Patient Autonomy Informed Consent and The Emergency Exception

In the 1999 Shine v. Vega case, the contradiction between a competent patient’s right to decline medical care and a doctor’s desire to preserve life without fear of responsibility must be resolved. In other words, patients’ refusal to get treatment vs. an exemption for emergency care.

Dr. Jose Vega, an emergency room physician, went against Catherine Shine’s wishes in 1990a and operated on her. According to court documents, Catherine was intubated, and the procedure traumatized her, so she could not seek hospital treatment when she was ill. Two years after this occurrence, Catherine passed away.

In 1993, Dr. Vega and the Massachusetts General Hospital (MGH) were sued for torture and wrongful death by Catherine’s father, the executor of her estate. He claimed that his daughter’s traumatic event while in the hospital caused her to pass away. She died due to this event because she resisted going to the hospital when she had asthma attacks. On the other hand, Dr. Vegas asserted that the patient’s condition was urgent since she was hallucinating. Although the patient did not want to be set, there was no other option than to incubate her; her agreement was not required.

In the initial trial, it was found that MGH and Dr. Vegas took all necessary measures to preserve the patient’s life. According to the judge, a patient does not have the right to decline medical care when their life is in danger. She added that a doctor might not require the patient’s or her family’s permission to proceed with an intrusive procedure in an emergency. The Massachusetts Supreme Judicial Court sided with Dr. Vega on his appeal, concluding, “A competent patient’s refusal to consent to medical treatment cannot be overridden whenever the patient faces a life-threatening situation.”

We can see the value of doctor-patient relationships by looking at this scenario. The benefits and drawbacks of incubation should have been explained to the patients by Dr. Vegas and the hospital. Additionally, they are ensuring that the dangers are present. In this situation, the patient would not return to sue the hospital if they decided against receiving treatment and left to go home. Eyal (2012) made the following claim regarding informed consent and trust: “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 the medical system, compliance with treatment, and participation in research.”

Catherine might have asked for assistance when she had another attack if the doctor and the hospital had listened to her. She avoided any medical care the hospitals should have offered because she didn’t believe they would treat her fairly. According to her father, Catherine was sensible and aware of her illness. The doctor and the hospital should have left her alone to make health decisions.

Beauchamp et al. (1994) state, “Expressing respect for patient autonomy means acknowledging that patients who have decision-making capacity have the right to make decisions about their care, even when their decisions conflict with their clinicians’ recommendation.” Dr. Vegas and the hospital in the Shine v. Vega case should have respected Catherine’s autonomy and given her and her family all the information they required for her asthma episodes. This would have aided Catherine’s family in sharing their consent for the subsequent stage of Catherine’s treatment. Thanks to the doctor and the hospital, Catherine’s asthma would have been the subject of ongoing conversations.

The lesson learned from this case is that the doctor-patient relationship is fiduciary, requiring the doctor to act in the patient’s best interest regarding the patient’s autonomy.

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

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