You are the Chief Executive of a Local Health Network is New South Wales. E is a patient in one of your hospitals. E had suffered from anorexia since her early teens, brought about by serious sexual abuse which she experienced between the ages of 4 and 11. Despite the challenges of her illness, she was universally described as intelligent and articulate and had completed several years of a medical degree at university before her illness rendered it impossible to continue. She had undergone a number of admissions for medical and psychiatric care, including legislative sectioning on about 10 occasions. In July 2012 E signed a document saying that she did not want to be resuscitated or to be given any medical intervention to prolong her life.
In October 2012, she signed another advance directive in a standard form, assisted by her mother. Following her discharge and return to the community, a familiar pattern re-asserted itself. By early 2013 E was drinking very heavily. She was re-detained in March 2013 and was initially fed by tube but opposed this and tube feeding was stopped. As a result, she has not been taking any calories at all since the end of March. On 20 April 2013 E was admitted to a community hospital for palliative care and placed on an ‘end of life’ care pathway with high doses of opiate medication, to which she is physically addicted.
E has been diagnosed as suffering from a very rare triad of anorexia, alcoholism and personality disorder. Her parents, although not wanting E to die, did not support any further medical intervention unless there was a real prospect of success. E's treating doctors are doubtful about further coercive treatment. The NSW Health Solicitor has been instructed by you and she has relied on the advice of an expert, who advised that highly specialized treatment was available, which had not been tried, that although not without significant risk might return E to relatively normal life. The treatment involves a number of medical interventions including forcible feeding and using chemical sedation.
The Department of Health, on your behalf, has applied to the NSW Supreme Court in its parens patriae jurisdiction for orders on how to proceed.
What do you think will be the outcome of this application? In addressing this issue, include the following:
1. Does E have the capacity to refuse life-sustaining treatment, including feeding? (10 marks)
2. Were E’s attempts to make binding advance directives refusing treatment valid? (10 marks)
3. A. If the court decides they were valid, what is the procedure the health service should follow to enact those directives?
B. If the court decides they were not valid, what test will the court apply to decide whether or not the proposed treatment of force –feeding is valid? What will their decision be after applying the test? (5 marks)
4. What are the ethical factors, legal principles, and critical thinking framework(s) that you, as a health service manager, would apply in balancing the value of Es life in one scale and the value of her personal independence on the other? In considering your answer please pay particular attention to how you would manage the team treating E, some of which may object to the way the matter proceeds. (10 marks)
READ: Chapter 1-4 of your text.
READ: Chapter 2 of Windows into Safety and Quality in Health Care 2008 and the ACSQHC Charter of Health care rights.
READ: Chapter 2 of Windows into Safety and Quality in Health Care 2008 and the ACSQHC Charter of Health care rights.
READ: Chapter 5-8 of your text
READ: Kerridge et al (2013) Chapter 10, and the Inquest into the death of Vanessa Anderson
READ: Kerridge et al (2013) Chapter 10, The NSW Health Open Disclosure Policy, Civil Liability Act NSW Pt 10, The NSW Health Incident Management Policy, Coroner’s Act 2009 (NSW), NSW Coroner's website and NSW Health Coroners Act and Cases Policy (2009)
READ: Chapters 15 & 16 of your text and The National Framework for Advance Care Directives(AHMAC 2011)
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