Healthcare Ethical and Legal Issues
Student name
Name of institution
Introduction
End-of-life decisions and care are one of the key medico-legal issues that the medical practitioners, healthcare professionals and all stakeholders in the medical field face. End-of-life care refers to the healthcare of patients both in their last hours and days of life as well as the care of the patient with a terminal illness and diseases that have progressed to an advanced stage and are incurable( Burkle and Benson, 2012). End-of-life care needs abroad range for atonal decisions with the consideration of the patients’ rights, medical experiments, and ethics and efficacy of continued care and interventions. The choices made are informed by technical, economic, bioethics and legal factors among others.
Laws in New York State on end-of-life decision and care
The state of New York laws recognizes four possible medico-legal issues that can arise as the life of a person comes to an end. They include removal and withholding of life-sustaining treatment, based on patients consent or that of relatives and other people close to them (White et al., 2016). The state law also distinguishes suicide, support commission of suicide, and euthanasia. The state laws function to strike an appropriate judgmental balance between an individual’s independence and desires of the society in the prevention of harm and wrongdoing.
The rules regarding treatment decision take into account the right of self-determination and the patient’s autonomy placed as the central issue. On suicide and euthanasia, the law exerts a constraint on individual’s actions for their benefit and the sake of the common interest. Concerning right to decide on treatment, adults of sound mind have a right to accept or refuse any treatment. The courts recognize that the fundamental right is in line with the patient’s liberty interest whose protection is guaranteed in the New York State Constitution. It further resonates with the provisions of the Federal Law. However, there are state interests that might function to deny the patients’ rights to refuse life-sustaining treatment.
Just as in any other states patients can make an advance degree about the treatment decisions to be used in case they lose the capability to make the decisions by themselves. Healthcare proxy or “durable healthcare power of attorney” allows an adult to give authority to an agent to decide on his or her behalf in case the patient is incapacitated. Also available is the living will containing the directions to be followed by the individual becomes incapable of making decisions.
Legal handling of suicide dates back to old times and has a reflection on cultural, religious and practical beliefs on human life, personal responsibility and the relationship between a person and the state. Suicide or attempted suicide is no longer considered a criminal. However, though it’s legal, there exists no right to commit suicide under the common law. Nevertheless, the state of New York has made a statutory offense. Therefore, any suicide assistance leads to prosecution for manslaughter or murder. In the state of New York, it is an independent offense classified as second-degree murder unless suicide is due to other factors like duress or deception (Shepherd, 2014). Liability arises when a person intentionally acts to cause or aid a suicide. Any engagement in irresponsible conduct that causes suicide falls under the manslaughter category. The above is contained in section 125.15(3) of the Penal Law.
Section 125.25 of the Penal Law states that suicide through the duress and deception is classified as a second-degree murder. This is through the provision that causing suicide does not lie within the confines of intentional murder. Suicide through fraud or duress differs from assisted suicide in the fact that the defendant is not seeking to effectuate the wishes of the victim to commit suicide. Instead, it piles pressure to cause a suicide that would have otherwise not taken place (Shepherd, 2014).
Shepherd 2014 notes that the arguments have it that suicide and active euthanasia are almost equivalent, the laws of the state have clear distinction’s regarding the two. Whereas assisted suicide is a form of second-degree manslaughter, euthanasia is categorized under the definition second-degree manslaughter. The defendant kills the victim intentionally and in a direct act. Because consent is not a defense into murder euthanasia is thus prosecuted as a second-degree murder.
Consent in end-of-life decisions and care
New York State’s conditions the withdrawal of life-sustaining treatment on vivid and convincing evidence of the wishes of the patient (White et al., 2016). However, there is a Task Force that once recommended for the establishment of a statute that would allow family members of the patient to have a hand in decision making as regards the treatment for patients who have no decision-making capabilities
The New York state does not allow withdrawal or withholding of life-sustaining treatment from adult patients with no health care proxy, living will or oral instructions of clear and convincing manner. For example, in1981, the court denied a mother’s request to dismiss blood transfusion services to her son who was developmentally disable. It was because the patent had no ability to t make treatment choices for himself. The judges of the court ruled that no one, including the family members, could reject life-saving treatment for soemone3 else with no clear and resounding indication of the patient’s interests and wishes. Nonetheless, the health care proxy currently allows the family members and people close to the patient to refuse cardiopulmonary resuscitation when a cardiac emergency or respiratory arrest occurs.
The New York state laws have a less clear on the withdrawal of or withholding of life-prolonging treatment for minors. Also, the decisions by the organs of the judiciary underscore the role of parents in having a broad authority to decide for the minor children, but their decisions should not violate the legal prohibitions concerning abuse and neglect.
Healthcare ethics and institutional review boards on end-of-life decision and care
There are standards set in the civil and criminal law where a physical ought to practice medicine with the classic provisions established by the medical profession. The establishment of standards is set ways that include the Legislature policies, statement from reputable professional bodies like the American Medical Association, and the physicians (Weissman et al., 2016).
Hospitals and other healthcare providers, through quality programs, take a review of patient care to find out if the medical professionals are conducting their practice by the accepted medical standards. Professionalism in medical practice in the US is enforced in every state through the administrative disciplinary process. In New York, disciplinary issues are under the authority State Board for Professional Medical Conduct. This board is under the New York State Department of Health. The board comprises of about two hundred and thirty members who are tasked with the duty of investigating the protests of misconduct in practice. The also take necessary charges and sanction medical officers who violate the accepted medical standards.
Corrective proceedings to be mentioned before the board can arise from grievances by patients, doctor of medicine, hospitals or the issues can be raised by the state Department of Health. After receiving the complaints, the board can determine whether or not to commend the bringing of formal charges. Many times, the board does not recommend the proceeds as evidenced by the very small percentage of the formal charges. In times when the board does not opt for proceeds, the state department of health will officially work for charges against the medical practitioner. The move triggers a series of committee adjudicatory decisions that can be challenged in the court if their outcome is not satisfactory. In case of sustenance of disciplinary charges, penalties are instituted and can include reprimand, suspension from practice or revocation of license, and fines among other penalties. Disciplinary charges against offenders of assisted suicide attempt to look at the physician’s objectives or whether the doctor was the proximate cause of the death of the patient. In such situation, the board can apply the general negligence standard with the accepted standard.
Taking a closer look at the healthcare ethics committees, have a great responsibility in decision making and healthcare delivery in end-of-life care. The committees have the core function of educating the community regarding the end-of-life care. They boards also set the institutional guidelines and policies concerning bioethical issues they have to review cases (Caulfield, 2007).
The case review function or the ethics share an overlap with other organizational rules like the expression of corporate ethics, compliance with accreditation standards and risk management. The committees have an extended and an added advantage of having the powers to interfere with the autonomy and privacy of the patient and can influence the professional judgment concerning the treatment options (Caulfield, 2007). The selection of the committee has to be of high integrity considerations. They committee has the power to make the end of life decisions for patients who have no identified alternative decision maker if some specific conditions have been met.
However, the functions of the committee can be limited by the patient's objection to life-sustaining treatment, or for breach of confidentiality and privacy of patient’s information (Coyle, 2016). They are always involved in malpractice suits. The choice of the committee is a critical life management decision of an institution. The decisions of the board and their jurisdiction should be subject to the recognition of the risk associated with their decisions. Their recommendations should be approved by the patient's representatives and the physicians.
Role of government and HIPAA
The government plays an important part at the end of life decision and care through ways such as legislation, policy development, quality assurance, and financing among others. Policy formulation is a pivotal role that the government can play (Thomas, 2016). The policy serves to give direction and guidance regarding the end of life care like life-sustaining treatment. The policy should contain clearly defines the extent and limits of the application of the bioethical rules and concerns. It should set guidelines regarding terminal illness and other medical dilemmas. It should give guidance to institutions and medical practitioner in determining the appropriate steps to take when the patient is not able to make decisions
Thomas, 2016 argues that funding is imperative that the government can jointly undertake with the insurance companies to facilitate funding of the end of life care and treatment. Under, Health Insurance Portability and Accountability Act, Title IV has a definition of health insurance reform, encompassing the provisions for individual with pre-existing medical diseases. It also covers those who seek continued medical coverage. The expenditure should be directed at finding long-term solutions regarding end of life care.
The quality of medical care is an essential tool towards the realization the realization of the end of life care. The government can enhance this through setting up of high-quality standards to govern long-term care giving personnel and institutions ( Harrison & Connor 2016). The participation in end life care should be guided by conformity to the set standards. To realize this, there must be established bodies to ensure the standards are met. A center for Medicare and Medicaid Services is a federal agency that administers Medicare and Medicaid programs. The programs are meant to improve the quality of end life care. According to Harrison and Connor, 2016, quality of end of life care can be improved by ensuring that there are relevant and necessary skills among the caretakers. Ensuring that the training centers equip the health providers with the necessary skills and expertise is crucial to the realization of quality en-of-life care. Continuous training is essential to enhance decision-making capacity of the practitioners and institutions as a whole. Quality management programs when properly instituted ad applied can propel the decision and care of the patients.
Housing and provision of social services is an imperative jigsaw in helping people with terminal illnesses. Provision of social services will make the patients and caregivers get the necessary psychological stability and enhance their decision making on the appropriate care to be given. Good housing had been found to be an important element in health and social care. It offers benefits for the public purse that and enhances the ability of individuals to come to the end of life with dignity, respect, and control.
Conclusion
In summary, end-of-life decisions, and care is a major medical issue in the current world. With growing movements and advocacy for patient rights, coupled with rising levels of medical literacy, there is a concomitant increase in medical, legal issues. The right to self-determination and the right to liberty have been protected as supreme in the care of the patient. The Constitution of State of New York recognizes several medical, legal issues that might arise as the life of a person comes to an end. They include withdrawal and withholding of life-sustaining treatment, suicide, and euthanasia, with each aspect having its complexities.
The consent to end of life decisions and care are contained in the various statutes and subsection of the law. In consenting, the rights of the patient are always superior. His or her decisions should, therefore, be respected at all moments. Besides, end of life care decisions and care are subject to the various institutional and professional boards that have been entrusted with the task of managing healthcare in the different institutions, state and the federal government. Ethics committees are important consultation bodies on the clarification of bioethical.
Development of standards, goals, and objectives can help in quality assurance. It also helps create efficiency and effectiveness in the delivery of care. Government plays a bigger role in policy formulation and its application, funding, and provision of housing and social welfare services. Therefore, end-of-life decisions and care is a multidisciplinary item that requires the efforts of each stakeholder.
References
Burkle, C. M., & Benson, J. J. (2012, November). End-of-life care decisions: importance of reviewing systems and limitations after 2 recent North American cases. In Mayo Clinic Proceedings (Vol. 87, No. 11, pp. 1098-1105). Elsevier.
Caulfield, S. E. (2007). Health Care Facility Ethics Committees-New Issues in the Age of Transparency. Hum. Rts., 34, 10.
Coyle, N. (Ed.). (2016). Legal and Ethical Aspects of Care. Oxford University Press.
Harrison, K. L., & Connor, S. R. (2016). First Medicare Demonstration of Concurrent Provision of Curative and Hospice Services for End-of-Life Care. American Journal of Public Health, 106(8), 1405-1408.
Shepherd, L. L. (2014). The End of End-of-Life Law. North Carolina Law Review, 92(1693).
Thomas, K. (2016). Matters of life and death: the new Government report on choice in end-of-life care. British journal of community nursing, 21(10), 528.
Weissman, J. S., Cooper, Z., Hyder, J. A., Lipsitz, S., Jiang, W., Zinner, M. J., & Prigerson, H. G. (2016). End-of-life care intensity for physicians, lawyers, and the general population. JAMA, 315(3), 303-305.
White, B., Willmott, L., Cartwright, C., Parker, M. H., & Williams, G. (2016). Knowledge of the law about withholding or withdrawing life-sustaining treatment by intensivists and other specialists. Critical care and resuscitation: journal of the Australasian Academy of Critical Care Medicine, 18(2), 115-115