Introduction
Discussing the issue of care provided without consent has always been challenging. Patients may often refuse treatment even in emergencies due to various reasons, including their religious beliefs. Both legal and ethical consequences are expected to arise from the mandatory treatment of patients who did not give consent to them. However, in life-threatening situations, doctors are expected to act immediately and put the health of their patients first regardless of whether the latter agrees with the method of the intervention. The current discussion will explore the case of a patient refusing emergency care despite the diagnosis of abdominal aortic aneurysm and the actions of a healthcare provider targeted at eliminating the adverse risks of non-treatment.
There are several general principles established over time within the medical practice and apply to case law associated with healthcare ethics. For example, it is expected that every adult that is in sound mind has a legal right to determine what treatment will be done, which means that any health care intervention completed without consent is considered a trespass. Informed consent, in the medical context, refers to the ability of patients to make their own decisions regarding care based on all material information presented to them. The need to obtain consent is different from the duty to warn about the possible risks for the health of a patient. For example, in the described case, the doctor explained to the patient that if she does not receive immediate treatment, there is a high risk of mortality. Despite this fact, a patient has a right to refuse treatment, as the woman did in the scenario (Clancy, Vaught, and Solomon 2017). However, an important legislative exemption states that treatment without consent can be done in limited circumstances, such as an emergency.
Discussing Informed Consent in Healthcare
In the healthcare setting, informed consent is associated with the provision of information from doctors to patients about a specific test or treatment to decide whether the latter wish to undergo the recommended treatment. The understanding of both benefits and threats of intervention represents the possession of informed consent by a patient. The principle is detrimental to the discussion of patient autonomy since each of them has the right to make informed decisions about their health and various medical conditions. Therefore, it is expected that patients in a sound state of mind must give voluntary consent for the majority of medical procedures implemented in a healthcare setting. The failure to obtain informed consent from a patient before performing a certain test on a patient is legally considered battery, which is a form of assault. There are also various types of patient-doctor interactions, informed consent is assumed. For example, during a physical examination of a patient, there is no need to give consent since the patient is aware of the implications of such a procedure. Although, for a range of invasive tests that imply various risks to health or alternatives to treatment, doctors ask to give written consent by their patients.
Emergencies and Giving Consent
The emergency department (ED) of a healthcare facility is the main recipient of acute care and is the key source of last resort healthcare. Emergency physicians are therefore expected to act quickly when assessing the state of incoming patients who usually present with a variety of life-threatening illnesses. Thus, it is challenging for healthcare providers to manage the refusal of care, although it can occur even when the ramifications of such decisions include severe morbidity or mortality. This points to the possibility of arising ethical dilemmas associated with the methods of dealing with care refusal, as described in the case study. It is essential to determine whether patients’ unacceptance of treatment recommendations is grounded on intact decision-making capacity instead of the lacking informed judgment. Ethical tensions in emergencies are inevitable, and patients who refuse life-sustaining care in the ED pose a great challenge to the healthcare profession because of the need to deal with individuals who pose a barrier to the duty of care.
There have been multiple instances of patients or their relatives trying to refuse healthcare because of various reasons. The most significant challenge is presented by patients who refuse emergency treatments, such as blood transfusion or surgery based on religious beliefs. Patients whose religious ideas do not align with the recommended health interventions are particularly problematic in emergency settings because immediate treatment is essential to the preservation of life and the avoidance of potential morbidity. Physicians must be very particular when communicating their clinical concerns to patients refusing treatment and ensure that they understand the implications of their decision. Religion-associated ethical dilemmas in ED settings are complex because of the freedom of individuals to practice their religion, and it is important to respect this right as well as patients’ autonomy, which is protected even when individuals are in danger.
Nevertheless, physicians in emergency settings have a certain degree of obligatory beneficence, which is an implication of a duty of care. Beneficence is one of the key social roles of healthcare specialists within the development of the profession (Clancy, Vaught, and Solomon 2017). Although, it is essential not to confuse the principle with medical paternalism, which was a dominating idea within the medical practice of the twentieth century, with the attitude of ‘doctors know best.’ With the growing popularity of autonomy, the importance of paternalism reduced significantly.
If a patient cannot provide informed consent, another individual may be allowed to consent on their behalf. For example, parents make informed consent decisions for minors and also have the right to refuse care on the behalf of their children. Nevertheless, emergencies do not require consent from all patients, especially in instances of extreme danger to patients. Proceeding with the example of parents consenting to the care of their children, if physicians consider a specific situation an emergency, they can treat children despite the objections of their parents. Reports of parents refusing blood transfusions for their children in critical health states are easy to come by, thus challenging the idea of beneficence and compassion. As mentioned by Dalai Lama, people should start with the care for their loved ones when fostering positive relationships between people, and the lack of action when it comes to caring for children goes against this idea (Clancy, Vaught, and Solomon 2017). In the case of the woman refusing surgery because it would leave a scar, there was not enough viable reasoning that would outweigh the risks of not having the treatment.
Discussion
Therefore, emergencies require physicians to perform the necessary procedures in instances when patients cannot give informed consent. State laws make it possible for healthcare specialists to act without obtaining consent from patients, relying on implied consent. In cases when people are unable to communicate his or her wishes, emergency specialists must assume that a patient would want to receive the most appropriate treatment. In the described scenario, it is most likely that the patient did not understand the potential outcomes of refusing the treatment. It is up to a physician to determine whether an individual needing emergency care is in the correct state of mind to proceed with the treatment without the most recommended intervention. In the described case, the diagnosis of abdominal aortic aneurysm calls for immediate surgical action. Although the patient opposition to the surgery that will leave a scar, the physician made the right decision because he acted in the interests of the patient as applied to her health and subsequent well-being.
Thus, the actions of the physician described in the case can be justified by the fact that he acted in the interests of the patient in the situation of an emergency. Had the surgery was not performed, the woman would have most likely lost her life. Consent, therefore, is a requirement for cases of emergency as healthcare providers must do everything in their power to prevent death or severe health impairments. As applied to emergency care settings, informed consent rules still apply; however, it is most likely that in very dangerous situations, it will be presumed for patients. That is, a patient is presumed to have given consent to any relevant, immediate, and medically appropriate care that must be provided to avoid adverse health consequences and even death. Such a presumption reflects the acknowledgment of the law that a patient requiring emergency treatment but refusing does not understand his or her real situation.
Summary
In the described scenario, the actions of the emergency department physician are completely justified as the emergency called for immediate action to preserve the patient’s life. The most likely outcome of the patient’s legal action against the hospital is the acknowledgment of the surgeon’s duty of care and the fact that he acted in the context of an emergency to ensure the preservation of the patient’s life. In a situation when the life of a patient is at stake, consent is not considered a requirement as there is a high likelihood that patients in a state of shock from their condition cannot make decisions using sound and informed judgment. Moreover, the physician was effective in explaining the potential outcomes of both treatment and the absence of treatment, and the patient continued resisting an emergency intervention. The greater controversy could have existed in the described scenario if the patient explained her refusal to treatment from a religious standpoint. However, the fear of having a scar that can potentially harm the patient’s career as a model did not outweigh the adverse consequences of the aneurysm, which is why the physician did everything in his power to avoid the decline of the patient’s health. Had the emergency practitioner not decided to operate immediately, it is likely that he would have been sued by the patient’s family for malpractice and failure to provide care.
Reference
Clancy, Martin, Wayne Vaught, and Robert Solomon, eds. 2017. Ethics Across the Professions: A Reader for Professional Ethics. Oxford: Oxford University Press.