C426 Healthcare Values and Ethics TaskPassed
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Western Governors University *
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426
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Medicine
Date
Jan 9, 2024
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docx
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Uploaded by rdern
Course: C426 Healthcare Values and Ethics
A1. In this scenario, the ethical dilemma involves Jamilah Shah, a 90-year-old woman admitted from her extended care facility to our hospital after collapsing near her bedside. She has suffered a heart attack and has COPD and adult-onset diabetes mellitus. The social worker, medical care team, and Jamilah's sons disagree about Jamilah's treatment and care plan. Bashir, her son, has requested that she not receive any treatment or interventions and have a DNR order placed. The social worker believes that Jamilah would like to receive treatment and live, as she took her hand and told her she wanted to live. Jamilah will only live a few days if the medical team does nothing. The dilemma raises three causes of action to analyze: non-maleficence, autonomy, and beneficence to help decide Jamilah's future care.
Having autonomy is expressing authentically one's desires and recognizing that a patient can make their own decisions. Jamilah purposefully got the social worker's attention by reaching out for her hand and saying she wanted to live and help her. Bashir is her emergency contact at her extended care facility. Still, there are no advance directives on file, so it's unknown if Bashir has power of attorney or if Jamilah can make her own decisions. Jamilah's barrier is communication, as she is not fluent in English. The hospital did not provide an interpreter or translator when she was admitted to help bridge the communication barrier. The hospital is responsible for delivering patient-centered care, validating patients' sound of mind while checking for any advanced directives, and providing an interpreter or translator to explain the treatment plans that are best for their care. If Bashir's wishes were to be followed, the medical care team would not support Jamilah's autonomy.
Beneficence consists of a moral duty to show compassion, kindness, and the best interest of someone. In this scenario, both the sons and the medical team have shown beneficence for Jamilah from
their perspectives. Bashir is compassionate and caring as he decides to have their mother go on comfort care so she may pass away peacefully and no longer be in pain. At the same time, beneficence is also a moral compass for all medical providers to promote the course of action they believe is in their patient's best interests. With Jamilah stating she isn't ready to give up and wants to fight to stay alive, the medical care team is responsible for listening to their patient's wishes. The providers must do good by discussing Jamilah's test results and treatment options. If time allows, they can request an urgent ethics committee meeting to analyze this case for Jamilah's best interest.
The obligation not to inflict harm on others or do no harm is an ethical principle referred to as non-maleficence. Hospitals and medical professionals have a moral duty to ensure everyone involved in patient care is not harmed. As Bashir requests a DNR order for his mother, this response, unfortunately, does not align with Jamilah's wishes to stay alive. If the medical care team acts on Bashir's wishes, it will cause a delay in care for Jamilah, which will cause harm to her. As a consulting service, the cardiologist is in violation as he did not speak with Jamilah about the results of her tests, which could extend her quality of life. The cardiologist wrote notes in her medical chart stating that the family has a DNR and should not proceed with any interventions.
A1a. Legal implications – Autonomy: The hospital ensures that Jamilah's voice is heard and valued. Informed consent is an essential aspect of autonomy, and legally the hospital must make sure they
provide all components of any interventions or treatment plans, along with any risks and benefits. If the patient's preferred language is not English, a translator should be provided to ensure they understand the whole picture around their medical complications and care plan. Failure to provide language assistance or informed consent will result in legal implications. The social worker did not speak to Jamilah's sons about their mother's wishes, nor did the cardiologist talk to Jamilah and her sons about the outcome of her tests and the options for treatment. Neither Jamilah nor Bashir has consented to anything which would be negligence for the hospital since it has no official documentation filed for consent or advance directives.
Legal implications – Beneficence: The hospital and workforce member's moral duty is to provide compassionate, kind, and high-quality care in the best interest of each patient. Failing to provide appropriate interventions and treatment plans would be negligent and not providing a legal duty to their
patients. The medical staff has a legal responsibility to give the best care to Jamilah until they confirm and resolve who can make legal decisions for her care. The cardiologist wrote notes in Jamilah's chart stating that the family wishes not to have treatment and be placed on comfort care. This response violates beneficence and negligence.
Legal implications – Non-maleficence: Jamilah has expressed her will to live, and her son, Bashir, has expressed that he would like her to be placed on palliative care. Jamilah has no advanced directives, and the medical team has not confirmed that Bashir can legally make decisions on her behalf. The medical team will be causing harm to Jamilah by not continuing any intervention or treatment. They have a duty not to cause harm to their patients. Until they resolve the ethical dilemma of advance directives in Jamilah's case, they should continue treating her with the highest quality of care. Not providing an interpreter for Jamilah is another violation of causing harm as it violates ADA laws and regulations. Not providing care to Jamilah will result in her passing away, and the other sons can legally sue the medical staff and hospital for not providing care to their mother when she expressed her will to live.
2.
Course of action 1: Follow Bashir’s wishes
If the medical team decides to follow the wishes of Bashir, then Jamilah has no autonomy. She will have no interventions or treatments despite expressing the will to live. Jamilah has also not been allowed to fully understand her diagnosis, as the medical team has not brought in a translator. These tactics are not supporting autonomy or getting informed consent. Jamilah will be placed on comfort care,
and a DNR order will be placed in her chart. The medical team will be causing harm by not following their patient's autonomy as she told the social worker she wanted to live, by not receiving any form of consent since she has no advance directives, and by following the wishes of her son, who has not proven
any legal documentation that he can make decisions on her behalf.
Course of action 2: Refuse to follow Bashir’s wishes
Refusing the wishes of Bashir will allow the medical team to fulfill Jamilah's autonomy, and the providers will not harm her. Jamilah has no advance directives on file, allowing her to make her own decisions to the best of her ability. Bashir and the hospital have yet to find any reason thus far that Jamilah is incapable of understanding, except that she speaks a language other than English. The
providers can be compassionate when providing Jamilah with different interventions and treatment plans. If time allows, the social worker could bring a translator to help Jamilah understand the treatment and services she needs for her care plan.
Course of action 3: Briefly delay the decision to gather additional information and other perspectives.
Delaying the decision would allow an interpreter to help Jamilah understand the treatment and services she needs for her care plan. Having an interpreter present would allow Jamilah autonomy while ensuring she has the whole picture for her care plan. The translator, social worker, and providers would explain the interventions and risks for her care. This approach would provide the patient's consent that the hospital would need to move forward or not. The hospital can also request an urgent ethics committee meeting to review Jamilah's case. The ethics committee can help determine the best course of action to follow, whether with Bashir or Jamilah's wishes. Delaying the decision on Jamilah's course of treatment will put her health at risk, as the providers mentioned with no treatment, she has days to live.
2a.
The best action for Jamilah's case is refusing to follow Bashir's demands. Having the entire medical care team come together for an urgent huddle to understand Jamilah's treatment options and any associated risks fully will help provide the whole picture for Jamilah's case. Then, the provider, social worker, and translator can meet with Jamilah to explain her diagnosis, the options with risks, and post-
care. They would be able to work with the translator to make sure Jamilah understands the dangers and ask any clarifying questions she may have. The hospital would be able to assess in real-time with the appropriate people if Jamilah is sound of mind to understand and make decisions for herself fully. Refusing to follow Bashir's wishes allows for autonomy for Jamilah, the hospital, and the providers to do no harm.
2b.
The social worker said Jamilah spoke with her alone and wished to live. After observing the interactions between Jamilah and her sons, regardless of their cultural beliefs, it would be in the best interest not to follow Bashir's course of action. Bashir states he can make decisions on behalf of his mother even though she does not have any advance directives, so he is requesting that his mother receive palliative care. With this response, the hospital and providers risk legal ramifications if they follow Bashir's wishes. Not pausing to look at the entire situation of Jamilah's case and doing the right by
the patient would violate non-maleficence and beneficence moral principles. Further investigation and lawsuits against the hospital are possible if the other sons find out that their mother requested to live, and the hospital chose not to do their due diligence to ensure they uncovered every stone before making the course of action for Jamilah.
3a.
To make Jamilah's wishes clearer to the providers, the hospital could have made the following two resources available:
1. Provide an interpreter or translation service once the team learned that Jamilah's preferred language of care was not English.
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2. Once an interpreter or translator was available, the hospital could ensure that Jamilah's wishes were clear by helping her complete the necessary documentation for her advanced directives.
3ai.
By providing an interpreter or translator to Jamilah, the providers would have been able to provide better care. This resource would make communication between all parties clear and allow space for clarifying questions about her medical diagnosis and options for treatment. Having a standard process around interpreter use positively impacts the medical team to ensure they have consent, so, they don't delay care. The interpreter/translator could help the medical team identify Jamilah's state of mind and help her understand medical decisions, as she had no advanced directives. Patients with advanced directives support not only the medical team but it also helps the family understand Jamilah's wishes, regardless of their requests or beliefs. It would allow them to discuss the future to have a living will or power of attorney in place.
4.
As an organization, we recommend implementing the following three policies to ensure all our workforce members have the resources to support our patients.
Policy recommendation #1:
Access to language services such as an interpreter or translation service for patients who use a language other than English.
Policy recommendation #2:
Create an annual web-based training module on Healthcare Ethics to support additional education for workforce members.
Policy recommendation #3:
Notifying and Documentation of Advance Directives upon admittance, registration, or surgery.
4a.
Granting interpreter and translation services to all patients who use a language other than English ensures patients and families receive proper and concise communication about their medical diagnosis and treatment. When patients get admitted to the hospital, the registration will ask for their preferred care language. Suppose the patient or family states, their language is not English. In that case, registration will notify the interpreter or social work department to ensure the patient and family can access this service for their visit. Creating a policy that serves our patients who speak a language other than English will start bridging the communication barrier in healthcare.
Providing additional resources and education around Healthcare Ethics will help workforce members and the hospital aspire to the highest ethical behavior. Supporting the workforce members around the rules and laws for ethics will help impact the safety of our patients and staff. It allows workforce members to know and understand the implications, liabilities, and risks of regulations and laws surrounding ethical dilemmas. Making this a requirement for the entire hospital will help build knowledge of rules and regulations and do the right thing by providing high-quality care to patients. Patients admitted or checking into the hospital will provide registration if they have an advanced directive. Regardless of if they do or do not, it will be entered in the patient's registration. If patients do not have advanced directives, we will provide them with community resources and state requirements and have them meet with a social worker to create one. A copy of the advanced directive must be in the
patient charts by a specific timeframe. This recommended policy will provide awareness of patients' healthcare decisions for their families and medical staff.