In your future role as a health care professional, you will be faced with complex and challenging situations. There will at times be a legal solution that can be applied to the situation. It is important that you are aware of what this might be so that you can confidently practice within these legal boundaries. Almost always, there will be differing ethical positions that need to be considered.

The aim of this written assignment is for you to identify values and principles that underpin decision-making and become familiar with how the law supports adults who lack decision-making capacity. This written assessment will assess all of the learning outcomes of the course

You are required to write a 2000-word essay in which you address the ethical and legal issues raised in the scenario provided. You will use peer reviewed academic literature and the relevant legal authority (legislation/case law) to support your analysis. Be guided by the specific instructions against each question.

Your essay should be structured using only the following headings:

Introduction

Making Ethical Decisions

Making Legal Decisions

Conclusion

You are not required to decide the outcome in this scenario.

In relation to the ethical issues, there will not be one “right” answer.

In relation to the legal issues, this is a role for the courts. It is the process you are being asked to apply.

Be guided by the criteria (1 – 9) in this essay. Careful scrutiny of the criteria is recommended; also, be guided by the marks available for each criterion as well as the recommended word count for each criterion.

Firstly, read the case scenario that we have provided for you in this document.

How to approach this essay

In your introductory paragraph, outline what you will be presenting in your assignment. You do not need to include a detailed account of the facts in the scenario; the markers are aware of the scenario. (150 words)

Making Ethical Decisions (second heading)

In this section of your essay, you will address four criteria (Criterion #1 to Criterion #4).

Criterion One - Criterion Four: Ethical problems require gathering the facts, and this includes ascertaining the beliefs and values of those caring for the patient (Kerridge et al 2015). Many different values influence decision-making in healthcare which sometimes makes it difficult to know which is the ‘right’ decision.

Criterion One - Identify ONE value that Ashley may have and, referring to appropriate academic literature, describe this value. (200 words)

Criterion Two - Identify ONE value that Steven may have and, referring to appropriate academic literature, describe this value. (200 words)

Note: This section (criteria 1 and 2) requires a comprehensive description of the chosen VALUE supported by peer reviewed academic literature. Application of facts not required.

Criterion Three - Discuss how the different values held by Ashley and Steven may contribute to their different points of view on Archie’s ongoing care. (200 words)

Note: This part of your essay (criterion 3) requires application of the facts in your analysis.

Consider this section of the case scenario: “The healthcare team caring for Archie believed that continuing treatment was not in Archie’s best interests and inconsistent with good medical practice; and the team recommended that any treatment to Archie must be discontinued”. Criterion Four

Making Legal Decisions (third heading)

In this section of your essay, you will address five criteria (Criterion Five - Criterion Nine).

Criterion Five - Criterion Nine: When an adult has decision-making capacity, providing consent is one way of ensuring that their values and beliefs are given priority. The law also promotes individual values by providing a framework for consent when an adult lacks decision-making capacity.

Note: You will need to address the following questions or statements about Archie’s case in relation to Queensland law.

Criterion Five

1. How is ‘capacity’ defined? (50 words)
2. “Capacity is ‘decision-specific’ and ‘time-specific’.” Discuss this statement. (100 words)

Note: Your answer must include the relevant legal authority.

Criterion Six - In the absence of any valid consent given by Archie or anyone else who could provide it under law, how do you justify the act of paramedics in treating Archie for his head injury before transporting him to the hospital? (100 words)

Note: Your answer must include the relevant legal authority.

Criterion Seven - Adults who do not have decision-making capacity cannot provide consent. Identify all potential substitute decision-makers that health practitioners could rely upon to provide consent for treatment to adults without decision-making capacity, under Queensland law. (100 words)

Note: Criterion Seven does not require identification of Archie’s substitute decision-makers (that is, names) in your analysis. Your answer must include the relevant legal authority.

Criterion Eight - Describe the factors the substitute decision-maker must consider when making decisions about Archie’s healthcare, under the Queensland Guardianship law. (300 words)

Note: Criterion Eight does not require identification of Archie’s substitute decision-makers (that is, names) in your analysis. However, it requires discussion of the factors to be considered by Archie’s substitute decision-maker in relation to his healthcare. Your answer must include the facts and the relevant legal authority.

Criterion Nine :-When there is a disagreement amongst two or more substitute decision-makers who could potentially provide consent for the treatment to the patient, explain the course of action the health practitioner should take. (150 words)

Note: Criterion Nine does not require the identification of the substitute decisionmakers/parties in your analysis. Your answer must include the relevant legal authority.

Other elements:

• Word limit of 2000 words needs to be strictly adhered to. The word limit for an assessment item includes in text citations. The word limit DOES NOT include the reference list. Please note the marker will cease marking your submitted work once they have reached the allocated word limit.
• Ensure that you use only peer-reviewed literature and relevant legal authority to support your analysis.
• Use the APA7 referencing style. Unless otherwise instructed, write in the third person.
• Use health specific and academic language throughout.
• Refer to the marking rubric (criteria) when writing your assignment. This will assist you in calculating the weightings of the sections for your assignment.
• Save copies of your version and FINAL. (It can be useful to email your final assignment to yourself as well so you can always access a copy).
• You can submit your essay to the draft submission point (‘Written Assignment Case Study DRAFT Submission’) to check your own text matching, prior to submitting the final version.
• Submit your assignment via Turnitin as per the instructions.

Case Scenario:

Archie, a 25-year-old married man with two young children is a viticulturist and has worked at the Canungra Valley Vineyard in Queensland for seven years. He has recently been promoted to manager. He has been married to Ashley for 4 years who works as an administrative officer at the local City Council. Although Archie’s family home is in Lismore, he stays at the vineyard and comes home to his family when he can. He has shared a  unit at the Canungra Valley Vineyard with his best friend and vineyard supervisor (Steven) for the past seven years. Archie has always been a keen sportsperson. He is very fit, and competing at the Olympics debut is his dream: he is preparing for the Olympic decathlon in 2024.

In late October 2021 Archie was mowing the lawn and suddenly has severe pain in his neck and right arm. He becomes breathless and nauseous. He took a break, and resumed mowing the lawn. Steven advised Archie that he should visit the local clinic. The nurse took his observations and noted a mild variation from normal respiratory rate. Further tests including ECG, Oxygen saturation (SpO2) and blood pressure were done, and Archie remained at the clinic for repeat observations. When the nurse returned 20 minutes later, Archie had collapsed on the floor. An ambulance was called, and by the time it arrived, Archie had recovered and insisted on going home. His respiratory rate appeared normal, but he wouldn’t allow the paramedics to take his blood pressure, retracting his arm each time they tried. The paramedics advised Archie to drink plenty of water and take rest for a couple of days. They further advised him against any type of sports training for the next four weeks.

The following week at work, Archie fell from a ladder from a height of 6.9 meters. Steven and other staff rushed over and saw that Archie had sustained a head injury and was lapsing in and out of consciousness. Paramedics arrived on the scene, and requested an air ambulance to a tertiary hospital. The paramedics concurred he had suffered severe traumatic brain injury (TBI), had a negative corneal response, and an extensive facial and skull fracture. They also suspected injury to his thoracic spine. Archie was intubated and transferred to the nearest tertiary hospital.

At the hospital, Archie’s computerized tomography (CT) scans confirmed multiple skull and facial fractures, a subdural hematoma, tentorial herniation and injury to his thoracic spinal cord nerves T-1. While the cumulative effect of these injuries was potentially life threatening, considering Archie’s otherwise good health, the healthcare team considered he could recover and admitted him to the intensive care unit. They explained to Ashley and Steven Archie’s scan results and their treatment plan.

Archie’s haemodynamic condition was stabilised, and he was prepared for surgery to fixate the facial fractures and evacuate the haematoma. He also required a tracheostomy. Ashley was hopeful of Archie’s recovery whilst Steven, who has seen Archie’s injuries at the scene of the accident, was less optimistic.

Following three weeks of intensive treatment, Archie’s medical prognosis based on neurologic examinations was guarded. Ashley, however, was encouraged because he occasionally moved his head and squeezed her hand when she spoke to him. However, Archie could not be weaned from the ventilator and continued to show no signs of recovery after a month at hospital. Ashley began to accept that Archie may never return to his former state of health.

The healthcare team concluded that Archie was in a minimally conscious state (MCS) and recovery of his neurologic function was unlikely. Continuing treatment was not considered to be in Archie’s best interests and they recommended withdrawing treatment, strongly opining that continuing treatment would be medically futile and  practice. The healthcare team treating Archie was informed by the hospital administrative office that they were in receipt of a certified copy of Archie’s advance  directive (AHD) executed in June 2021. However, the AHD was deemed legally invalid as it has not been properly executed (the AHD has not been duly certified by a doctor as required under Queensland law).

Steven agreed with the prognosis and recalled a conversation he’d had with Archie about how they would want to be treated if they were ever faced with a situation where they became dependent on others, such as their wives. He further recalled that Archie made him promise that he would ‘turn the bloody machine off’ if he ever faced that situation.

Ashley had a different perception. She strongly believed that her husband was exhibiting clear signs of self-awareness. She undertook extensive research about TBI would one day regain his neurologic function to the point where he could communicate with his family, if not return to his prior self entirely.