Parameters of the Doctrine of Substituted Judgment

DISCUSSION BOARD

Discussion Board

Question 1:  You are the risk manager at an urban healthcare institution.  Describe three (3) action plans your department will implement and oversee in the next fiscal year to reduce the incidence of medical malpractice lawsuits brought against your institution.

It would be prudent to note that when it comes to medical malpractice, the focus happens to be on the duty of a healthcare practitioner to adhere to certain medical standards of care. A medical standard of care could be defined as “the specific conduct or implementation of procedures considered to be customary by the local relevant medical community at the time of the alleged negligent action” (Lamberg, 2018, p. 131). Carol Gunn indicates that 200,000 persons die in the US on an annual basis due to medical errors (TEDx Talks, 2015). It would be prudent to note that in the context described, there are a number of action plans that could be implemented in efforts to prevent claims related to medical malpractice. To begin with, my department would seek to ensure that all clinical procedures and undertakings are in line with nationally and globally accepted clinical guidelines. This is especially important given that the said clinical guidelines often come in handy in efforts to ensure that there is no significant variation in care. For this reason, they are especially instrumental in clinical decision-making. The said clinical guidelines would also help avert adverse clinical events owing to the fact that they are firmly rooted in evidence-based practice.

Secondly, I would also ensure that all those who work in the said department are aware of the relevance of informed consent. This is more so the case in seeking to ensure that patients are aware of the nature and conduct of the relevant medical procedures, and that they consent to the proposed procedures. It is important to note that as Pozgar (2019) indicates, undertaking a procedure or treatment that the patient has not consented to routinely gives rise to malpractice claims.

Third, documentation could also be of great relevance on this front. For this reason, there will be need to ensure that up-to-date, specific and accurate records are maintained during every stage of interaction with patients. Proper documentation helps clarify incidents and present truthful as well as accurate accounts of interactions with patients.

Question 2:  Discuss the parameters of the doctrine of substituted judgment, as detailed in Strunk v. Strunk, Hart v. Brown, In re Quinlan, and elsewhere.  In what circumstances do state interests prevail over an individual’s rights?  When might the courts be required to resolve such a dispute?

In basic terms, the doctrine of substituted judgment largely relates to the establishment of the course of action that a patient who happens to be incompetent would likely embrace if they were in a position to make decisions for themselves. In this case, it is a surrogate who seeks to establish the said course of action. One of the key doctrine of substituted judgment parameters – specifically as highlighted in re Quinlan – is that the patient’s interests ought to be deemed predominant, as perceived by the said patient’s guardian (who happens to be the patient’s surrogate) (Lamberg, 2018). Further, it would also be prudent to note that with every increase in the extent of bodily invasion, there is weakening of the interests of the state and the growth of the right to privacy of the individual (Lamberg, 2018). This also happens to be the case with the diming of prognosis. Lamberg (2018) also indicates that in Cruzan v. Director, it was established that the evidence of the patient’s preferences must be presented in a convincing and clear manner. Thus, to a large extent, the two court cases highlighted above demonstrate the relevance of individual liberty. In essence, state interests could prevail over an individual’s rights if there is a prevailing need to ensure that public good is served. This, however, results in tension between individual rights and collective good. When such inherent tensions emerge, the courts may be called upon to intervene.