should be respected and adhered to. The doctor should clearly explain to the patient or the family about the treatment and all available alternatives. They can, therefore, choose what is best for them.
Moreover, the beneficence means that the doctor should act in the best interest of the patient. He should help where possible and restore the health status of the individual (Marcus, 2001). The clinician should focus on the treatment that will bring a benefit to the client. They are always driven by the motives of doing well. For instance, the immune system of the terminally ill and the elderly is weakened and suppressed; therefore, they should not be given steroids or immunosuppressant, and there should be no prolonged use of antibiotics on them because it can cause further resistance to antimicrobial therapy (Marcus, 2001). The physician should choose the treatment to initiate by looking at the future outcome of the treatment.
Non-maleficence is another ethical factor that should be considered when treating the elderly and the terminally ill. The principle states that “first do no harm” (Mueller, 2004). It is the obligation of the healthcare provider not to do harm to the patient. They should ensure that the choice of the treatment is the best and that it would not cause any damage to the patient. For instance, the elderly should be allowed to have hospital bed rest for a longer time since it may result in spinal cord injuries and bed sores. Those suffering from HIV/AIDS should also be treated with antifungal and antibacterial drugs to prevent them from getting the opportunistic infections such as tuberculosis.
Justice is also another pillar of ethics and it advocates for fair and equal allocation of medical resources (Luce, 2009). Throughout the world, the medical resources such as dialysis machines are few and expensive to get. Determining who should get access to the medical services should be done with a lot of justice. No discrimination should be there. Every patient should be treated fairly and with dignity. The elderly and terminally ill should not be discriminated upon and denied medical services simply because they are almost approaching death. They should receive medical care and attention until they meet their death.
Visibility Cases
An eighty years old woman presents to the hospital with a breast mass that is diagnosed with breast cancer. The surgeon orders for a biopsy and gives the patient a form to sign after explaining to her the procedure. The woman is competent to make decisions and signs the form. After the procedure, she was left paralyzed. Her family sued the surgeon. The result was that the surgeon produced a fully signed form by the woman clearly stating that she had understood the procedure and gave informed consent to be given the treatment (Emanuel, 1999). This is a good case that emphasizes the need to respect patient‘s autonomy.
A forty-nine-year-old man suffering from prostate cancer is admitted to the hospital. The relatives are poor and claim that they cannot afford the resources for chemotherapy. They approach a doctor whom they convince him to perform euthanasia on the patient who is surviving on life support machines. The doctor does not give in to their demand because this is against the law and the principle of non-maleficence (Rosin, 1998).
The Impact of State Laws
The Law of Advance Directives. It is part of safety codes as outlined from section 7185 to7194. California state was the first to enact “natural death act” that allowed leaving of wills and advance directives in 1976 (Luce, 2009). The impact of this act was that it established a durable power for health care allowing a competent patient to delegate decision making to a surrogate. If the doctors have doubt on the surrogate, a court review can be obtained (Woo, 2006).
The supreme court of California in 1972 established that the physician should communicate effectively to the patient and properly meet their need (Emanuel, 1999). This is outlined in the Communication Act of 1934 laws in under section 605. This greatly serves as the pillar of beneficence. The need of the patient should be put in the forefront because it affects the decision they are going to make concerning the treatment (Luce, 2009).
The law of Informed consent. The Court of Appeal of California under the Salgo V of Leland Stanford University Board of Trustees stated that clinicians must give all information and facts to the patient that affects his rights and interests in making decisions (Marcus, 2001). It touches on the autonomy of the patient and justice. They deserve to be given the right information and then the freedom to choose the treatment.
Impacts of Decision-making
The legal and ethical considerations on decision making issue pertaining the elderly and terminally ill has impacted on the provider, the patient, and the administrators. The provider, for example, the doctor works to respect autonomy and beneficence (Woo, 2006). Autonomy can sometimes be violated. For example, a patient is suffering from HIV/AIDS, the threat to the whole society, and he or she refuses treatment, the clinicians should notify the public health department that gives consent for the treatment.
The patient being involved in decision-making has brought about a good doctor-patient relationship that has enhanced confidence (Mueller, 2004). There are reduced court cases of malpractice and negligence. People have become more responsible in term of having advance directives and wills.
The courts as the administrators have been greatly involved in decision making especially when there are no wills and surrogates (Emanuel, 1999). The law enforcers can step in and decide for the patient. This has led to reduced cases of patients suing doctors and health care facilities. It has also promoted justice since the patient family feels that the judgment was fair and just.
In conclusion, ethics and legal considerations are important aspects of health care delivery. They need to be respected by the practitioner for a healthy and peaceful society. Decision-making is vital for health care and all parties involved play a role a crucial role in the process. The patient is the main party involved only if they are competent and sober. Relatives and surrogates can also be considered in case of incapacitation. The state is actively involved in regulating the legal and code of ethics governing medical practice delivery.