Life-sustaining Treatment, Family Health Care Decisions Act, and The Living Will

Tutorial Questions
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TQ 6.1: In re Conroy:
The approach to such decisions demands consciousness that issues on life and death require a high level of responsibility that is only undertaken with a profound sense of humility. Therefore, the case of Claire Convoy raises eyebrows as concerns interplay of various disciplines, especially those touching morality, social, philosophical, technological, and legal fronts (In re Conroy case). The provision of complete answers on the case seems an issue that will resonate over the years. The issue encompassing all its ramifications is surrounded by the complexity that entails interests from different quarters such as civil and criminal law, medical ethics, and social morality. However, looking at it from the legal perspective, there is an opportunity for representing various entities with interest, where each view is synthesized fairly. Such allows for every institution and individuals (Fulton, 2017).
Such people like Conroy should be treated with respect because they cannot speak for themselves on life-and-death issues, especially regarding their medical care. However, such decisions do not implicate that the patients lack the personal right to self-determination. Under major considerations, Claire Conroy was once competent enough to determine the course of her medical treatment, and this remains intact despite her present condition of inability to make her own decisions (Fulton, 2017). The law respects the aspect of testamentary dispositions irrespective of the testator's ability to view his gift's bestowing. Firstly, due to the patient's condition, a third party acting on the patient's behalf cannot steer the treatment decision confidently. In the case Cf. Smith, "In re Quinlan: Defining the Basis for Terminating Life Support Under the Right of Privacy," 12 Tulsa L.J. 150, 161 (1976), the argument was that the Act of granting permission to a guardian to make a medical decision concerning a patient interferes with their right of privacy (Week-6 video transcript).
Notwithstanding, the objective of such decision-making concerning incompetent patients should focus on effectuating as much as possible the decision that the patient could have made in the situation that she was competent (Hempton & Bhatia, 2020). Generally, in such cases, considerations should be made on all aspects by respecting the patient's right concerning bodily integrity, right to consent on medical issues, and right to refuse any intervention. Therefore, the life-sustaining treatment may also be withdrawn from the incompetent patient if the intended patient has refused the treatment under the surrounding circumstances (Week-6 video transcript).
Secondly, the other circumstances under which life-sustaining treatment may be withheld or withdrawn from a patient entails when the patient declines the treatment. Thirdly, the treatment may be withdrawn if it is clear that the patient would have denied undertaking the proposed treatment under the specific circumstance and in the clarity that such treatment may merely prolong suffering (Robertsen et al., 2019). In Conroy's case, the court reasoned that the inquiry should focus on whether such life has become permanently burdensome to the patient herself. In such a case, the idea of prolonging life is considered cruel and ideally pointless. Ms. Convoy's reasoning capability was permanently damaged, making her life impossibly alongside permanently burdensome guaranteeing the possibility of removing the feeding tube (Hempton & Bhatia, 2020).
TQ 6.2: The New York State Family Health Care Decisions Act: 
The Family Health Care Decisions Act (FHCDA) empowers and grants family members and those closest to the patient to make decisions pertaining to medical treatment on behalf of incapacitated patients (Swidler, 2010). The FHCDA creates a legal mechanism that allows for the appointment of a medical surrogate that makes healthcare decisions for incapacitated patients. The Act eliminates the aspect of uncertainty that health care practitioners face in the vent that a patient cannot make individual decisions with assurance that patient's best interests are respected (Finger et al., 2018).
The potential surrogates in order of priority entail court-appointed guardian, spouse, adult son or daughter, the parents, the brother or sister including a close relative and friend. The various medical decisions entail all powers conferred to an individual on making personal medical decisions that also include decisions to withhold or withdraw from various life-sustaining medical treatment. In such a case, the decisions that safeguard withholding or withdrawal from life-sustaining treatment are made according to additional standards provided under the FHCDA (Swidler, 2010). The surrogate is allowed to withhold or withdraw life-sustaining treatment for the patient if the prediction guarantees that the patient will lose life within six months irrespective of the treatment provided. Such prediction is determined by two independent physicians making it clear that treatment would be the addition of an extraordinary burden to the individual patient. The same withholding or withdrawal may also occur because the patient's condition is irreversible, as per medical reports from independent physicians. This is qualified because treatment under such a scenario would involve much pain, suffering alongside other inhumane burdens to the patient and the family (Finger et al., 2018).
Concerning the patients without a surrogate, the FHCDA confers authority to the attending physician to give direction about routine medical attention in the place of surrogate (Swidler, 2010). The physician may stand as the surrogate in cases that entail major medical treatment upon consent from another physician on the necessity of such a medical process. In this case, the decision is made upon agreement from another physician that the life-saving treatment provides no benefits medically to the patient since death is imminent. Therefore, the provision of such life-sustaining treatment violates acceptable medical standards.
TQ 6.3: Physician Perspectives and Compliance with Advance Directives
In considering life-supporting measures, the physicians are basically influenced by patient preferences, medical considerations, and external factors. The impediments from external factors entail family wishes, various financial abilities, the fear for legal liability alongside physician characteristics. Such factors usually describe ethical conflicts that involve patient care (Peicius et al., 2017).
There are instances where the provision of patient care was inconsistent with the various desires as provided in the Advance Directive (A.D.) (Wickersham et al., 2019). Physicians can always refuse to adhere to the patient wishes in the A.D. If they have any objection of conscience or otherwise be considerate of medically inappropriate wishes. In this case, they are obligated to transfer the patient to another health care professional capable of complying. The legal issues in the aforementioned cases are derived from a moral dilemma, which reflects a personal character. The courts have the right to exercise their inherent jurisdiction to determine the threatened interests in any litigation. The law protects the patients within the state incapable of protecting themselves owing to an innate legal disability (Burkle et al., 2012).
Considering the values of the patient's privacy and autonomy in such a scenario reveals the incapacitated individual's interest in making an actual personal choice. In such a case, the reliance on the principles of personal privacy alongside autonomy may not necessarily enhance their ability to make critical decisions in their lives. Thus, invoking the courts' decision in such a setting serves the fundamental interest of the patient. Therefore, it is the responsibility of the judiciary to intercede for the reasons of preserving the patient's interests under equitable principles (Carr & Luth, 2017).
Discussion Question
DQ 6.1: Compare and contrast the living will and the health care proxy
The healthcare Proxy confers authority to another person in making medical decisions if the patient is unable to do so. The healthcare proxy is also referred to as the medical power of the attorney, whereby a patient assigns someone to make a medical decision on their behalf. Such decisions incorporate the same force of law as the patient's personal decision. The Healthcare Proxy allows patients to choose an individual they trust can honor their wishes. Therefore, very important that selection be made on an individual with an elaborate understanding of the patient's requests and committed to honoring them (Sean Morrison, 2020).
On the other hand, a Living Will provides the listing of wanted and unwanted medical treatments in case of terminal illness that hinders patients from individual decision making. This is a document with a set of instructions that clarifies the patient's wishes, such as religious objections to treatment, choices on certain medications, informed consent on risk management, and organ donation, amongst others. In this case, a Living Will takes effect only in cases involving life-or-death treatments. The advantage of the Living Will is that it does not confer authority to third parties, therefore, eliminating the risk of depending on someone's judgments concerning individual treatment. The Living Will works best in cases where unambiguous circumstances regarding health need to be covered, such as religious rights on certain treatments (Week-6 video transcript).
DQ 6.2: What approach would you suggest to deal with this situation? What objections do you think your proposed approach might face?
In such situations where the patients lack surrogates, shared-decision making should be considered the preferred model to help the situation. Those in dialogue with the physicians should not be under any external influence and must be knowledgeable in ethical decision-making, thus providing further perspectives that support...