Patient Brain Death Case
In many hospital cases, there are complex presentations that come with dilemmas, which are difficult for medical professionals to fathom. In light of the dilemma, there are always decisions that have to be made. Before making the decisions, medical professionals are required to not only work with the patient but the family members as well. It is a possible scenario that disagreement is bound to occur when family members are supposed to make a crucial decision on behalf of the patient. This essay seeks to break down a case of dilemma in decision making, some of the legal and ethical issues that arise over time. Further, the paper will also suggest some of the actions that should be considered by the health administrator as well as the resources that are utilized in the long run.
Medical issues arising from the case
The patient in the case study is a victim of traumatic brain injury, secondary to a traumatic encounter and therefore, unconscious and unable to make decisions appertaining her health interventions. The prognosis of the condition would be determined by several factors including age, GCS scale, and the location of the injury and the length of time one is in a coma. The severity based on the location of the damage would affect notably different parts of the brain that control specific areas of the body (Rubin, Yamal, Chan, & Robertson, 2019). In all cases, however, the prognosis of TBI is poor, and most patients do not survive despite aggressive measures to resuscitate. Patients affected by this condition are often in a vegetative state and have no response to the stimuli.
The brain imaging of those with symptoms, based on the neurological examination revealed that the patients have deficient functions in the brain. The dysfunction in the brain occurs as a lesion in the brain stem, some of the subcortical structures of the cerebral hemisphere as well as the cerebral cortex. There are unlikely to transition towards healing regarding those with severe brain injury. It is only on rare occasions that one would transition from the comatose to full consciousness. In the presented case study, the patient appears to be hanging between the comatose stage and the vegetative state, showing no possible return to consciousness. Brain death is out of the question, and the patient can, therefore, be diagnosed with coma.
Laws and Regulations that apply to the situation
There are many instances when medical professional are supposed to make decisions that would cost a life. However, the fear of litigation is among the many reasons why most would shy off from making step. The legal provisions on taking an action that has an impact on one’s life vary from one state to another. Acting in a manner that is not in tandem with the legal provisions has negative implications on the professionals, and there are many times where this cost people withdrawal of their practising licenses. Building up to the current practice, the legal practice in medicine has been through an enormous trail of a historical journey.
The legal provisions in the United States, on whether or not to withdraw life primarily depends on the principles of both informed consent and informed refusal. The principle is anchored and firmly rooted in the common law. For the principle to hold, treatment cannot be initiated devoid of approval by the patient or the surrogate when consent cannot be obtained from the patient (Luce & Alpers, 2000). The first application of the law came into limelight in Quinlan case, where the New Jersey Supreme court ruled that the patient had a right to decline on mechanical ventilation and since she was vegetative and could not consent her parents would be used as her surrogates.
In a Berber case, a similar ruling was made in California Court of Appeal when physicians who had withdrawn nutrition and hydration from comatose patients upon consent by family members were acquitted of any wrongdoing. Later on, the aspect of withholding or withdrawing life was first addressed by the U.S Supreme Court in the Cruzan case that entailed the request by a mother to remove a feeding tube from a vegetative daughter (Stewart, Mathiesen, Ammar, & Honeybul, 2020). In this particular case, there was a need for robust evidence to demonstrate that the patient was unable to make decisions and hence needed the intervention of the surrogate.
In an elderly patient, in the event life is to be terminated, there is a need to establish the possible availability of a competently written will or advance directive. In the case presented, there was no will or advance directive. There was also no power of attorney to authorize how decisions would be made on behalf of the patient in the event the patient was unable to create one. This is therefore responsible for the brewing conflict between the family members.
Ethical principles
The conduct of all healthcare professionals is grilled between the bounds of ethical principles. When about to make any life-determining decision, the medical professionals ought to obtain written consent from either the patients or their caregivers/ surrogates in this case. In the event, the patients are unable to pin a consent; a decision can be made on their behalf by the surrogates who are, in most cases, trusted family members. The surrogates are mainly required to be family members or the next of kin indicated by the patient.
In the event there is a medical power of attorney, will or advance directive, the ethical committee of the hospital can be able to propose the utilization of these documents as voices for the patients, dictating any interventions given. The hospital does not, however, interfere with the issues of inheritance in the family (Cohen & Loewy, 2018). In this case study, just like many other cases, there is no power of attorney, advance directive and competent will. Therefore, court processes, based on evidence and testimonials, would be used to wedge off the stalemate.
Actions of the Health Administrator
As a health administrator, the backrests with ensuring that the wishes and rights of the patients/ surrogates are respected and adhered to the latter. Actions also ought to be informed by the recommendations made by the members of the critical care team on the progress and conditions of the patients. Any steps are supposed to be guided by ethical considerations and strict adherence to the federal, state or local government provisions. Conformity and adherence to the appropriate legal procedures make it possible for the hospital to maintain its integrity and therefore protect the reputation. The hospital administrator also has a role in ensuring proper availability of staff members and adequate rotations which then facilitates an efficient working system. Correctly constituted and functional human resource would enhance efficiency hence better outcome.
Resources
Majorly, human resources are crucial in this case. Some of the essential service providers include physicians and nurses. Social workers can also be involved since they help bring about an understanding between patients, families and medical professionals. The social workers also work to ensure the wishes and requests of the patients are taken into consideration and addressed utterly. The ethic committee would guide the ethical considerations throughout.
Conclusion
The family form a significant portion of the social support system to patients suffering critical conditions. They play numerous roles, including making informed consent on behalf of the patients when they cannot. Collaboration between the patients, their families and medical professionals helps to reduce possible medical dilemma and ease the delivery of healthcare interventions. In different cases, the decision to withdraw or withhold life by the medical professional ought to be informed by informed consent, failure to which, it is risky.
My clinicians face potential litigation when they act without sufficiently demonstrating that they did so in the best interest of the patient or family members’ wishes. It is therefore imperative that professionals try to find common ground between the ethical principles in healthcare and what they encounter daily. The human resource is some of the essential resources in critical care settings. Integration of different healthcare professionals would, therefore, be crucial, especially in critical care settings.