Laws And Ethics In Anesthesia Flashcards
A 14-year-old pregnant patient at 10 weeks gestation presents to the gynaecology outpatients department requesting termination of pregnancy (TOP).
What law governs termination of pregnancy ?
The circumstances and conditions under which a pregnancy may be terminated are provided for in the Choice on Termination of Pregnancy Act No. 92 of 1996.3.
the question presented above will be outlined by applying the Act. A female person regardless of age is classified as a “woman” in section 1 of the act.3 A pregnant woman may request TOPduring the first 12 weeks of the gestational period with no reasons required, as provided for in section 2(1)(a).3 This patient’s gestational period falls within the stipulated 12 weeks, meaning that the Act allows her to request for the TOP if she wishes.
Is the consent valid 12 year old requesting TOP
○ The Act defines a minor in section 1, as “any female person under the age of 18 years”; thus the patient in this scenario will be considered a minor.
○ It is, however, important to note that although the Choice on Termination of Pregnancy Act provides for a female of any age to consent for TOP, the patient would need to have the capacity to give a valid informed consent.
○ In the case of minors, the capacity to consent is provided for in the Children’s Act No. 38 of 2005.
○ The capacity to consent, according to section 129 of the Act, refers to children of sufficient maturity, with the mental capacity to understand the benefits, risks, social and other implications of the procedure undertaken. ○ The sufficient maturity provided for in the Children’s Act provides a useful guideline that one can use to determine the capacity of a minor to consent for a TOP.4
○ Therefore, the consent given by this patient for the TOP will be considered valid according to the Act, despite the patient being a minor, if she fulfils the capacity to consent as described above
○ If there are sufficient grounds suggesting that this patient is not capable of giving consent for a TOP, she will then be informed that her parent’s or guardian’s consent will be required.
○ If a parent or guardian cannot be contacted and/or the situation is an emergency as a result of TOP, consent can be sought from the medical superintendent of a hospital.
Choice of termination of pregnancy act 92 of 1996 vs children’s act #63 of 2003 consenting for TOP.
According to section 129 of the Children’s Act No. 63 of 2003, a child of sufficient maturity aged 12 years or older may consent to surgical procedures with the parent’s assent.5 However, the Children’s Act would not be applicable in this scenario, as the Choice on Termination of Pregnancy Act would be undermined.4 The patient could, therefore, consent for the evacuation of the uterus herself, if she demonstrates the capacity or sufficient maturity to consent as outlined earlier.
Jehovah’s Witness minor comsented for TOP and blood transfusion against parents wishes. She bleeds during procedure. What does the law allow you to do, minor vs parents life saving intervention.
Section 15(1) of the Constitution provides for individual’s right to freedom of religion of their choice. The right for people to belong to a religious community and to practise their religion is further provided for in section 31(1)(a) of the Constitution.6 In this scenario, the sections described will protect the rights of this patient’s parents to belong to and practise the Jehovah Witness’s religion. However, the Constitution further provides in section 31(2) that the right to practise a religion may not be realised inconsistent with any other provision of the Bill of Rights.
There are various sections of the Constitution that provide guidance to this patient’s rights. The Constitution provides for everyone’s right to life, the right to access health care and the right not to be refused emergency medical treatment in section 11, section 27(1) and section 27(3) respectively. With specific reference to children, section 28(1)(c) of the Constitution provides that they have the right to basic healthcare services. The Constitution also provides that in all matters concerning the child, it is paramount to consider the ‘best interest’ of the child according to section 28(2).6
The Children’s Act No. 63 of 2005
The parents’ refusal for their child to get a blood transfusion is addressed in section 129(10) of the Children’s Act 38 of 2005. The Act provides that parents or guardians may not refuse or withhold consent based only on religious beliefs, unless they can demonstrate that there is a medically acceptable alternative choice to the medical treatment concerned or blood transfusion in this scenario.5 If the alternative therapies to blood transfusion and the resources for their application, are not suitable, available and/or cannot be offered when blood transfusion is required in a medical emergency setting, the parents may not refuse their child this potentially lifesaving intervention. The refusal will be violating the child’s constitutional rights.
The National Health Act 61 of 2003
The National Health Act 61 of 2003 requires that healthcare providers may not refuse a person emergency medical treatment (section 5).8 The administration of a potentially lifesaving blood transfusion in an emergency setting will also be provided for in this section of the Act.
Physiological futility –
where a medical intervention cannot result in the physiological effect it is intended to achieve.
Imminent demise futility
where regardless of the medical intervention, the patient will die in the near future.
Lethal condition futility
where a medical intervention is applied in the presence of an underlying lethal condition and the intervention has no effect towards such a condition, and the patient will die from that lethal condition despite the intervention.
Qualitative futility
autonomy
The principle of autonomy refers to acknowledging the right of autonomous agents to hold views, make their own choices and act based on what they value and believe.11 This would mean that the family’s wishes in respect to the medical treatment of their loved one would need to be respected, if this principle is applied.
beneficence
The principle of beneficence encompasses three actions according to Beauchamp and Childress: “preventing harm, removing harm, and promoting good”, whereas nonmaleficence requires the “avoidance of actions that cause harm”.11 To apply the principle of beneficence and nonmaleficence, it would need to be demonstrated that the medical interventions undertaken in the case above, such as ICU care, ventilation, inotropic support and dialysis, would prevent harm, remove harm, promote good and avoid harm.11 Assuming the medical team assessed the medical interventions as futile, considering that despite such interventions, the patient will die from the brain herniation soon.
nonmaleficence
justice
The principle of justice encompasses a “fair, equitable, and appropriate distribution of benefits and burdens” according to Beauchamp and Childress.
Unnatural death
Unnatural deaths are defined according to the Regulations Regarding the Rendering of Forensic Pathology Service12 of the National Health Act No. 61 of 20038 which defines them as: • “Any death due to physical or chemical influence, direct or indirect, or related complications; • Any death, including those deaths which would be considered to be a death due to natural causes, which may have been the result of an act of commission or omission which may be criminal in nature, • Any death as contemplated in section 56 of the Health Professions Act, 1974 (Act No. 56 of 1974); and • Any death which is sudden and unexpected, or unexpl
