Task instructions:

You are required to write a assignment that accurately addresses the ethical and legal issues raised in the scenario.

Case Scenario

Oliver is a 37-year-old aspiring musician, and partner to Felicity. Together, they have two small children. Although Oliver and Felicity have been together for 8 years, they have recently experienced some difficulties in their relationship and frequently spend time apart. Oliver and Felicity live three doors down from Oliver’s mother, Eva. This is a convenient arrangement because after Oliver’s father passed away, Eva would regularly spend time at Oliver and Felicity’s house minding the children.

Oliver was diagnosed with Type 1 diabetes when he was 14, and since that time he has managed to maintain relatively stable blood glucose levels with a combination of diet, regular insulin and routine blood glucose monitoring.

Oliver had recently been unwell, complaining to Felicity of a sore throat and fever. He was treating this symptomatically with regular paracetamol and warm honey and lemon drinks. This was a bad time for Oliver to be unwell because he had recently obtained a gig out of town that he hoped would kick start his musical career. Felicity thought it best if Oliver went to see a doctor before he set off, however, Oliver was not keen on visiting the doctor and refused to go. Instead, he reassured her that it was just a viral infection, and that in a few days things would start to improve.

While Oliver was out of town, his viral infection worsened. He developed muscle aches, and the pain in his throat meant that he could not eat or drink – let alone perform on stage. When he did not turn up at the agreed time for his first performance, the venue manager tried to contact Oliver by phone. Receiving no response, he went to the hotel where Oliver was staying, discovering him unconscious in the bathroom. The ambulance was immediately called, and upon arrival the paramedics assessed Oliver as being in a diabetic coma. Despite instigating the appropriate life-preserving treatment, Oliver suffered a cardiopulmonary arrest en route to hospital.

Resuscitation was commenced and after several minutes Oliver’s spontaneous circulation returned. On arrival at the hospital, Oliver was intubated and ventilated. After a short stay in the emergency department, he was transferred to the intensive care unit.

Unfortunately, after several days of treatment it became apparent that Oliver had suffered a serious hypoxic brain injury. Subsequently, although he was successfully weaned from the ventilator and able to breathe spontaneously, he needed to be fed through a percutaneous endoscopic gastrostomy (PEG) tube. He had an indwelling urinary catheter and continued to receive regular subcutaneous insulin. Oliver no longer moved spontaneously, although Eva believed that he did make eye contact with her and blink appropriately in response to her questions.

Understandably, this was a devastating turn of events for Felicity, the children and Eva. Although they initially tried to remain optimistic about Oliver’s potential for full recovery, as weeks turned into months, it became increasingly apparent that this would not happen. The healthcare team caring for Oliver formed the opinion that he was in a minimally conscious state. They believed that because of the extensive hypoxic brain injury Oliver had no awareness of his surroundings, and no possibility of recovery.

Felicity agreed with the assessment made by the healthcare team, believing that Oliver displays no sign of recognising her, or the children. She described Oliver’s condition, saying that, ‘initially you could think that he was looking at you, but it was really like he was looking through you’. Felicity was also very mindful of conversations that she and Oliver previously had where he expressed views about what he would want to occur were he to ever experience such a catastrophe. Oliver had made it clear that he would not want to be left in a situation where he could not care for himself and would want Felicity to ‘turn the bloody machines off’.

Eva’s perception of Oliver’s situation was not quite as grim. She had undertaken some research and found several cases where people had ‘woken up’ after being in comas for prolonged periods. Eva did not agree that Oliver had no awareness of his surroundings and thought that from time to time he would track movements around the room – not always, but sometimes. She also knew that Oliver would not want to remain in this minimally conscious state permanently, but was hopeful that given adequate time and support, Oliver would once again be able to communicate with his family.

Felicity and the healthcare team caring for Oliver believed that continuing treatment was not in his best interests. They reached the conclusion that this treatment should stop. Eva, however, is opposed to stopping treatment and wishes for Oliver to be given every opportunity to recover; even if this means that he needs to remain highly dependent in hospital for many more months. Eva wants to do whatever is necessary to ensure that the life-sustaining measures Oliver is currently receiving continue.

Making Ethical Decisions

There are many different values that influence decision-making in healthcare. This sometimes makes it difficult to know which is the ‘right’ decision. In this section, you need to identify the values or principles present in the following statements and consider how they might affect decision-making. You are required to refer to peer reviewed academic literature to support your description of a value or principle.

1. “Oliver had made it clear that he would not want to be left in a situation where he could not care for himself and would want Felicity to ‘turn the bloody machines off’.”
2. In relation to Oliver, identify one value that is reflected in this sentence and describe it.
3. Describe how this value may affect Oliver’s decision-making.
4. “Eva, however, is opposed to stopping treatment and wishes for Oliver to be given every opportunity to recover; even if this means that he needs to remain highly dependent in hospital for many more months.”
5. In relation to Eva, identify one value that is reflected in this sentence and describe it.
6. Describe how this value may affect Eva’s decision-making in relation to Oliver.
7. “The healthcare team caring for Oliver believed that continuing treatment was not in his best interests. They reached the conclusion that his treatment should stop.”
8. Identify one principle from the Universal Declaration on Bioethics and HumanRights that is reflected in this statement and describe what it requires.
9. Describe how the selected principle may be used to guide decision-making by the healthcare team in relation to Oliver.

Making Legal Decisions

When an adult has decision-making capacity, providing consent is one way of ensuring that their values are given priority. The law also promotes individual values by providing a framework for consent when an adult lacks decision-making capacity. Using structured sentences and paragraphs, address the following questions or statements about Oliver’s case and the law in Queensland.

1. As Oliver had previously refused medical treatment for his viral infection, do the paramedics have any legal authority to institute treatment for his diabetic coma? What legal authority can you rely upon to support your answer?
2. Adults who do not have decision-making capacity cannot provide consent. With reference to relevant Queensland legislation, list all potential options or substitute decision-makers that healthcare practitioners could rely upon to provide consent for treatment?
3. Provide a rationalefor the legal obligation to obtain consent when adults lack decision-making capacity
4. In circumstances where there are two or more substitute decisions-makers who could potentially provide consent, and they disagree, describe the legal options available to provide a definitive answer as to what course of action the healthcare practitioners should take.
5. With reference to the Guardianship and Administration Act’s Health Care Principle, describe how the factors Oliver’s substitute decision-maker must consider when making decisions about his healthcare may be addressed.