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Jan 9, 2024
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Uploaded by BaronTreeKouprey39
Crystal Pearce
Student ID: 011335180
Healthcare Values and Ethics – C426
8/29/23
A1: The first potential ethical dilemma that is presented in the scenario, which is related to Autonomy, appears to be where Bashir acting to ignore his mother’s (Jamilah – the patient) wishes – demonstrating paternalism; this is where Bashir is acting on his mother’s behalf. Bashir
stated upon his arrival, that he would be the decision-maker in his mother’s care and would like his mother to have a Do Not Resuscitate (DNR) in place, and no other interventions performed other than comfort-care. Jamilah stated to the social worker during their visit together, “Please help me, I want to live.” The social worker was concerned with the dynamic between Jamilah and her sons, during their interactions at the hospital. It appears he is acting as if he thinks that applying the DNR is in his mother’s best interest; this could be due to the fact that she has multiple comorbidities or her age (90). Since Jamilah is only trained in basic English, and her sons are proficient in the language, there could be a language barrier involved as well. The family appears to be retaining their Turkish culture and norms, whereas the sons would act as patriarchs for the family, making many of the family's decisions – including their mother’s health
care decisions. Currently, there are no formal legal documents set in place for Jamilah’s healthcare decisions. If Jamilah wishes to move forward with the family’s cultural wishes/norms,
then she needs to place this information in an Advance Directive; this way, her wishes are expressed in a legal document that the family could use to support the Turkish cultural wishes/norms, for her sons to make the family decisions. The second potential ethical dilemma that is presented in the scenario, is related to beneficence and appears to be present when the social worker approaches the administrator with the information from her visit with the patient, as well as her concerns with the relationship between the patient and her son(s). The social worker believes she is doing something good,
while she could be unaware of the cultural norms and beliefs of the family. Demonstrating beneficence means you are trying to do good, demonstrate kindness, show compassion, and assist others. Unfortunately, demonstrating beneficence can even be harmful, when you think you are doing good. A legal implication in this situation, involves the family, where they are making the decision for the patient – even though she would be able to effectively make the decision for herself if provided an interpreter. This is a complex situation with the patient, the son(s), the social worker, and the cultural beliefs/norms all involved with this patient’s case.
The third potential ethical dilemma that is presented in the scenario, is related to non-
maleficence, which appears to be present with the Cardiologist consultant’s recommendations. Non-maleficence, in summary, is to do no harm. The consultant’s recommendations are based on
the family's (the son’s) wishes, which in return can harm the patient – in this case, death is the likely end result as stated in the scenario. The cardiologist should not be acting in coordination with the son, just because he is verbalizing HIS wishes for his mother. The cardiologist’s recommendations is exactly what would harm the patient, and it would not take long. A1a:
For the three ethical dilemmas I had spoken about, comes with possible legal implications
for each. The first possible legal implication, would be related to Autonomy. It appears that Jamilah has the sufficient ability to make her own decisions, which means she could agree to or deny her own treatment, as she appears competent. There is no POA legally set in place, therefore her son is not the legal dictator. Jamilah can make her own legal, healthcare decisions, as long as she is competent. Since Jamilah is not English proficient, the hospital should provide her with an interpreter, so she can communicate her wishes directly to the hospital in her language. The legal implication in this case, would be that the patient does not have any legal
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documents in place. The patient has not decided Kashir as her POA and is not wishing for a DNR. The patient does not have an Advance Directive in place. If the healthcare facility moves forward without the legal documents, then the healthcare staff can face legal consequences. This would be considered neglect and can result in criminal actions against the hospital and its staff. This neglect could also put the healthcare facility at risk for a civil lawsuit. The second possible legal implication would be related to non-maleficence. This would be a negative legal implication, which could result in death – and the end result would be losing the patient, as well as criminal charges against the hospital and the Cardiologist. He is knowingly
recommending for the patient to not receive any procedures or surgery, which is negligence and will result in the patient’s death. Legally, this is not following the patient’s wishes – as she has verbalized she would like to be saved. Again, there are no legal documents in place for Kashir to be the patients POA. The third possible legal implication would be related to beneficence. This legal implication is actually a positive one – remember, legal implications can be negative OR positive. The social worker is attempting to do good while approaching the hospital administrator. In return, this can help the hospital avoid negative implications. The patient does not have any legal documents in place, indicating that her son is her POA, or that she wants a DNR. The social worker informing the administrator of the patient’s wishes also avoids negative legal implications from the patient versus the hospital, as since there are no legal documents in place – there is no legal reason to listen to the son. If the patient were to die, there could be negative legal implications against the hospital due to the patient passing away. This could result in criminal actions again the hospital and staff. A2:
Next, I will discuss three courses of action as they relate to Bashir’s demands for only comfort care, as well as how they relate to each of the previous ethical dilemmas. The first course of action is to follow Bashir’s wishes. This course of action ethical dilemmas include not giving the patient her autotomy (as she had verbally stated to the social worker that she wanted to live), the Social Worker demonstrating beneficence – where she assumes she is doing good for
the patient but does not have information regarding the cultural beliefs of the patient and her family, and lastly, the cardiologist following Bashir’s wishes and recommending comfort care – as this is the families wishes as well as the patients multiple co-morbidities involved. The second
course of action is refusing to follow Bashir’s wishes. This course of action would ultimately be positive in the subject of the patient’s autonomy, where she would be able to voice her own opinions regarding her healthcare plan. The hospital could provide an interpreter to obtain the required preferences of the patient and she could decide her fate. In this case, the information provided by the social worker to the hospital administrator would be in good faith and hopefully result in a positive outcome. If Bashir’s wishes are not followed, then the Cardiologist consultant’s recommendations could possibly be different. The third course of action would be to
briefly delay the decision to gather additional information and other perspectives. This course of action provides the patient with her autotomy and the opportunity to voice her opinions with a hospital-provided interpreter so that the patient’s wishes are correctly identified. The social worker’s information provided to the hospital administrator would be beneficial, in investigating the patient's wishes and family dynamics. The cardiologist consultant’s recommendations could change to the patient needing/receiving the necessary surgeries and procedures – therefore would
result in the patient most likely living. A2a:
The correct course of action that I would choose, would be to gather additional information and other perspectives. I would choose to act quickly. I would also call the patient’s prior residence (the extended care facility) to see if there are any legal documents for the patient (DNR, POA, Advance Directive, etc.). If such legal documents are available, this could decrease the time of the information seeking and faster response in preventing the patient’s death or carrying out the patient’s (and family’s) potential wishes. This would also give the hospital the opportunity to consult with the legal team, in regard to this particular situation and patient. Time would be ticking in this case, as the patient has multiple comorbidities and would need to have medical attention ASAP. A2b:
I did not choose to solely not follow Bashir’s wishes, because this could cause an uproar in legal issues with the family and the hospital. As I did choose a situation similar to this one, this particular situation completely eliminates his act of paternalism and is not the best way to go
about this patient’s situation. This could cause negative energy between the family and the patient, as well as the hospital. This could cause an ethical concern as well, as the patient’s son has tried demonstrating his role in dictating the patient's wishes. A3/A3a/A3ai: There are multiple resources that could have or could still make Jamilah’s wishes clearer.
The first resource she could have utilized (and still could utilize) would be getting an Advance Directive. This type of legal document would show what type of medical care Jamilah would want if she were too hurt or ill to express her wishes. This type of document would have all of the patient’s decisions, particularly regarding end-of-life care, the patient’s wishes to her family,
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and the healthcare professionals working with her. This type of document would instruct her family, healthcare professionals, etc., on what treatments she would want/would not want if she were dying or permanently unconscious. In this case, the Advance Directive would report if the patient would like/would not like to be resuscitated if her breathing or heart stops, or if she would like medical treatment necessary to survive (the Cardiologist consultations written information, regarding surgeries). The second resource that should have been recommended to Jamilah, would be the Right to Have Special Needs Addressed. Due to the fact that Jamilah was not proficient in English and spoke Turkish, which is considered a language barrier, Jamilah has the right to this type of special help to have her needs addressed in order to ensure proper care. In the scenario, Jamilah was able to voice a small portion of her thoughts to the Social Worker, however, clearly demonstrates the language barrier. The hospital, hospital staff, and the administrator of the hospital should have an interpreter to be able to provide translation services for Jamilah, in order to provide her with high-quality care. If Jamilah had the interpreter services, Jamilah’s wishes would have been able to clearly be stated to the hospital – and there would not be a lapse in care or wasted time to decrease the likelihood of Jamilah surviving. A4: Three policy recommendations that I could make if I were an administrator to help my employees and the facility’s medical staff handle similar situations like this in the future, would be Requests for Consultations, Consultation and Conflict Resolution, and Education.
The first policy recommendation I would make would be Requests for Consultations. The request would be for an Ethics consultation, which can be requested by caregivers, patients,
or family members. These consultants are available any time, day or night, by calling the hospital
ethics hotline phone number. In the given scenario, this policy could be recommended to the patient and family members for an ethics review, regarding the patient and her wishes, the son and his wishes, while also taking into account the other 2 sons. This policy would address the ethical dilemma, regarding the patient and her son wishing for her to only receive comfort care, when she has verbalized to the social worker that she wants to live.
The second policy recommendation I would make is Consultation and conflict resolution.
In the scenario, there appears to be an ethical conflict between the son, the patient, and the hospital. The ethics committee can provide a consultation, regarding the difficulty of decision-
making as well as the language barrier of the patient. This consultation can be at the request of a physician, patient, family member or other caregiver. The ethics committee can provide alternatives that will lead to the best outcome for the patient, and the continuation of care. The third policy recommendation I would make is the education policy. This recommendation would be directed towards the hospital staff but can also be for the community. The main idea of this education is to decrease the number of end-of-life consultations in the hospital setting so that the hospital staff have ethical information before a situation like the one in the scenario occurring. The education programs can provide information regarding legal, ethical, or spiritual issues, and the family’s conflict, which all relate to the stated scenario. Another piece of information that the policy could provide, is how to prepare and execute an advance directive. This would be very beneficial in this scenario, as this would demonstrate the patient’s wishes legally.
References Legal and Ethical for Health Professionals (5
th
ed.) (2019).
(Multiple Pages).
Retrieved from:
https://wgu.vitalsource.com/reader/books/9781284174632/epubcfi/6/2[%3Bvnd.vst.idref
%3Dcover]!/4/2/2%4050:2
. Western Governors University. (n.d.). Ethical Dilemma Scenario [Course artifact]. Available from
https://tasks.wgu.edu/student/011335180/course/27380011/task/3434/overview
.
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