Legal and Ethical Aspects of A Case Study

In matters of life and death, critical decisions are made, these decisions go against the law or moral principles. Janet had her advance directives with certified signatures; she had named her husband Jack as her primary agent and durable power of attorney on her health issues and her parents as secondary actors. In the directives, she stated that if by any chance she ended up in a medical condition in which she can't recuperate from, her life should NOT be medically extended by any chance. While on the other side according to the State of Kansas, the declaration has no effect during Janet's pregnancy.

Janet was about nine weeks pregnant when she was about to be moved to hospice care for peaceful death. Her parents being the only agents remaining and even her priest came into an agreement that the wishes of Janet to be, respected. However, it is illegal for the hospital to take Janet off life support since she was pregnant. The law outlines well that her directives will have effect when she gives birth or in case the child dies.

According to be ethical and moral principles that guide a nurse where ethical decisions or in the event of a dilemma the nurse should allow the patient to make their judgments in an independent manner regardless of the therapist's values. In this case, Janet had made a decision, and her parents were given the freedom; to choose the fate of Janet. Unfortunately before that, the freedom was taken away the moment the resident physician discovered that she was pregnant; in this case the principle of veracity applies, the physicians obligations were to explain to the parents the law, her medical condition and how she can cope with the pregnancy in her vegetative state for them to rethink their prior decision. Janet's parents refused to go against Janet's directives hence the physician was left with only one decision to make.

Going against the law that governs a state comes with consequences but at the same time going against a patient's advance directives does too. The principle of beneficence gives the nurse a directive to protect a vulnerable minor. The unborn child's right to live where being abuse. Janet's chances of recovering from her medical condition were very faint, but even in her state, the child would grow healthy. Besides going against the law would have dire consequences for the hospital. There are prior cases where hospitals had been fined heavily.

There are state laws that give guidance on pregnancy and health care directives. These laws acknowledge the patient's medical wishes to be respected. Some states laws say that doctors may not withhold or withdraw life support from a pregnant woman or that such treatment may not be withheld if the fetus can be brought to term. These laws take away a woman's right to choose whether or not to bear children. In the state of Kansas, the law does not allow the advance directives to take effect in the case of pregnancy.

In this case, the legal issue is to defend the life of a vulnerable minor, the unborn child. But in protecting the children, they infringe the patient's freedom of choice. The nurse's ethical principle, freedom; where the nurse has to respect the patient's decisions regardless whether she agrees with it or not. The nurse should give the patient information on alternatives but let her decide the appropriate course of action. The patient must function independently. The legal and the ethical responsibilities repel each other leaving the nurse in a dilemma. The nurse's decision will be dependent on what has fewer penalties than what is morally and ethically right.

RECOMMENDATION FOR PROBLEM RESOLUTION

In Janet's health care directive she did not state if in her medical condition she would wish for the life of her unborn child to be saved even though that went against her wishes. In that case, the medical official's hands are not tied. If she had stated that; her parent would argue that irrespective of the state laws that, under the U.S Supreme Court rules that, the constitution protects women's right to choose whether or not to bear children. Thus her wishes would be protected. Hence the only thing lawful is the state laws that override the patient's health care directives. Its suggestions are that in case the nurses decided to go against the state law they can end up being in contradiction of the law, and a heavy fine can be inflicted in the future in case Janet recovers from her condition and sue them for not saving her child. Individually, I respect Janet's instructions, but I don't know if she would have the life of her son to be protected, her parents don't either. According to Janet she hadn't thought of such a situation, therefore, we don't know what her decision would have been.

Protecting the right of a minor is very vital. The unborn child if given a choice he/she would have probably wished to live. The physician said that Janet was not imminently dying which means that she could have survived a couple of more months and was in good condition to handle the pregnancy. When the patient is in a vegetative state the brain stem function is preserved but lack cerebral function, the patient can appear to be awake, have sleep-wake cycles, but there are no purposeful interactions. According to research, these conditions have resulted in near-normal neonatal outcomes.

Considering all the possible alternatives, I would have chosen to let the unborn child live. This is because whether I decide to protect Janet's wish, she would eventually die. The period of her pregnancy was a few months, and she would be let off life support, that way I have protected the right to live of the unborn child. On the other side, Janet did not provide any directives in case of a pregnancy that means my hands are not tied; I will also have concealed any loopholes in the event in future something happens. Thus I'll be on the right side of the law.

Marlise Munoz was brain dead after collapsing on her kitchen floor from a blood clot in her lungs. She was 14 weeks pregnant. Texas is one of the states doesn't allow, with varying degrees of strictness, medical officials from cutting off life support to a pregnant patient. She remained on life support at John Peter Smith Hospital. Her case was a collision of law, medicine, the ethics of end-of-life care and the issues spinning around abortion when life begins and how it should be valued. The court ruled that she be taken off life-support since brain death, an absence of neurological activity, is legal death, even if bodily functions can be maintained. The health of the child also was at stake since she/he could be delivered dead.

Jane was a forty-year-old from Kentucky. She had suffered severe brain trauma and was declared to be in a persistent vegetative state by the time she was transferred to the University of Kentucky Chandler Medical Center. She was six weeks pregnant hence the life-sustaining treatments could not be withdrawn, even though she had wished them to be. As a result, she was kept alive for thirty-six weeks so that the fetus could be brought to term.

Mrs. Cooper, 24, of Warsaw, Kentucky, suffered head injuries when her car slid into the path of another vehicle on a rain-slick road. She was two weeks pregnant, she was in a coma in her entire pregnancy, but she gave birth to a healthy daughter. She cannot move or talk, she is in a vegetative state, able to open her eyes and follow people around the room. The baby was delivered vaginally; doctors ruled out a Caesarian Section due to her medical condition. The baby was two months premature but healthy.

Whether it legal or not, morally and ethically right or not, ones right can be violated to protect others human rights. And in such cases we make choices that have more benefits and least penalties, that is which choice is more probable not what we stand for as an individual.

Reference

Kristen L. Johnson. Forcing Life on the Dead: Why the Pregnancy Exemption Clause Of The Kentucky Living Will Directive Act Is Unconstitutional.

Statute | Kansas State Legislature (2017). Legislative Resources. Http://kslegislature.org/li_2016/b2015_16/statuteState laws on pregnancy and health care directives (2017). www.nolo.com/legal-encyclopedia/state-laws-pregnancy-health-care-directives.html

The New York Times (2014). Pregnant, and Forced to Stay on Life Support. https://www.nytimes.com/2014/01/08/us/pregnant-and-forced-to-stay-on-life-suppory.html

Daily Mail Online. Coma Woman Gives Birth to Daughter. http://www.dailymail.co.uk/news/article-62940