Dispute and Legal Issues:
A 32 year old woman was admitted to the Trauma Intensive Care Unit following a motor vehicle accident; she had multiple injuries and fractures, with several complications which continued to develop over the first couple of weeks. The patient rapidly developed Adult Respiratory Distress Syndrome, was on a ventilator, and was continuously sedated. Shortly after the patient's admission, her parents were contacted and remained vigilant at her bedside. The parents reported that the patient was one month away from having her divorce finalized. The patient's husband was reportedly physically and emotionally abusive to her throughout their five years of marriage. The parents had not notified this man of the patient's hospitalization, and reported that visit by him would be distressing to the patient if she were aware of it. The patient's soon to be ex-husband is her legal next of kin. Some key legal and ethical issues raised by this Case are informed consent and surrogate decision-making. While the details of this case will determine the advice provided, it raises a number of issues with legal ramifications. Specific legal issues:
•There is implied consent by law for provision of "emergency" medical treatment. The Washington law (statute-RCW 7.70.050(4)) uses the term "emergency" but doesn't define it. Hospital policy defines what the hospital will consider an "emergency" and sets an institutional documentation standard: Consent for care is implied by law when immediate treatment is required to preserve life or to prevent serious impairment of bodily functions and it is impossible to obtain the consent of the patient, his/her legal guardian, or next-of-kin. Ethical Dimensions of this case:
In such emergency situations, the physician should consult, whenever possible, with the patient's attending physician or with another physician...