Nursing Law and Ethics

(Marcin) #1

BAnEthical Perspective ± Declining and Withdrawing Treatment


Robert Campbell


What does it mean for a patient to be critically ill? TheOxford English Dictionary
defines `crisis' as:


`path.) The point in the progress of a disease when an important development
or change takes place which is decisive of recovery or death.'

Critically ill' is not a synonym fordying'. We should remember that critically ill
patients may recover. TheOEDalso defines `critical' as among other things):


`involving suspense or grave fear as to the issue, attended with uncertainty or
risk.'

The prognosis for critically ill patients is often very uncertain. We should always
remember that a critically ill patient may die or may recover. We cannot know for
certain which will happen.
However, patients with a strong chance of recovery and a clearly indicated and
effective treatment present few ethical dilemmas for those who care for them. The
truly challenging situations are those where treatments are contested, of uncertain
value or unavailable, or where the probability is high that no treatment will be
beneficial and the likeliest prognosis is poor.


10. 7Consent

Often such situations are ethically challenging because of the issue of consent. In
law to touch someone against their wish is battery, and medical treatment, espe-
cially in critical situations, usually involves procedures far more invasive than
merely touching. For everyday treatments like having a tooth filled or an eye
examination, consent is both presumed and implicit in the patient's simply being
there. For more complex, unusual or potentially dangerous interventions, more
formal procedures are needed to establish consent. This is because both the law
and morality assume that consent involves more than simple acquiescence. To
consent in any real sense one must know what one is consenting to, and one's

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