Patient Rights and Informed Consent the Relevant

¶ … Patient Rights and Informed Consent

The relevant legal issues at stake in this case are those related to the question of whether Mr. Jones is indeed incompetent and if Mr. Jones is indeed incompetent then what is the authority that should be assigned to the surrogate daughter of the patient in this case. The hospital physician and staff must avoid legal liability and ensure that they are in adherence to relevant laws and regulations informing the proper actions in this particular case. The patient has a legal right to be fully informed on any treatment that is considered and has the right to either provide consent or alternatively to refuse to consent to any proposed treatment. In this particular case, Mr. Jones has been found to have the condition of Alzheimer's and to be incompetent. Proof has been provided for the treating physician and nursing staff of Mr. Jones incompetency. Mr. Jones has refused a leg amputation with his decision based on leaving the world in one piece. His daughter, the surrogate in this particular case has backed Mr. Jones refusing the leg amputation on behalf of her father. There is conjecture on the part of the staff that the daughter is afraid she will have a charge of neglect leveled against her. In examining the issues of the right of the patient and the surrogate, several things must be considered. Although the daughter appears to have proof that her father has been deemed as incompetent, there is doubt among health care professionals in this scenario that he is indeed incompetent and it is stated that it is believed that his problems with breathing are to blame for his confusion. With these issues in mind the "Uniform Health-Care Decisions Act" drafted by the National Conference of Commissioners on Uniform States Laws" (1993) which states that a "surrogate may make a health-care decision for a patient who is an adult or emancipated minor if the patient has been determined by the primary physician to lack capacity and no agent or guardian has been appointed or the agent or guardian is not reasonably available." (Uniform Health Care Decisions Act, 1993) In addition, there is a requirement that the surrogate immediate communicate "his or her assumption of authority as promptly as practicable to the members of the patient's family" as required in subsection (b) who are able to be contacted immediately. The surrogate is required to make a health-care decision "in accordance with the patient's individual instructions, if any, and other wishes to the extent known to the surrogate. Otherwise, the surrogate shall make the decision in accordance with the surrogate's determination of the patient's best interest. In determining the patient's best interest, the surrogate shall consider the patient's personal values to the extent known to the surrogate." (Uniform Health Care Decisions Act, 1993) It is important to understand that the surrogate's health care decision does not require approval by a court to be effective and that at any time an individual may "...disqualify another, including a member of the individual's family, from acting as the individual's surrogate by a signed writing or by personally informing the supervising health-care provider of the disqualification." (Uniform Health Care Decisions Act, 1993) Subsection (f) imposes on surrogates the same standard for health care decision making as is prescribed for agents in Section 2(e). The surrogate is required to follow the individual instructions of the patient and any other wishes expressed by the patient to the extent known by the surrogate. It is specifically stated as follows: "In determining the patient's best interest, the surrogate is to consider the patient's personal values to the extent known to the surrogate." (Uniform Health Care Decisions Act, 1993) In Subsection (g) it is held that a healthcare decision made by the surrogate does not require judicial approval. This act affirms that health-care decisions should whenever possible be made by a person whom the patient selects to do so. Expressed in the act is a preference that is stated strongly for honoring the individual patient's instruction on their care. Under the Act the surrogate is required to honor individual instruction of the patient. The individual instruction of the patient can only be voided when the court rules that it be so voided. Because the courts do not have "particular expertise with respect to health-care decision making" it is held in the Act that decisions should be made by the patient, their guardian, surrogate, or agent whenever possible. (Uniform Health Care Decisions Act, 1993) The physician is responsible to ensure that there is no advance health care directive available, which the patient has signed according to Section 7 of the code. When no such document exists the physician must record the decision of the patient and/or the surrogate in the health-care records. The health care provider is required to comply with the instruction of the patient or their surrogate or other person authorized to make health care decisions for the patient. In the event the health care provider believes that there is a "reason of conscience" in regards to the decision, the physician may decline the individual instruction or health care decision made and as well the health care provider may decline the individual instruction or surrogate decision if the decision requires "medically ineffective health care or health care contrary to generally accepted health-care standards" (Subsections e and f). If the health care provider declines the individual instruction or surrogate decision, the health care provider is required to "promptly so inform the patient, if possible, and any person then authorized to make health-care decisions for the patient; provide continuing care to the patient until a transfer can be effected; and unless the patient or person then authorized to make health-care decisions for the patient refuses assistance, immediately make all reasonable efforts to assist in the transfer of the patient to another health-care provider or institution that is willing to comply with the instruction or decision." (Uniform Health Care Decisions Act, 1993: Subsection g) In the case that the health care provider decides to decline the individual instruction of a patient or the decision of their surrogate the ethics consultant committee is able to assist in three ways and specifically in the following ways: (1) providing a case review; (2) giving advice on policy matters; and (3) educating health care provider and their staff. (Moreno, nd, p.2)