TEXAS A&M UNIVERSITY – CORPUS CHRISTI COLLEGE OF BUSINESS HCAD 5330 – Health Law

TEXAS A&M UNIVERSITY – CORPUS CHRISTI
COLLEGE OF BUSINESS
HCAD 5330 – Health Law and Ethics– SUMMER I 2023
Case Analysis # 2: Consent and End of Life Decision Making Analysis
For this assignment, you will need to review: I WILL PROVIDE these in reference list
1. Chapters 12, 13, 14 and 16 of the Pozgar text.
2. Texas Health and Safety Code ch. 166 § 166.002 – 166.053. Advance Directives.
Available at: http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.166.htm
3. Texas Health and Safety Code ch. 166 § 166.151 – 166.166. Medical Power of Attorney.
Available at: http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.166.htm
4. Texas Health and Human Services, Advance Directives. Accessed at:
https://hhs.texas.gov/laws-regulations/forms/advance-directives
You will approach this case analysis as if you were a lawyer for a Texas hospital. You were
consulted to assist the physician and the hospital in understanding what rights to end of life
decision making the patient has, who is legally authorized person to make decisions for the
patient, and what options are available to the doctor and the hospital when there is a conflict in
treatment decisions.
When analyzing the issue to provide sound legal advice, you will want to understand the rights
the patient has in making decisions regarding their healthcare treatment, who consents for the
patient when they are unable to consent for themselves, what is required for a valid Advanced
Directive and Medical Power of Attorney in the State of Texas, and what is the role of an ethic’s
committee and the court systems in resolving disputes over treatment decisions.
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Please consider the following scenario to complete this assignment:
Julie Adams is a 65-year-old female who lives in Houston, Texas. She was diagnosed
with metastatic breast cancer in May of 2019. She has 2 adult children. Her son John is 40 years
old. Her daughter Susan is 43 years old. Both are of sound mind and considered competent. Ms.
Adams divorced her husband and the father of her children 12 years ago.
In May of 2019 after Ms. Adams was diagnosed with breast cancer, she met with her
attorney, James Dean, to prepare and update her will, medical power of attorney (MPOA), and
advance directives. Her will was updated to remove her ex-husband as beneficiary, and to add
her children as sole and equal beneficiaries of her estate. She had not previously prepared a
MPOA or advance directive, so she informed her attorney about the need for these.
Mr. Dean started by preparing her advance directive by using the Directive to Physicians
and Family or Surrogates form as outlined in the State of Texas Advance Directives Act. (See
her attached Directive to Physicians for her wishes).
Next, Mr. Dean prepared her MPOA. Ms. Adams named her son John as her medical
power of attorney, and her daughter Susan as her 1st alternate agent. She did not list any
limitations of decision making authority in her MPOA. She did not list an end date for her
MPOA. She signed her MPOA. It was witnessed and signed by Mr. Dean and his legal secretary,
Jamie Phillips. She gave her son a signed copy of her MPOA and her Advance Directives.
Ms. Adams immediately started pursuing breast cancer treatment at MD Anderson
Cancer Center. Her Oncologist, Dr. Mary Dale, was responsible for her care and treatment. She
initially responded very well to her treatments, and was declared to be in remission by January
2020. In June of 2020, she started having reoccurring headaches. She went to see Dr. Dale who
ordered a CT scan. Upon review of her CT scan, Dr. Dale informed her that her breast cancer
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had metastasized to her brain. She informed her that there was a treatment available, and Ms.
Adams chose to move forward with it. She informed Dr. Dale of her Advance Directives and her
MPOA. She gave copies of the documents to Dr. Dale to put in her medical record.
Her treatment was going well, and she was experiencing overall mild side effects until
October 4, 2020 when she had a seizure at home. She was admitted to MD Anderson under the
care of Dr. Dale. Upon admission she was awake, alert, and able to converse with the nursing
staff. Dr. Dale ordered a CT scan that showed the cancer in her brain had progressed beyond
treatment. She discussed the scan results with Ms. Adams, and explained that nothing else could
be done, and that her life expectancy was 1 to 6 months. Ms. Adams and Dr. Dale discussed her
advance directives, and if those were still her wishes. Ms. Adams informed Dr. Dale that she had
not changed her mind as to her advance directives, and told her that she did not want to be
intubated or resuscitated either. Dr. Dale wanted to keep her in the hospital for a couple more
days to work on pain medication management before discharging her home.
On October 6, 2020 Ms. Adams began to get confused, and the nursing staff notified Dr.
Dale. At the time of her assessment, Dr. Dale determined that Ms. Adams was incompetent. She
called her son John who was listed as her MPOA. She spoke with John about his mother’s
condition, her advance directives, and the discussion she had with Ms. Adams previously. She
told him that at this time there was nothing else to be done for his mother because of her terminal
condition. She recommended that Ms. Adams be discharge to hospice. John was very upset, and
said that he wanted everything done for his mom, that he was not ready for her to die. He told
Dr. Dale that he was the MPOA and she had to follow his wishes.
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Requirements and Structure of Analysis:
1. Your analysis should be a minimum of 3 pages and not more than 7 pages excluding title
page and references. An abstract is not required.
2. A minimum of 3 references are required to support your opinion. They may include but is
not limited to:
a. Your text.
b. State Law (statutory law – Texas)
c. Federal Law (statutory/legislative law – US)
d. Case Law (common law; exemplar judgement or ruling)
e. Medical standard of care from an authoritative source (medical or nursing text,
practice guidelines or treatment standards)
3. Be sure to cite all references using both in text citations and a reference page. Use APA
formatting for all referencing.
4. Use the following structure to help guide your analysis
a. Identify the main issue you are analyzing.
i. Phrase the issue in the form of one or two brief statements.
b. Is Ms. Adams’ Advance Directive valid?
i. What is required in the State of Texas for an Advanced Directive to be
valid?
ii. What facts support it being valid or invalid?
c. Is Ms. Adams’ Medical Power of Attorney valid?
i. What is required in the State of Texas for a Medical Power of Attorney to
be valid?
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ii. What facts support it being valid or invalid?
d. Upon Ms. Adams admission to the hospital who has the authority to consent for
her medical treatment?
e. After Ms. Adams is determined to be incompetent, who has the authority to
consent to her medical treatment?
f. Does John have the right to ignore his mother’s advance directives?
g. What options are available to Dr. Dale and the hospital after John overrides his
mother’s advance directives?
h. As the hospital attorney, what advice would you give to Dr. Dale and the Hospital
leadership?
i. What type of conversations would you have with John and Susan?