Case Study Scenario
Richard is 41 year-old-man who works as a fly-in-fly-out worker for a mining company in
Central Queensland. Richard has worked at the mines for twelve years, and is an experienced blast
crew member. He has been in a relationship with Meryl for 22 years, and they have four children
aged 9, 11, 13, and 15. Although his home is in Brisbane with Meryl and the children, he shares a
two-bedroom unit with his best friend and crew manager Lucas every second week, while they are
on-site at the mines.
Richard is muscular and physically fit, as he works out in the gym nearly every day on top
of his physical work in the mines. His mining crew call him ‘The Mountain’ in honour of his size
and strength. It was a surprise to them, then, when partway through a scorching hot workday he
announced that he simply couldn’t continue work and needed to sit down in the shade tent because
he felt like he was going to collapse. Lucas took Richard over to sit in the cabin of the crew vehicle
with the air conditioner on, and gave him some chilled water to drink. A few minutes later Richard
let himself out of the vehicle and loudly announced, he did not feel well at all.
Lucas decided to take Richard to the mining camp clinic, which was staffed by companyemployed paramedics. The paramedics offered Richard a drink and sat him down to rest in the
adjacent treatment room. They took his observations, which were mostly within normal limits, but
noted that his respiratory rate was high. After about half-an-hour one of the paramedics went to
retake Richard observations, only to find him collapsed on the floor. She immediately called an
ambulance, but by the time it arrived, nearly an hour later, Richard had recovered and stated he was
ready to go home. His respiratory rate had slowed, but he wouldn’t allow the paramedics to take his
blood pressure, retracting his arm each time they tried. The paramedics advised Richard to drink
plenty of water and stay out of the heat for the rest of the day, as he left the clinic.
Richard did not intend to return home though. He was a diligent worker so headed straight
back to the mine site, ready to get back on the job. As he got back to site he realised he had left his
safety equipment in the shade tent, and began walking over to pick it up. Unbeknown to Richard,
while he had been at the clinic the crew had set up for the next round of blasting. As he crossed the
site the blast was set off. A large chunk of rock hurtled through the air and struck Richard in his
unprotected head. Richard fell, landing heavily on the ground.
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Lucas rushed over and saw that Richard had sustained significant head injuries and was
lapsing in and out of consciousness. He radioed for urgent medical assistance. Luckily, the
ambulance had not long left the clinic and was only a few minutes away. Upon arrival, the
paramedics assessed Richard as having severe traumatic brain injury with bleeding and bruising,
extensive facial and skull fractures, suspected fractured ribs and a pneumothorax. As Richard was
minimally responsive and bleeding profusely, they immediately intubated him, attempted to address
the bleeding, and called for helicopter evacuation, to transport him to Brisbane Hospital.
At the hospital CT scans confirmed multiple skull and facial fractures, a large subarachnoid
haemorrhage and a left pneumothorax. While these injuries were potentially life threatening, given
Richard’s excellent physical condition the healthcare team believed that with appropriate treatment
he could recover and, therefore, was admitted to the intensive care unit. In the meantime, Lucas had
begun the long drive back to Brisbane hospital. Meryl, too, had been contacted and immediately
went to Richard’s bedside.
After ensuring that Richard’s haemodynamic condition was stabilised he was prepared for
surgery to fix the facial fractures and evacuate the haematoma. Meryl was hopeful of positive
outcomes; Lucas had seen the extent of Richard’s injuries before he received any health care, so
was considerably less optimistic.
Unfortunately, after treatment in the intensive care unit for several weeks, Richard’s
progress was poor, and as time went on the chances of a full recovery become increasingly slim. A
tracheostomy tube was inserted, but despite several attempts, he could not be weaned from the
ventilator. Richard also no longer moved spontaneously, although Meryl believed that he did tilt his
head towards her and squeeze her hand when she spoke to him.
Understandably, this was a devastating turn of events for Meryl and the children, as well as
for Lucas. As weeks turned into months, Meryl began to accept that Richard might not return to his
former state of health. The healthcare team caring for Richard formed the opinion that Richard was
in a minimally conscious state. They believed that because of the extensive traumatic brain injury
Richard had no awareness of his surroundings, and as long as he remained unable to breathe on his
own there was no possibility of recovery.
Lucas agreed with the assessment made by the healthcare team, believing that Richard
displayed no sign of recognising anyone, or even that people were there with him at all. He
described Richard’s condition, saying that, ‘initially you could think that he might notice you were
there, but it was really like he was asleep on the inside and just startling at noise or contact’. Lucas
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insisted that he and Richard had discussed how they would each want to be treated if they were ever
to be involved in a significant workplace accident. Richard had been clear and adamant that he
would not want to be left in a situation where he could not care for himself, would be a cause of
distress to his family, and would be unable to provide for the people he loved the most. Lucas said
Richard had said ‘if that ever happens, mate, please just turn the bloody machines off’.
Meryl’s perception of Richard’s situation was quite different. She had undertaken some research
and found several cases in which people had ‘woken up’ after being in comas for prolonged periods,
and several more in which people had substantially recovered from traumatic brain injury. Meryl
did not agree that Richard had no awareness of his surroundings, and thought that from time to time
he would try to turn his head when he heard the children’s voices – not always, but sometimes. She
also knew that Richard would not want to remain reliant on others’ care in the long term but was
hopeful that given adequate time and constant encouragement, Richard would once again be able to
communicate with his family, if not return to his prior self entirely.
Lucas and the healthcare team caring for Richard believe that continuing treatment is not in
his best interests. They have reached the conclusion that all treatment should stop. Meryl, however,
is opposed to stopping treatment and wants Richard to be given every opportunity to recover; even
if this means that he needs to remain highly dependent in hospital for many more months or years.
Meryl wants to do whatever is necessary to ensure that the life-sustaining measures Richard is
currently receiving continue indefinitely.
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Full Details of the Task
You are required to address the following ethical criteria and legal questions as a structured
essay with the following headings.
Introduction
A short introductory paragraph that outlines what you will be presenting in your case report.
You do not need to include a detailed account of the facts in the scenario; the markers are aware of
the facts and this is an unnecessary use of words.
Ethical Issues
In structured sentences and paragraphs address the following criteria that are loosely aligned
with the Kerridge et al model of ethical problem solving. Kerridge et al note that solving an
ethical problem requires gathering the facts, and this includes ascertaining the beliefs and
values of those caring for the patient. You are required to:
- Identify one belief or value that Meryl may have and, referring to appropriate academic
literature, describe this value. - Identify one belief or value that Lucas may have and, referring to appropriate academic
literature, describe this value. - Discuss how the different values and beliefs held by Meryl and Lucas may contribute to
their different points of view on Richard’s ongoing care.
Kerridge et al also recommend that we consider broader principles when seeking to solve an ethical
problem. - Select two of the principles in the Universal Declaration on Bioethics and Human
Rights and describe how they conflict when applied to facts in the scenario.
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Legal Issues
Using structured sentences and paragraphs, answer the following questions in relation to
legal issues raised by the case. - What elements must be present for Richard’s consent to treatment for heat shock be
valid? What legal authority can you rely upon to support your answer? What potential
legal consequences may flow if healthcare practitioners provide treatment without first
obtaining consent? - As Richard had previously refused medical treatment by the ambulance crew for his
heat shock, do the paramedics have any legal authority to institute treatment for his
head injury? What legal authority can you rely upon to support your answer? - After sustaining the head injury, Richard will not have decision-making capacity.
Provide a rationale that supports the legal obligation to obtain consent for
Richard’s ongoing healthcare in these circumstances. - What are the legal options for obtaining consent for Richard’s ongoing care in these
circumstances? Support your answer with Queensland legal authority. - Assume that Meryl is Richard’s substitute decision maker. Describe how the
healthcare decisions she wants to make are consistent with, or in opposition to, the
Health Care Principle set out in the Guardianship and Administration Act 2000.
Sample Solution
