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Woman With Dementia Refusing Treatment
The community needs to explore a elderly patients rights to end of life and quality of life decisions though beneficence, non-maleficence and justice. You There will be ever increasing economical costs to the community to insist patients consent to medical interventions. Studies have shown that some medical intervention with a high cost with little or no medical benefits towards the patients will only add to the economical cost to the community. This starts to become an ethical issue as how much should the community should spend towards chronically ill to prolong life. There are already acts designed to help and govern the rights of a ageing population such as mental health act 1986, mental capacity act 2007 and the medical treatment act 1988.
A) Dementia autonomous: autonomy;
Examples of dementia are Alzheimer’s disease, Vascular dementia, Parkinson’s disease and Dementia with Lewy bodies. This disease is progressive in the way it attacks and degenerates the brain. They leave the victim with frequent memory loss, confusion, personality change and a loss of ability to perform every day takes. In this particular case, the paramedics are called to a nursing home, an elderly patient who has dementia and is refusing to eat. An ethical dilemma is brought up straight away, the elderly patient has dementia, at what point does this chronic disease affect his/her ability to make functional and rational decisions. The mental health act 2007 protects individuals with a mental illness, as they do not automatically lose their legal rights and they are presumed to have a legal capacity unless proven otherwise. To prove incapacity to the patient, they must sit through cognitive testing, these test are designed to determine whether the disease is affecting their ability of thought, comprehension, orientation, memory and attention. "Patients may be cognitively intact but may lack decision- making capacity, may be able to make less complicated decisions"(Kerridge et al.,2009). In this case the patient is refusing to eat, are they in the right state of mind to be making that decision. They patient has shown an assumed non-verbal or verbal consent, this is an indication of his/her ability to make decisions thus making them autonomous, but one can argue how far gone their mental status is, there is no documentation such as a mental health advance directive or any known power of attorney. The patient's mental wishes towards their health are unknown.
This principle Beneficence is expressed in the Hippocratic Oath 'I will use treatment for the benefit of the sick, according to my ability and judgment (Kerridge et al.,2009). This principle is aimed at ones altruism and doing good to maintain the wellbeing of others. In this case the elderly patient is refusing to eat and if treated will end up having a percutaneous endoscopically-placed gastrostomy tube. This will allow the patient to be fed, this is common practice with patients with late stages of dementia. This medical procedure is deemed as appropriate, but is it going maintain their wellbeing or just prolong them to a slow and painful death. Little or no benefits can be maintained by the patient as the PEG has been found to cause diarrhea, nausea, bleeding, skin excoriation and is prone to tube malfunctions. All these factors are not benefitting the patient but acting as a hindrance.
The objective of all medical practitioners is to above all do no harm, this is known as non-maleficence. In modern medicine patients often undergo dangerous and painful procedures in the hope that they will lead to improvements in the long run(Kerridge et al.,2009). In this case, by taking the patient, are the benefits going to out-way the negatives. If the patient was transported to hospital and deemed incompetent she would undergo a battery of tests .
This principle relates to concepts such as fairness, rightness and equity (Kerridge et al.,2009). In this case the patient has the right to enhanced care as the nursing home can't provide the services to improve his/her health. The nursing home would be seen as negligent an unjust if they didn't offer a higher level of care.
Confidentiality is still deemed appropriate for a patient suffering from a mental disorder. Any information collected from both public and private sectors is covered from disclosure by the mental health act 1986. Relevant information can be disclosed for: general grounds for disclosure, disclosure to a court and disclosure for further treatment. In this case you have to recognize there is no paper work to go with the patient. If personal documentation did exist it is vital that only persons who are required to know the relevant information do so and confidentiality would be breeched under the information privacy act 2000.
Consider the law:
There are 3 main acts that are relevant within their concepts and design, they are the Mental health act 1986, Mental capacity act 2007 and Medical treatment act 1988.
Mental capacity act 2007: This act will give the courts powers to appoint an individual, who is seen to have the ability and the required judgment to act and make decisions. These decisions are made on behalf of a chronic mental illness suffer who has been deemed not competent by the courts. In This particular case the 75 year old women hasn’t been deemed as incompetent, her decision to refuse treatment is vindicated as she is still required as autonomous.
Mental health act 1986: This act is designed to protect the rights of an individual with a mental illness in regards to treatment and consent.
Medical treatment act 1988: This act governs the patients’ rights to refuse treatment and the procedure required to go about this. This act also enables an agent to make medically related decisions on behalf of a incompetent patient.
These laws are designed to govern the patient rights towards consent and treatment. The practitioner must have a firm understanding of these laws as they effect there values and approaches to situations. Consent and the different ways it can be obtained from a patient is critical to understand as the law, as it is based around this fundamental idea. The acts above give powers to mentally ill patients while practitioners have to respect their autonomy even if they believe there doing, is right by the patient.
This particular case has raised many ethical dilemmas in association of an assumed second stage dementia. The patient refuses transport to hospital for treatment of a chronic illness, that Is refusing to eat. I believe that if the patient was admitted to hospital all of the services core principles would have been broken. If the patient was to be treated and her wishes ignored, a crime has been committed assault and battery. There are acts that govern medical practitioners actions, theses acts protect the patients’ rights. Peoples who have a mental illness have the same rights, these patients rights are protected under the acts of law, she is competent until it can be proven otherwise, via the appropriate testing. If I was the attending paramedic knowing about the relevant acts, and respecting her particular wishes. I strongly believe that she is competent, she has shown this to me through the ability to refuse treatment and acknowledging her end state with dignity.
Kerridge, I., Lowe, M. & Stewart, C. (2009). Ethics and law for the health professions (3rd ed.). Sydney, NSW: The Federation Press.
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