Patient Autonomy Informed Consent and The Emergency Exception

Patient Autonomy Informed Consent and The Emergency Exception

The 1999 Shine v Vega case was a case that needed to resolve the conflict between the right of a competent patient to refuse medical treatment and a doctor’s interest in preserving life without fear of liability. In other words, this was a case of emergency care exemption versus patients refusing treatment.

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In 1990a, an emergency unit doctor, Dr Jose Vega, performed an invasive procedure on Catherine Shine against her wishes. Catherine was intubated, and per the court papers, this process traumatized her to the point where she could not go to the hospital for medical care when she was sick. Catherine died two years after this incident.

In 1993 Catherine’s father, the administrator of her estate, sued Dr Vega and Massachusetts general hospital (MGH) for torture and wrongful death of his daughter. He said that his daughter’s death resulted from the traumatizing experience she received in the hospital. This experience led to her death as she refused to go to the hospital when she had asthma attacks. On the other hand, Dr Vegas argued that the patient’s situation was an emergency since she was delusional. The only alternative was to incubate her; her consent was unnecessary even though the patient did not want to be set.

In the first trial, it was determined that Dr Vegas and MGH did what was necessary to save the patient’s life. The Judge said that a patient does not have a right to refuse medical treatment in a life-threatening situation. She also concluded that a doctor may not need the patient’s or her family’s consent to proceed with an invasive treatment in an emergency. Dr Vega appealed, and the Massachusetts Supreme Judicial Court agreed with him; they stated that “A competent patient’s refusal to consent to medical treatment cannot be overridden whenever the patient faces a life-threating situation.”

Looking at this case, we see the importance of doctor-patient relationships. Dr Vegas and the hospital should have informed the patients of the pro and cons of incubation. And they are making sure that the risks are involved. In this case, if the patient does not want treatment and leaves to go home would not turn around to sue the hospital. On Informed consent and trust, Eyal (2012) argued that “it takes the value of informed consent to lie in its role in ensuring trust in medical practice; in turn, trust is instrumentally valuable because it promotes health through use of medical system, compliance with treatment and participation in research.”

If the Doctor and the hospital had listened to Catherine, she might have sought help when she had another attack. Since she did not trust the hospital to do right by her, she shunned any medical service the medical facilities should provide. Catherine, per her father, was a person of sound mind and knew her condition. The hospital and the Doctor should have let her decide on her health without interference.

“Expressing respect for patient’s autonomy means acknowledging that patients who have decision -making capacity have the right to make decisions regarding their care, even when their decisions contradicts their clinicians’ recommendation” ( Beauchamp et al., 1994). In the Shine vs Vega case, Dr Vega and the hospital should have respected Catherine’s autonomy and provided her and her family with all the information needed for her asthma attacks. This would have helped Catherine and her family make informed consent for the next phase of her treatment. The Doctor and the hospital would have laid the groundwork for continued discussions on Catherine’s asthma.

This case teaches us that the doctor-patient relationship is a fiduciary type of relationship in which the Doctor must act in the patient’s best interest concerning the patient’s autonomy.

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Reference

Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 4th ed. New York, NY: Oxford University Press; 1994.

Nir Eyal. 2012, Using Informed Consent to save trust. Retrieved from https://www.researchgate. net/publication/233880228_Using_informed_consent_to_save_trust

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Analyze the case of Shine v. Vega. Be sure to include a thorough discussion of patient autonomy, informed consent, and the emergency exception. 2 1/2 pages apa