A Case Analysis of Informed Consent

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Mrs. Sparza, a 70 year old grandmother with little English skills, is scheduled for surgery of her right eye. Upon entry to the hospital, she and her son review the general admission documents and Mrs. Sparza signs them all. Mrs. Sparza also completed and executed a durable power of attorney for health care. Mrs. Sparza identified her daughter and son as her agents for decision making in the event that she became incapacitated. Mrs. Sparza also specified that she did not wish any heroic measures and that in the event she went into a coma she wanted the life support terminated.

After changing into a patient gown and having her vital signs taken, Mrs. Sparza is taken into the pre-operative room where she is placed on a gurney. After administration of pre-operative muscle relaxant medication, she is rolled into the operating room. Upon entering the operating room, Mrs. Sparza is greeted by Nurse Johnson who asks Mrs. Sparza to sign the surgical consent form. The form is in English and identifies the procedure as surgery of both eyes. Mrs. Sparza is told that she is scheduled for surgery of both eyes and is asked to sign the consent.

When Mrs. Sparza objects and refuses, Dr. Pinnette enters in his green scrubbs and talks with Mrs. Sparza with the aid of an interpreter. After a minute of conversation, with tears in her eyes, Mrs. Sparza signs the consent form and is placed under general anesthesia. At six a.m., on the next day of her hospitalization, Mrs. Sparza suffers a heart attack and her kidneys ceased function. She subsequently went into a coma. Her children were immediately notified and arrived at the hospital at 8:30 a.m. When informed of the doctor's decision to place Mrs. Sparza on a dialysis machine, the son and daughter declined consent and asked that life-support be terminated pursuant to the patient's directive.

Mrs. Sparza's cardiologist, Dr. Lox, a world famous cardiac surgeon, refused to give the nurses the order to terminate life-support. Dr. Lox looked for every excuse to avoid the family. At the family's request, Mrs. Sparza's nurses provided comfort care until 3:30 in the afternoon of the next day. The two day ordeal was a long and emotionally traumatic experience for Mrs. Sparza's family, who received relief when Mrs. Sparza's nurse injected a fatal dose of morphine to ease and expedite her death.

Assignment Expectations;

Identify and briefly explain the elements of informed consent;
Discuss whether Mrs. Sparza's consent was properly obtained;
Identify Mrs. Sparza's rights regarding end-of-life decision making;
Discuss the nature of the act of injecting morphine. Was it legal?