The refusal of consent to a particular medical treatment, or intervention, is an issue that raises several legal, ethical and moral considerations. The appropriateness of judicial intervention, the patient’s right to self-determination, the principle of sanctity of life as opposed to the quality of life – particularly in terminally ill patients, are all issues which are subject to the ongoing debate. Due to the infinite variety in the circumstances and personal histories of patients, a ‘one-size-fits-all’ legal and ethical approach is an impossibility. Each case has to be considered on its own, unique merits, with certain underlying principles serving as guidelines. In this case study, the indisputable facts are: Mrs. Col is a resident who is terminally ill with cancer. she is physically and mentally competent at present. she has executed an Advance Care Directive prior to her admission to the retirement village, in consultation with her physician. she has specifically requested no cardiopulmonary resuscitation in the event of her demise. subsequently, the management board has adopted a policy which mandates cardiopulmonary resuscitation in all cases of cardiac arrest, regardless of the patient’s wishes. In the context of the above scenario, several legal and ethical issues are relevant.
Consent or the refusal of consent, to treatment is a fundamental and established law in the United States. The concept of consent is an integral part of the fundamental precept of respect for a person’s bodily integrity. The emergence of consent as a medico-legal issue dates back to 1914, in the case of Schloendorff vs. .Society of New York Hospital. Supreme Court Justice Cardozo declared that “Every human being of adult years and of sound mind has the right to determine what shall be done with his own body” (qtd. in Thula. 2004). Subsequently, the term ‘informed consent’ entered jurisprudence in 1957, in Salgo vs. Stanford University, in which the court held that “a physician violates his duty to his patient and subjects himself to liability if he withholds any facts which are necessary to form the basis of an intelligent consent by the patient to the proposed treatment”.