Introduction
The case study entails a series of ethical, medical as well as legal issues. These shall be examined in light of the duties and responsibilities of all the parties concerned in the latter claims.
Analysis of the Mary Wright case
Several participants were involved in the latter case study and they include Doctor I like Children, Mary Wright, Mary’s grandfather, Mary’s parents, the CEO Of Happy Valley hospital, and Nurse Thisismyward.
Doctor Ilike Children performed a surgery classified as cosmetic on a teenager. There are several legal implications of such actions but before getting into the legal implications of her actions, it is essential to understand the context of Australian law on that matter. Australia has been one of the first countries in the developed world to pass legislation restricting cosmetic surgeries for teenagers. In the state of Queensland, this matter has been banned completely for persons under the age of eighteen years. According to this law, candidates for cosmetic surgery are required to wait for three months in order to fully internalize all the issues involved in the surgery. This is a legal duty that Doctor Children should have carried out but it was clear that she skipped this responsibility and could therefore be liable for the problems that emanated after the surgery such as poor satisfaction from the client. (Yates, 2009)
Aside from that, the medical practitioners involved in the surgery must consider a number of factors that may contribute towards malpractice and they shall be examined below. Before choosing to carry out the surgery, it was Doctor Ilike Children’s responsibility to ensure that her patient has the right judgment and maturity to be able to go through such a drastic and permanent procedure. Medical findings indicate that human beings reach full brain development during their twenties and some even in their thirties where the frontal lobe grows to its maximum level. The latter section of the brain is important in controlling such issues as impulsiveness, decision making, and other thought processes. In fact, improper development of the frontal lobe can be used to explain why teenage suicides are a common phenomenon or why adolescents tend to engage in drug abuse. Mary Albright was at a point in her life where she was still discovering and learning to accept herself. Her reasons for getting involved in the surgery are rather questionable – she was just self-conscious and wanted to fit into her environment. These matters may still drive an adult to engage in cosmetic surgery, however, their judgments are more solid than those of teenagers.
However, there is a twist to this matter – sometimes some surgeries may not be purely cosmetic in that they may entail some reconstructive aspects. For example, Mary had prominent ears that made her very self-conscious. Her issue can be likened to a girl who may undergo breast implant surgery to correct asymmetrical breasts. In other words, Mary’s imperfections were outstanding and this was hampering her day-to-day life. The surgery may therefore be regarded as being both reconstructive as well as cosmetic. Doctor Children may therefore defend herself by asserting that this surgery was essential in correcting a mild irregularity. Ear surgery or otoplasty is classified as a medical procedure and not a cosmetic one. This implies that Dr. Children may have justifications for her actions.
Doctor Ilike should also have thought of the safety issues surrounding this surgery. In other words, she should have asked – did Mary Albright’s age, health or history put her at a particular risk that would negatively affect the outcome of the surgery? The answer to this question is no. In fact, there was no medical problem with the alterations that Doctor Children carried out – the main controversy arose with the patient’s opinion on her appearance afterward so the surgery was safely done.
The Doctor was also obliged to comply with a series of codes of practice. The Australian College of Cosmetic surgery asserted that all surgeons must obtain informed consent and cooling-off times between the surgery and consultation. Besides this, surgeons are expected to inform patients about possible outcomes, risks, alternative treatments, and any other issues surrounding such a move. From the information provided in the case study, there was no assertion that Dr. Children offered any such help. The only thing that she did was to look into the biological or physical fitness of this patient to undergo surgery. Consequently, he prevented Mary from considering other viable options and this may have impeded her ability to carry out the surgery. (Thomson, 2003).
A psychological evaluation of the patient must also be done where the doctor must look into the reasons why the patient is interested in surgery and whether there may be some psychological risk factors that may come in the way of making patient outcomes satisfactory. Dr. Children may not have adhered to this code of practice as expected because she should have been in a position to assess the fact that Mary had a psychological risk factor.
The CEO of Happy valley Hospital was also expected to comply with a series of legal obligations. Before approving this surgery, the CEO of the hospital should have reconsidered some of the statistical evidence in the country concerning the kind of procedure he was to carry out on Mary. Several reports indicate how numerous adolescents are opting for body-altering procedures. Besides that, other reports have asserted that some adolescents may be unhappy with their bodies but these opinions change as they get older. Teenagers tend to exaggerate their flaws and want to look perfect yet this may not necessarily be realistic. The CEO could have considered postponing the surgery up to a time when the patient was old and mature enough to wait for the results of the surgery. (Parker & Lidz, 2001).
The CEO should also be aware of the fact that the surgery is governed by tort law. In other words, if it is found that there was negligence on the part of the practitioner i.e. failure to carry out necessary measures for preventing possible injury, then one should be in a position where they have to face the consequences of the actions. This is because patients can sue for damages based on negligence. In the case study, Mary may not be in a position to get damages on such grounds because Happy Valley Hospital ensured that they complied with tort law. (NSW Parliamentary library, 2006).
Children can have a right to make their own biological or medical decisions. However, this must be done based on the patient’s maturity. The major principle governing such an issue is that of patient confidentiality. It was the CEO’s duty to examine whether Mary possessed such maturity. However, the process of determining a patient’s duty may be rather difficult, therefore, the CEO should have looked towards Marion’s case which set the precedent for determining whether a minor can give an informed case. In this case, it was held that a minor can give informed consent if they fully comprehend what is entailed in a medical decision. They need to demonstrate that they are intelligent enough to do so. The following is a summary of some of the things that should be considered in such procedures: the child’s age, the level of dependency on one’s parents, mental illness, personality, history, family dynamics, attitude, voluntary presentation, and apparent maturity. The CEO and Dr. Children should have been in a position to see that Mary lacked some of these qualities. This matter can therefore be argued under two lenses. In the first perspective, Dr. Children can argue that she had checked for the latter mentioned qualities and found that Mary possessed almost all of them. On the other hand, Mary’s parents can argue that she missed some of the qualities required for informed consent and that she was not capable of fully understanding the situation. (Binabauer, 2008)
The other party that was involved in this complex case was Nurse Thisismyward. She believed that she was doing the right thing by refusing to take part in Mary’s surgery and was summarily dismissed. She has support from the Union and the NSW. For the Nurse’s case to be valid, she needs to show that her employer had seriously breached his contractual terms. One of these terms is the issue of public notice before termination. An employee is entitled to a minimum warning period before termination of her employment. This did not occur in her summary dismissal. Exceptions to this rule are allowed when the employee has committed a serious offense such as theft. The matter under question may not fully justify summary dismissal because Nurse Thisismyward did not commit a very grave offense. This means that the CEO may have wrongfully dismissed this registered nurse. (GLD, 2009)
Mary’s parents are also suing Happy valley hospital with claims of assault. In order to see whether the latter group has a case, it is essential to understand some of the legal and health principles that come into play. First of all, these parents may argue for contributory negligence. In other words, the plaintiff and the defendant all contributed towards the issue of Mary’s disappointing surgery. (Southby, 2008). However, the plaintiff does not have a duty towards her Doctor. Instead, it is the practitioner’s negligence that may constitute this breach of duty. In the past, Australia had a paternalistic approach towards the doctor-patient relationship, however, due to advances in technology and increasing patient knowledge, now patient autonomy has gained a lot of precedence in determining who remains a final decision maker when carrying out a medical procedure. (Thomas, 2004)
For the case of Mary Wright, it can be argued that she was a consumer of medical services. In other words, the concerned doctor needed to offer her suitable advice so that she was in a position to come to the best decision. In this case, Mary had rights that had to be respected and upheld by her medical practitioner. For the parties involved to have eliminated contributory negligence, then Mary should have been told about the differences of opinion that cosmetic surgeries can cause between a patient and a medical practitioner. Nonetheless, Mary was responsible for her actions. This means that the court is likely to hold her accountable for the choice to have her ears reduced rather than place the blame squarely on the shoulders of the Hospital CEO or Doctor. Contributory negligence in Australia is not as widely accepted as a cause or making claim against a certain medical practitioner because it is believed that patients’ negligence can cause their own injuries. In other words, it may be difficult for Mary’s parents to prove that Dr. Children has assaulted their daughter on medical grounds because the patient had a right to self-determination. (Harper, 2001)
Besides the latter matter of contributory negligence, Mary’s parents can argue under the grounds of medical negligence alone on the part of Mary’s doctor. This group can argue that standards of care and scopes of duty were ignored in this case and that this contributed to medical negligence. Failure to warn patients of possible problems can make such situations more complicated. In fact, many plaintiffs often cite the fact that they were not duly warned before surgeries as grounds for assault. But the problem with this approach is that it often places doctors on the defensive. Consequently, one way of dealing with such a matter is by using statistical evidence of the occurrence of the matter. Mary‘s parents can rely upon some of the challenges that have arisen in lawsuits whenever one has to take part in similar surgeries to their daughters’. However, it is likely that the court judge may refrain from depending on such an approach because it may make the judge appear as though he or she is favoring the plaintiff or that the legal system is inclined towards this direction. Therefore, Mary’s parents possess a fifty chance of winning their claims on assault if they take the route of medical negligence. (Amirthalingam, 2003)
Conclusion
All the parties involved in the case had legal duties towards one another. Doctor I like Children had a duty to ensure that she obtained informed consent. This would have been possible from the patient if she passed an attitudinal and maturity test. However, the patient demonstrated that she has yet to reach that limit. Consequently, Mary’s parents may have grounds for their claims. Besides that, they could also argue for medical and contributory negligence. The hospital CEO breached his duties because he summarily dismissed an employee who had not engaged in an extreme form of disrespect. Lastly, the nurse herself may have a case against the CEO because she was exercising her sound judgment. Mary herself may not have been in a sound position to make her own decisions.
References
Amirthalingam, K. (2003). Anglo Australian law of medical negligence. Torts law journal 11(2):1-19.
Harper,B. (2001). The application of contributory negligence to doctor/ patient relationship. Torts law journal 9: 1-37.
Yates, Y. (2009). Teens are getting plastic surgery. Sunday Tribune.
GLD (2009). Children and young people using cosmetic surgery. Web.
NSW Parliamentary library. (2006). Cost shifting in the Australian health system. Web.
Thomson, C. (2003). Confidentiality and privacy – beyond legal duties. MJA 6: 252-253.
Binabauer, W. (2008). The Age. Associate press.
Thomas, D. (2004). Walking through minefields: Health complaints in Australia. The Australian Health consumer 1: 1-3.
Southby, R. (2008). Health care reform: looking back to go ahead. MJA 189, 1: 1-3.
Parker, L. & Lidz, C. (2001). Informed consent – clinical practise and legal theory. Oxford: oxford University Press.