PART 1
Framework for ethical problem solving
On the basis of given case scenario, the ethical issue identified in both case of Michelle and Maria is informed consent. It is seen that Michelle is minor and have intellectual disability that affects her ability in providing the informed consent (Das et al, 2025). On the other side, Maria is depressive and have schizophrenia condition that affects her in understanding options for euthanasia completely, affecting her in providing informed consent. The other issue identified in case of Michelle is refusal to treatment right, as it contradicts with the beneficence principle of healthcare.
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Trying to discover the facts in this case offer insights about this problem. As Michelle is minor and 31 weeks pregnant and have suicidal tendencies as well as refusing to the treatment. While, in Maria’s case, schizophrenia and depression affects her ability to take decision in relation to euthanasia option. Although these facts does not provide solution but this added information to make right decision for both patient (Faissner et al, 2024).
In healthcare, principle of autonomy is important to maintain while offering care to the patient . In Michelle’s case it is crucial to understand her choice of treatment and her reason for refusal to treatment. However, she is not mentally competent, and to respect her autonomy it becomes crucial to involve her parents in treatment decision making. In Maria’s case, beneficence principle guides in providing safer environment to her and maximising benefit to the patient by making her clearly understood about the condition as well as options available for euthanasia.
For Michelle case the key stakeholders identified are- her mother who wants her daughter to undergo treatment and live prosperous life (Maguluri et al, 2024). Michelle herself is feeling discomfort in the proposed medical intervention. In this regard, Healthcare professionals are trying to provide the best possible care to her. In case of Maria, her perception is to end her life take place in a dignified manner due to the on-going illness challenge. Thus, considering all these perceptions and writing it in a note helps in making the best decision in both cases.
By doing evaluation of case scenarios, it has assessed that the ethical conflicts arose between beneficence and autonomy principle of ethics. As Michele is self- determined and has autonomy to make her decision to refuse or undergo treatment. However, beneficence principle of ethics guides health practitioner to provide best care to their patient. In case of Maria, the conflicts arose between informed consent and beneficence principle. As she is not in a state to provide informed consent because of her condition that makes her vulnerable to understand options of euthanasia.
Mental health act 2007 (NSW) is identified for both the cases (NSW, 2025). This legal regulation helps in providing support to the patient who is not mentally competent to provide informed consent for the medical intervention (Bahadurzada et al, 2024). Concerned case also indicates the legal involvement where Michelle’s mother have requested to court for restraining her to receive the treatment. Further, euthanasia is considered as legal in Australia under certain conditions, therefore, involving legal practitioner in case helps in making decision for Maria.
Critical reflection
I have learned that clear use of framework helps in making ethical decisions within clinical setting. This case has made me realised that how comprehensive patient centred care is important to balance legal, ethical and medicinal components in intervention. This has supported me in understanding both the cases. Before that, I was not aware of the fact that in clinical setting ethical principle may contradict at some point and resolving this requires holistic approach and patience. Further, I have reinforced that strong clinical base, communication strength and legal understanding are important to consider through analysis of the case. Further, I was not aware that positive culture plays a vital role in boosting communication, that’s why I have learned that transparent communication helps in empowering patient and their carer to remain involve in the decision making.
PART 2
Framework for legal problem solving
Issue: Legal issue identified in both Michelle and Maria’s case is capacity to provide the informed consent. Michelle is 15 year old and have mental incompetency making her reluctant to express consent. However, Mental Health Act 2007 (NSW) helps in determining whether patient is competent to make informed decision. Along with this, it guides whether to involve guardians in decision making if patient found mentally incompetent (Zhou et al, 2024). In case of Maria this issue is found where her condition restricting her to provide consent for euthanasia to end her life.
Rule: The rule that requires to be applied in Michelle’s case is Australian Mental health act (2007) to analyse whether patient is competent to provide consent by considering all the risk factors associated with her deteriorating health and potential benefit which medical intervention can provide. Further, this law also helps in involving guardian if patient is not mentally competent. Therefore, involving Guardians of Michelle helps in decision making across the treatment cycle of Michelle, their involvement also makes her feel safe while drawing blood and other clinical process (Stigter-Outshoven et al, 2024). The rule applied for Maria’s case is involving court in her case, as euthanasia is legal in all Australian state, where understanding in VAD (voluntary assisted dying) act is important to analyse whether Maria’s conditions are meeting eligible criteria for ending her life or not (QUT, 2025). Thus, court’s inclusion helps in the legal proceeding of case.
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Application: It has been identified from the case that Michelle’s understanding in refusing to treatment may indicate her capacity to provide consent (Chen et al, 2024). Therefore, careful analysis is important to decide whether she is competent enough to provide consent or her parent’s involvement is equally important. Thus, it is legally relevant to Australian Mental health Act (2007) to provide equitable support to the patient and seeking their support in the decision making. Further, Michelle’s recent suicidal attempt and current admission for mental health intervention suggesting that she may lack ability to make better decision. Further, careful assessment of her condition is needed to determine whether she is understanding her condition or not aware of it. In case of Maria, the court need to determine whether she is meeting all the eligible criteria of VAD or not to proceed with euthanasia options (Lynch et al, 2025).
Conclusion: From the Michelle’s case, court involvement would be beneficial to decide whether she is competent to provide consent for refusing blood test. Refusal to treatment indicates that she may have capacity to give consent, which implies that her mother’s court application for restraint may fails for proving that Michelle is not mentally competent. Thus court must investigate Michelle’s intellectual disability claim petitioned by her mother to provide best verdict. Likewise, court’s investigation in Maria’s case helps in understanding her eligibility for VAD act.
Critical reflection
This legal decision making process has helped me to understand applicability of IRAC framework. Before that I was unaware with the fact that how court and legal involvement plays a vital role in the field of healthcare. Now, I have learned that legal and ethical understanding helps in seeking support of legal practitioner that helps in resolving the case without compromising the health of patient. I have also learned about the legal regulations that guide’s the patient’s right. For instance: Mental Health Act (2007) helps in providing the best support to mentally ill patient by providing them care aligning with their best interest. Therefore, in near future I will ensure to abide with this law and other crucial regulation to provide support to my patient. Additionally, both the cases have helped me to understand how court’s involvement is essential to decide whether patient is mentally competent or not to provide consent. Thereby understanding in legal and ethical regulations helps in providing person-centred approach leading to positive health outcomes of patient.
REFERENCES
Books and Journals
- Bahadurzada, H., Kerrissey, M., & Edmondson, A. C. (2024). Speaking up and taking action: psychological safety and joint problem-solving orientation in safety improvement. In Healthcare (Vol. 12, No. 8, p. 812). MDPI.
- Chen, Z. Z., Ma, J., Zhang, X., Hao, N., Yan, A., Nourbakhsh, A., ... & Wang, W. Y. (2024). A survey on large language models for critical societal domains: Finance, healthcare, and law. arXiv preprint arXiv:2405.01769.
- Das, B. C., Zahid, R., Roy, P., & Ahmad, M. (2025). Spatial data governance for healthcare metaverse. In Digital Technologies for Sustainability and Quality Control (pp. 305-330). IGI Global Scientific Publishing.
- Faissner, M., Brünig, L., Gaillard, A. S., Jieman, A. T., Gather, J., & Hempeler, C. (2024). Intersectionality as a tool for clinical ethics consultation in mental healthcare. Philosophy, Ethics, and Humanities in Medicine, 19(1), 6.
- Lynch, L., Moorhead, A., Long, M., & Steele, I. H. (2025). “I Felt Like There Was Something Wrong in My Brain”: Growing Up with Trauma–How Young People Conceptualise, Self-Manage and Seek Help for Mental Health Problems. Journal of Child & Adolescent Trauma, 18(1), 103-125.
- Maguluri, K. K., Ganti, V. K. A. T., & Subhash, T. N. (2024). Advancing Patient Privacy in the Era of Artificial Intelligence: A Deep Learning Approach to Ensuring Compliance with HIPAA and Addressing Ethical Challenges in Healthcare Data Security. International Journal of Medical Toxicology & Legal Medicine, 27(5).
- Stigter-Outshoven, C., Van de Glind, G., Wieberdink, L. J., van Zelm, R., & Braam, A. (2024). Competencies emergency and mental health nurses need in triage in acute mental health care: a narrative review. Journal of emergency nursing, 50(1), 55-71.
- Zhou, T., Luo, Y., Xiong, W., Meng, Z., Zhang, H., & Zhang, J. (2024). Problem-solving skills training for parents of children with chronic health conditions: a systematic review and meta-analysis. JAMA pediatrics, 178(3), 226-236.
- Online
- NSW, 2025. Mental health act 2007. [Online]. Available through: <https://legislation.nsw.gov.au/view/whole/html/inforce/current/act-2007-008>
- QUT, 2025. Voluntary assisted dying. [Online]. Available through: <https://end-of-life.qut.edu.au/assisteddying>
