C426 Task 1
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Western Governors University *
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426
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Health Science
Date
Jan 9, 2024
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docx
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6
Uploaded by MagistrateJayMaster719
Brooke Rayl
010779249
Healthcare Values and Ethics C426
01/08/2023
Revised 08.13.19 CSS
A1. Potential Ethical Dilemmas Jamilah Shah is a 90-year-old female that was admitted to the hospital after collapsing at her bedside of the extended care facility (ECF) she resides in since her husband’s death. Testing performed at the hospital reveals Jamilah suffered from a heart attack. Jamilah is originally from
Turkey and moved to the United States over 40 years ago along with her wealthy husband. Prior to leaving Turkey she practiced law, but upon arriving in the US she became a homemaker and learned minimal English. The social worker met with Jamilah alone. During this visit Jamilah stated she wants help and wishes to live. Medical records were requested from the ECF and it was discovered that Jamilah has three sons with Bashir as her emergency contact. She does not have any Advanced Directives and has multiple pre-existing comorbidities. Bashir was contacted and arrived bedside at the hospital with Jamilah. Bashir has expressed that he is the decision maker and wishes his mother to be a DNR. He does not wish for Jamilah to have any interventions other than comfort care. Without a cardiac catheterization or cardiac bypass surgery Jamilah will likely pass away within days. The social worker also witnessed concerns surrounding the interactions between Jamilah and her sons. The hospital’s ethics committee has not yet been involved. This scenario presents a few issues including autonomy, beneficence, and
non-maleficence.
Autonomy is the right of an individual to make their own decisions surrounding what is best for them. Autonomy can be affected by several different situations, including mental capacity, maturity, or disabilities. This is not the case for Jamilah. She was able to express her wishes to the social worker that she wanted help and wanted to live. Jamilah’s sons do not have the same wishes for her healthcare. With Jamilah not having Advanced Directives listing her specific wishes, the verbal statement from Jamilah to the social worker, and the verbal requests from Bashir this presents an issue for the ethics committee.
Beneficence is the act of showing kindness or doing good. In a healthcare setting, beneficence is thoroughly providing the benefits of a treatment/medication/procedure and balancing the benefits with the risks of the treatment/medication/procedure. The medical professionals working with Jamilah have a responsibility to show Jamilah beneficence. It was witnessed that Jamilah’s sons have an unsupportive relationship with their mother. Jamilah currently has no Advanced Directives in place clarifying her wishes, although she verbally expressed that she wants to live. This presents an issue for the medical professionals. They have stated that without medical intervention Jamilah will pass away within days, which is what Bashir has decided for his mother. Jamilah has not shown any signs of cognitive impairment. Beneficence would encourage the medical professionals to follow Jamilah’s wishes and save her life. If it is proven that Jamilah is incapacitated, she would lose her autonomy and the decision would ultimately fall on the sons. Non-maleficence is a principle that states a person should not intentionally inflict harm on another person. Medical professionals have a timely and important decision to make. They must decide whether Jamilah is of sound mind and follow her wishes or if she does have a cognitive Revised 08.13.19 CSS
impairment that would cause her to lose her autonomy and follow Bashir’s wishes. If they choose to follow Bashir’s wishes they risk legal implications seeing as they are aware of Jamilah’s wishes and knowing that she is likely to pass away in a matter of days without interventions. That would be considered non-maleficence on the hospital’s part and they must present this situation to the ethics committee to make an informed and educated decision.
A1a. Legal implications – Autonomy Jamilah has not been proven to have any cognitive impairments to alter her rational decision making and therefore should have full autonomy in her treatment plan. Jamilah’s wishes are to receive medical intervention in hopes of living. If she does not receive medical intervention it is predicted that she will die in the next couple of days. The hospital must examine this case thoroughly and explore all ethical and legal pathways to ensure they make the best choice. For instance, if the hospital were to follow Jamilah’s wishes and provide either a cardiac catheterization or coronary bypass surgery in order to save her life there could be legal implications. The hospital could face civil law charges from Bashir and his brothers. Bashir has stated that he is the decision maker in the family and wishes his mother to have a DNR and have no life saving measures take place. Bashir and his brothers could have a case of contract action due to not following the wishes of Jamilah’s sons. If it is discovered that Jamilah does have a cognitive impairment or is not of sound mind and the hospital provides her necessary treatment to save her life the hospital could face criminal law charges.
A1a. Legal implications – Beneficence Beneficence is showing kindness or doing good. Showing beneficence to Jamilah in this situation would be providing medical intervention so they can hopefully save her life. The hospital could potentially face legal implications under civil law from Bashir and the sons if the hospital does decide to show Jamilah beneficence. As aforementioned, this could lead to Bashir and the sons filing a contract action against the hospital. A1a. Legal implications – Non-maleficence Non-maleficence is the principle of not intentionally inflicting harm on another person. In this situation if the hospital chooses to follow Bashir and the sons wishes they have the potential of showing maleficence, which is intentionally inflicting harm on another person, rather than non-
maleficence. This causes the hospital to run the risk of facing a criminal law suit. As long as the patient is considered to have full cognitive function, they should follow the patient’s autonomy and show beneficence. This leads to the act of non-maleficence. With Bashir and the sons not showing a supportive relationship with Jamilah it is believed the hospital would be showing maleficence knowing Jamilah will die in a matter of days.
A2. Course of action 1: follow Bashir’s wishes Revised 08.13.19 CSS
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Bashir wishes that his mother receive no medical intervention and that she be placed on comfort care only. The dilemma that the hospital faces is that Jamilah did not admit to the hospital with advance directives in place. Advanced directives would directly reflect Jamilah’s wishes without
questioning whether she has any type of cognitive impairment. Even if there was decreased cognitive function they could still follow the advance directives knowing that she did express those wishes while of sound mind. Bashir states that he is the decision maker of the family, but it
was also witnessed that all the sons do not have a supportive relationship with their mother. They
face the dilemma of showing Jamilah autonomy, beneficence, and non-maleficence by following
Bashir’s wishes.
A2. Course of action 2: refuse to follow Bashir’s wishes By refusing to follow Bashir’s wishes of placing his mother on a DNR with only comfort care the hospital assumes the risk of legal implications such as a criminal law suit against the hospital. Ethically, they will need to definitively decide whether they deem Jamilah of sound mind, and therefore autonomous, in order to refuse Bashir’s wishes. It would greatly benefit the situation if Jamilah had presented to the hospital with advance directives already in place so there would be no question on what the course of action should be. A2. Course of action 3: briefly delay the decision to gather additional information and other perspectives Delaying the decision on following Bashir’s wishes or refusing them runs a risk to the hospital and the patient. If the hospital delays too long and Jamilah codes or dies prior to them making a determination they have to make the decision quickly on whether to resuscitate Jamilah or follow
Bashir’s wishes in an extremely emergent situation. If they decided to follow Bashir’s wishes and not save Jamilah’s life, they run the risk of legal implications. If they do resuscitate Jamilah and she has other conditions that arise from that, ethically they did not show Jamilah non-
maleficence.
A2a. I believe the correct course of action in this situation is to refuse Bashir’s wishes. Bashir wishes his mother to be a DNR and only receive comfort care. Although she does only know basic English, they can bring in an interpreter in order to eliminate any language barrier issues. Jamilah does not have any advance directives in place but is considered to not have any cognitive impairments and therefore autonomy should be practiced in this situation. They face legal implications regardless of the decision they make. As long as the hospital finds Jamilah to have no cognitive impairments they should follow her wishes and they should be able to win a law suit assuming they have the proper documentation to support this fact.
A2b. Revised 08.13.19 CSS
An incorrect course of action in this situation is to follow Bashir’s wishes. By following the wishes of placing Jamilah on a DNR and only receiving comfort care the hospital is ethically not
allowing the patient to have autonomy. They also are not showing the patient beneficence or non-maleficence. The hospital risks a criminal law suit filed by Bashir and his brothers for not following Bashir’s wishes, but assuming they have performed cognitive testing and documented to such they should have good grounds to win the law suit. I believe, both ethically and legally, they should refuse Bashir’s wishes.
A3. The first resource the hospital should have utilized was the use of an interpreting service. With Jamilah knowing only basic English a language barrier is sure to hinder all communication. Jamilah could have a hard time understanding what the medical professionals are trying to tell her. She may not understand the risks and complications that come with cardiac catheterization or cardiac bypass surgery. The hospital needs to ensure they practice beneficence to the best of their ability and explain the benefits of the treatment options against the risks. She may also have
trouble getting the medical professionals to understand what she is trying to communicate to them. An open line of communication without any barriers should be practiced from the very beginning so that the hospital can ensure everyone understands the options the patient and family
may have.
Another resource the hospital could utilize is having personnel on staff in order to complete an advance directive or living will with the patient during their admission process. I believe the hospital could benefit from having someone well versed in the completion of the advance directive process so that they can educate the patient/family members and answer any questions that may arise during the process. Having an advance directive in place prior to Jamilah’s admission would have prevented this ethical and legal issue altogether. There wouldn’t have been any questions as to whose wishes they should follow, whether it be Bashir’s or Jamilah’s. This scenario further stresses the importance of having advance directives or living wills in place
prior to any serious medical conditions or decisions.
A3ai. As previously mentioned an interpreter should be used for any patient with a language barrier. It is important that all medical personnel understand the patient. They must be able to know exactly
the patient’s symptoms, medical history, medications, onset of symptoms, etc. to get a clear picture of the patient’s health. They must also understand the wishes of the patient and how they would like to proceed. It is just as important for the patient to understand the medical professionals caring for the patient. The patient must understand their diagnosis, prognosis, treatment options, risks and benefits, etc. They must proceed without any language barriers for the patient or the hospital staff in order to make an informed decision.
Having staff members or a designated staff member trained and educated in advance directives or living wills would make the process of creating these documents a little easier on everyone Revised 08.13.19 CSS
involved. They could make that part of their admission process and eliminate this issue moving forward. With Jamilah having a pre-existing advance directive this never would have been an issue. The hospital staff could perform and cognitive function test and decide if Jamilah is considered autonomous. If she is, they would move forward with the advance directives to clear up any further decision making between Jamilah and her sons.
A4. As a hospital administrator for this organization the first policy recommendation I would have is to ensure that there is either an interpreter or interpreter service on staff at all times. I would initially try to gather data around the population’s languages that are spoken around the community. With the most common language (aside from English) I would try to have an interpreter in person. For any other languages that may not be as common I would ensure there is
an interpreter service we could utilize at all hours of the day or night with multiple different language options. This would alleviate any language barriers moving forward for the organization.
The second policy I would recommend is having all medical professionals educated and trained in advance directives and living wills. This would allow the patient to be able to ask necessary questions and receive answers quickly. The medical professionals can also stress the importance of having either an advance directive or living will. This ensures the patient always have their wishes in regards to medical decisions listened to without fear of making the wrong decision. There would be absolutely no guessing on what the patient is wanting or what the hospital should do based on legal implications or ethically what is “right”.
The third policy I would recommend would be to have a social worker available at all times to work with the patient on their advance directives or living will. The social worker can perform the mental cognition tests to ensure the patient is of sound mind. They can then work together to create the legal documents to ensure the patient has autonomy in their treatment plan. Again, this
prevents any ethical or legal questions from arising on how to care for the patient. The hospital would have a clear idea of what the patient is wanting and can proceed without delay moving forward.
Revised 08.13.19 CSS
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