I’m stuck on a Nursing question and need an explanation.
Riser v. American Medical Intern, Inc./Lack of Consent – p. 375 (Case file)
The material spans a broad spectrum from Patient Rights and Responsibilities to End of Life Issues and Legal Reporting of Incidents.
Here are the guidelines for this week’s posting:
Select one topic to discuss.
State the issue.
State the underlying legal principle associated with the issue.
Comment on the public policy benefit/detriment associated with the issue.
Think about public policy or the reason why the underlying law is important. We may not think it is always the case, but laws exist to benefit society.Topic: Physicians and Informed Consent: Physicians Must Disclose Alternatives
Case: Stover v. Surgeons
Facts: The patient (plaintiff) had rheumatic fever as a child which damaged her heart
valves. Dr. Ford (defendant) informed the patient she needed a valve replacement and
briefly went over the procedure with her. The patient claimed she was not informed
about any risks of the procedure or the specific valve she was receiving. Common risks
of her valve replacement include strokes, thromboemboli, and anticoagulant use for life.
The doctor performing the surgery, Dr. Zikria (defendant), only discussed the risk of
clotting with the patient. After the surgery, the plaintiff suffered severe brain damage
from multiple thromboemboli and sued for lack of informed consent. The jury ruled in
her favor, and the physicians appealed to the Pennsylvania Superior Court.
Issue: Did the court correctly reason that the patient did not have informed consent? Did
the defendants breach their duty to disclose sufficient information to the patient prior to
Rule/Legal Principle: The Pennsylvania Superior Court agreed with the prior decision
that the plaintiff did not give informed consent. The heart valve she received was no
longer in general practice at the time of her operation, and alternative valves were
available but never discussed. It was agreed that patients must be informed about risks,
benefits, and alternatives before making a judgment about their treatment. They also
must present a waiver of consent.
Public Policy Benefit/Detriment: If a patient does not understand an operation or its
seriousness, consent is not valid. Operations and medical treatments are contractual
agreements between physicians and patients. In this case, the physicians failed to inform
the patient about the risks of her valve replacement and neglected to mention there
were valve alternatives. This can be detrimental to the public since she suffered serious
side effects from the operation that she was not warned about and that other valve
alternatives may not have led to. Although physicians are medical professionals, a patient
should have control over the treatment they receive and understand every aspect of
their procedure. Having informed consent is beneficial to the public to make a decision
based on what a reasonable person would consider based on their mental status, age,
Topic: Constitutional Right to Refuse Care
Case: Cruzan v. Director of the Mo. Dept of Health (1990)
Facts of the Case: This case which worked its way through the Missouri state court
system all the way up to the Missouri Supreme Court ruled that plaintiff Nancy Cruzan
could not be taken off life support due to the Westchester ruling. The Missouri Supreme
Court ruled that the patient, Nancy was in a vegetative state since 1983 post-car
accident could not be taken off life-sustaining support by the decision of her family.
Cruzan Remained in an oxygen-deprived state for 12 to 14 minutes which caused
permeant brain damage and required permanent life-supporting healthcare. By Missouri
State law the patient was not considered dead and against her family’s wishes, Cruzan
was kept on life support. This case made it to the United States Supreme Court.
Issue: Does the State of Missouri and its rule of Living Will have the right to consider the
Plaintiff to be a competent person and not have a surrogate make life-sustaining
decisions if the plaintiff would be considered incompetent?
Legal Principle: The United States Supreme court ruled through the 14th amendment
that a competent person has the constitutional right to refuse life-sustaining care. By
Missouri Law, when there is an incompetent patient, a Surrogate is allowed to make
decisions about care for the patient. With these two principles, a surrogate can refuse
life-sustaining care for an incompetent patient in the state of Missouri. The Supreme
Court of the United States left the right-to-die decision up to the states.
Public Policy Benefit: The benefit of this case set precedent while competent patients
have the constitutional right to refuse life-sustaining. By extension of state rules when
patients become incompetent and a surrogate makes decisions for the patient, the
surrogate can make or refuse life-sustaining decisions for the incompetent patient. This
has allowed patients who did not write down that they do not want life support but
expressed it clearly to their family to be taken off or refuse life support through
surrogates. This gives more rights to patients and what they would want as their care.
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