Brief Summary of the Case
The case study which was presented both in text and in video was the case of a Martin Cavanagh, a patient diagnosed with COPD or Chronic Obstructive Pulmonary Disorder, a common respiratory disorder that typically presents with breathing impairments, increased fatigability, and in severe conditions, respiratory failure. Based on the types and volume of information being presented in the video, it can be implied that the film was made both for families of terminally ill patients as well as the different members of a rehabilitation and medical team, to make people from these two groups aware, how crucial the Advanced Care Planning phase of handling a patient can be. Healthcare-quality-related issues were addressed and exposed in the case, such as how frustrated the family members of the patients in a certain hospital, whose name would not be mentioned in this paper for confidentiality and other legal purposes, became upon witnessing first-hand the type of end of life treatment and palliative care that their relative received. This happens indeed even in cases wherein the quality.
Possible Legal Implications
The use of legal documents such as the medical power of attorney and other advanced directives were not properly justified nor showed in the case. The patient appeared too fragile and weak to handle the situation and even tell the medical team and his family members what he wanted to happen. That was one of the crucial points where advanced medical directives could have been used the best , especially during the period wherein the patient became too weak and easily fatigued to even simply turn his head while eating or driving. Another possible legal issue in the case was the deprivation of the patient’s ability to make a choice regarding his decision about his condition. The attending physician in the video himself said that there are certain instances wherein they do not ask what the patient wants them to do anymore and that they immediately proceed to doing their respective jobs to extend not the life of the patient but rather his death. As far as legality and ethics is concerned, every patient has the right to defer and refuse treatment. A medical waiver usually has to be signed in such cases to free the hospital administration and the attending medical team of any legal obligations in the future though
Ethical Issues
Primary, secondary, and tertiary healthcare systems may be the mainstream healthcare strategies that most hospitals and caregiving organizations today but it is also important to remember that there are also other specific types of care such as palliative care and the healthcare being delivered during a patient’s end of life stages . These two are important in a way that the quality and appropriateness of the healthcare that the patients receive during these stages may dictate whether they will manifest signs of exacerbations of clinical signs and symptoms of a certain disease—as in the case of patients being admitted for palliative care ; and whether the physician in charge would administer resuscitative measures after the patient suffers from a cardiac arrest or heart failure as in the case of making end of life decisions for a terminally ill patient .
The case study which was presented both in text and in video was the case of a Martin Cavanagh, a patient diagnosed with COPD or Chronic Obstructive Pulmonary Disorder, a common respiratory disorder that typically presents with breathing impairments, increased fatigability, and in severe conditions, respiratory failure . Based on the types and volume of information being presented in the video, it can be implied that the film was made both for families of terminally ill patients as well as the different members of a rehabilitation and medical team, to make people from these two groups aware, how crucial the Advanced Care Planning phase of handling a patient can be. Healthcare-quality-related issues were addressed and exposed in the case, such as how frustrated the family members of the patients in a certain hospital, whose name would not be mentioned in this paper for confidentiality and other legal purposes, became upon witnessing first-hand the type of end of life treatment and palliative care that their relative received. This happens indeed even in cases wherein the healthcare resources appear sufficient for a particular patient .
As far as legal issues in the case are concerned, there were two violations that have been identified: first was the violation of the patient’s right to take part in treatment decisions. Even though the staff asked for the patient’s consent before specific measures were undertaken, the staff still did what they thought would be the best for the patient. After all, the goal in administering end of life care to a terminally ill patient is to make him as secure, painless and comfortable as possible. A COPD patient who does not have any prior knowledge to the organs and organ systems of the body would only not know what would be best for him; he may even put himself in danger when the medical staff decide to fully reinforce the patient’s right to take part in treatment decisions. Nonetheless, that right, as stipulated in the patients’ bill of rights, was supposed to be followed because it was not placed there for any reason. It gives the patients the liberty to choose the type of treatment or management that they want. What complicated the case in the video though was the fact that Martin appeared to week to voice out all of his concerns regarding the treatment, secondary to his end of life levels of conditioning. Another ethical issue in the case was the violation of the patient’s right to voice out complaints and appeals. The complaints and appeals may actually be filed or voiced out by a patient’s family members . However, since the patient in the video appear to be treated for palliative care, the family members may have had no choice but to simply watch the medical team as they try to address the problems of the patient, even if in the first place, they did not like what they were seeing.
Reflection
Whenever I listen to the story of the persona in the case, I always ask myself two questions: whether the medical practitioners simply did their job and did what the patient’s family members expect from them or they did their job, based on what they thought was right and easier for everyone, not only for themselves to handle. To be honest, I am leaning towards the idea that they simply did their job. The patient’s family members may have misinterpreted the way how the medical staff, especially the doctors acted at such crucial a time, but the presence of the medical staff was definitely felt there and this fact alone is what makes it reasonable for me to think that they did their job, maybe not perfectly and flawlessly but they did it nonetheless. Some patients, especially those who are being admitted for palliative care or those who are in their end of life stages, may be more or less sensitive than others . Now, from what I saw in the video from the case study, the medical staff may have forgotten to consider that the level of sensitivity, the wants, and the needs, and the perceptions of every family member, especially when we become fizzled with the idea that they are about to witness the gradual weakening of a relative, and his death, come into play all the time, even in non-Advanced Care Planning settings. This patient may have required a certain variation in healthcare during his end of life treatments which obviously, based on how the events in the video turned out were not fulfilled, thus validating the statement of Professor Robin Taylor about the hospital where he appears to work, the Dunedin Hospital of New Zealand, suggesting that they were simply not hitting the mark when it comes to advanced care planning. Sure majority of their patients’ families appreciate the sophistication of the care that they provide to the patients but most of them get upset about how their loved ones appear to be treated as a patient just because they are in their end of life stages. The Dunedin Hospital’s management’s decision to look deeper into the issue of “dying well” through this video is a good and big first step towards addressing the frustrated minds of the people whose families the hospital’s medical staff may have failed.
References
Carolino, J. (2005). Ethics in Healthcare. Jorunal of Social Sciences.
Gray, J., & Wardrope, J. (2007). Introduction of Non Transport Guidelines into an Ambulance Service: A retrospective review. Emergency Medicine Journal, 727-729.
Lord, B., Recoche, K., O'Connor, M., & Yates, P. (2012). Paramedics' Perceptions of their Role in Palliative Care: analysis of focus group transcripts. Journal of Palliative Care, 36.
McNamara, B., Rosenwax, L., Murray, K., & Currow, D. (2013). Early Admission to Community Based Palliative Care Reduces Use of Emergency Departments in the Ninety Days Before Death. Journal of Palliative Medicine.
Medina, A. (2008). Issues and Challenges in Palliative Care. Journal of Advanced Health Planning.
Milton, R. (2009). COPD Patients' Remorse. Journal of Health Medicine.
Rosenberg, M., Lamba, S., & Misra, S. (2013). Palliative Medicine and Geriatric Emergency Care; Challenges, Opportunities, and Basic Principles. Clinics in Geriatric Medicine, 1-29.
Yore, J. (2005). Common Legal Issues Associated with End of Life Care. Public Health Review.
