Benny Has Always Been Very Active, Was Very Involved In The Community: Law And Ethics Case Study, TCD, Ireland

Case Study 1

Benny is 75, he lives alone and has two children. Benny has always been very active, was very involved in the community and was an enthusiastic cyclist. He has lived on his own since the death of his wife. He is extremely independent and reluctant to receive any help around the house, even from his own children.

His daughter, Beatrice, lives an hour away and uses public transport to visit when she can. Benny had a bad fall about 1 month ago and seriously cut his leg. He did not seek medical treatment at the time, he now has a serious infection and he has contracted gangrene.

He has increasing signs of dementia, confusion and memory loss. Beatrice visited her father and was very concerned about his health and called an ambulance. Benny has been admitted to Galway University Hospital. His health has further deteriorated due to the infection in his leg and he is receiving intravenous antibiotic treatment. Ms Turnbull his consultant surgeon is of the view that he should have a partial amputation of his leg. Benny has refused his consent for this operation, as he is concerned that he would not be able to live alone / independently after the amputation. The multi-disciplinary team responsible for his care is concerned that Benny does not fully comprehend the gravity of refusing surgery.

Law Question: Advice Benny and the medical professionals of the relevant law relating to his refusal to consent to the amputation.

Ethics Question: Explain the most important ethical issues arising in this situation, including an explanation of practical measures that staff should take to ensure an ethically satisfactory informed consent process.

Niamh is 40 years of age and lives in Co. Galway with her husband. In 2006 she was diagnosed with multiple sclerosis. Her neurological condition has progressed over the years and she is unable to walk or to use her lower or upper limbs. She has no bladder control, and she has lost the use of her hands and is almost totally physically helpless and requires assistance with all aspects of her daily living.

While she remained able to communicate it is becoming increasingly difficult for her to speak. She is very concerned that, in due course, she will lose the capacity to communicate verbally. She frequently chokes when swallowing liquids and can suffer choking episodes, even when not attempting to swallow. Such choking episodes are extremely exhausting, frightening and distressing. She is now in the final stage of her disease and is experiencing a rapid deterioration of her medical condition.

She states that she suffers from significant and frequent pain from a number of sources, which is intense and sometimes almost unbearable. She has made the decision to end her life as she wants to die with dignity, and she feels she can no longer live with the pain and distress associated with choking.  Her husband following months of conversation has agreed to assist her in ending her life.  However, she is worried about the legal consequences if her partner assists her.

Law Question: Advice Niamh about the relevant law relating to her circumstances.  In your case study, you should outline the relevant case law and legislation.

 Ethics Question: Explain the most important ethical issues arising in this case and ethically evaluate the decision-making opportunities that are available to patients like Niamh in Ireland and at least two other jurisdictions.

Mary is 20 years of age. She was diagnosed with bipolar disorder and has been engaging with adolescent and adult mental health services for the past 5 years. Her mental health had improved and stabilized over the last 18 months. She lives alone in a small apartment close to her parents with whom she has had a close, but conflictual relationship since her teenage years. Her entire family is very active in their local church and she often joins them at religious services. Her parents alerted her community mental health team two months ago, saying that she seemed increasingly irritable, had stopped her usual activities and had withdrawn from them.

The last time her parents talked to her on the phone she suddenly made comments that made them feel very concerned for her safety. When they went to check up on her she refused to open her door, shouted at them to go away,and said they did not have to worry about her for much longer. She has now been involuntarily admitted to an ‘approved center’ under the Mental Health Act 2001. Mary has stated on admission that she has been having suicidal thoughts. She informs the multi-disciplinary team responsible for her mental health treatment that her GP confirmed to her two weeks ago that she was 13 weeks pregnant. She said she was so shocked that she initially did not know what to do but now wishes to terminate her pregnancy.

She does not want her family or anyone else apart from her healthcare providers to know about it. Mary gets very upset when team members try to engage her in a conversation to better understand the background of her request and just says that it would ruin her life to continue with the pregnancy and that she does not want to talk about it.

Law Question: Advice Mary whether she can lawfully terminate her pregnancy.

 Ethics Question: Explain the main ethical concerns arising in Mary’s case and evaluate their significance for this case.