Integrative Case Analysis

Integrative Case Analysis
In this assignment we are to perform a critical analysis of the chosen case and identify the
ethical, legal and cultural safety issues which emerge in your analysis of the case. The case
is as follows;
Molly is a 14 year old indigenous girl who has been admitted with suspected appendicitis.
She is scheduled for emergency surgery in two hours time when Sandy the registered nurse
discovers that the consent form has not been signed. Molly’s parents are not present as she
has been flown in by the Royal Flying Doctor Service. She is however in the company of her

Integrative Case Analysis

In the modern age of medicine, it is important as a general rule for practitioners to obtain
the consent of a patient in order for any procedure, operation or treatment is undertaken if the
patient is a competent adult. Competence is an important concept in the consent form debate and
is in itself a legal status. An adult person is assumed as a competent individual unless they are
determined by a court of law to lack the ability to make the decisions required in order that they
live safely in the community in a way that they may not hurt themselves or others. Therefore, in
this context, all children below the age of Eighteen years are described as incompetent while not
all adults are competent (Rikoon, 1992).
The purpose of the content form in the case of molly brings ethical, legal and cultural
issues. She is a child and therefore she cannot be able to give a valid consent because she may

not comprehend the implications of having the surgery. The doctors cannot however go on with
the procedure without the consent of the child’s parents. If they do conduct the procedure
without the consent form being signed, they might end up with various legal issues such as they
may be faced with legal action for assault and battery which in itself is a criminal offence whose
acquittal may lead to other serious problems for the practitioner. The signed consent form is a
tool that also solves various ethical issues in handling surgical procedures. For example, it
ensures that the surgical and medical team has properly handled their moral and ethical
obligation of informing the patient and related parties about the condition and the procedures
necessary to rectify the condition as well as prospective material risks. The form ensures that the
patients receive their legal and ethical rights to know what will happen and the physicians have
an ethical duty to provide adequate information in order to allow the patient make the right
Decision (Stahl, 2004).

Since Molly’s parents are not around, a surrogate decision maker has the right to speak
and make decisions on her behalf. A surrogate or health care proxy is considered an advocate for
an incompetent patient such as a child and must make decisions on behalf of the child. Health
care proxies are however selected in some order of priority beginning with the clients’ guardians
of parents followed by the clients’ spouse of an adult brother or sister of the client. In this case
for Molly, the legal requirement in this context will make her aunt legally and also culturally
liable as the decision maker who needs to be able to sign the form (Devettere, 1995).
Culturally, it is expected that her Aunt be her guardian as she has been with her in that
situation in place of her parents. With her aunt as the decision maker however, she needs to
adhere to some general best practice powers and limitations of being a surrogate. For example,

she needs to be informed that she has to make substituted judgment in making the decision on
behalf of molly and that she should make the decision in the best interests Molly. The health care
practitioners should ensure that they help Molly’s aunt understand the situation and what needs
tie b done in order to help Molly as well as express to her the risks of the process. it is therefore
the legal, ethical and cultural duty of Molly’s aunt to make a decision at the best interest of
Molly and that decision would be to sign the consent form before Molly is taken up for surgery.
Other cultural issues that may arise in relation to Molly’s aunt being her surrogate is the fact that
surrogates use their own values to decide what decision is usually for the benefit and best interest
of the patient. Cultural values play a big part in the decision making process and should the
surrogate for instance not believe in medicine, she may not agree to sign a consent form Bush,


Bush, S. (2007). Ethical decision making in clinical neuropsychology Oxford: Oxford University
Devettere, R. (1995). Practical decision making in health care ethics cases and concepts
Washington, D.C.: Georgetown University Press.
Parker, A., & Fischhoff, B. (n.d.) Decision-making Competence: External Validation Through an
Individual-differences Approach. Journal of Behavioral Decision Making, 1-27
Rikoon, J. (1992). Handling your first health care proxy, living will, and durable power of
attorney New York, N.Y. (810 7th Ave., New York 10019): Practicing Law Institute
Stahl, M. (2004) Encyclopedia of health care management Thousand Oaks, Calif.: Sage

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