Ethical Dilemmas in Healthcare: A Case Study, Thesis of Financial Accounting

Download Ethical Dilemmas in Healthcare: A Case Study and more Thesis Financial Accounting in PDF only on Docsity! C426 C426 Healthcare Values and Ethics A1. Potential Ethical Dilemmas Highly educated, widowed, 90-year-old Jamilah Shah was taken to the hospital after collapsing beside her bed in an extended care facility. Diagnostic tests performed at the hospital revealed that Jamilah experienced a heart attack; Although highly educated, Jamilah spoke little English; However, her three sons were fluent English speakers and made many family decisions. At the time of the incident, Jamilah had no advanced directives. Additionally, because she had difficulties communicating, the emergency department physician started treatment before her youngest son, Bashir, who was listed as her next of kin in the extended care facility paperwork, was contacted. The care Jamilah requires is time-sensitive, but there are differing opinions regarding her treatment. Jamilah’s family is requesting that they only provide comfort care; on the other hand, Jamilah relays to the social worker that she wishes to live and receive help. The three ethical dilemmas that have been identified, and I would like to discuss further are autonomy, beneficence, and non-maleficence. Autonomy-Jamilah’s Wishes Autonomy is the right of a person to make one’s own health care decision. In the case of Jamilah, she had expressed to her social worker that she would like to live, despite her son stating that he did not want any type of intervention other than comfort care. In spite of the social worker's knowledge of Jamilah’s wish to live because of Jamilah’s age, and her current state her sons may feel she is not capable of determining her own health care decisions. Additionally, as a result of Jamilah’s not having an advanced directive on file, the hospital healthcare team is bound to follow the wishes of her next of kin, Bashir. Consequently, Jamilah’s life is in the hands of her son, and unless she is able to convince her son to allow additional interventions to save her life, she might not live. Beneficence-Ethical Principles Bashir’s Wishes Beneficence is the act of doing good, demonstrating kindness, showing compassion, and helping others. In order for the healthcare team to help Jamilah, they must use their training to provide her with the best care. Part of providing the best care is by doing good by understanding Jamilah’s beliefs, culture, values, and preferences. For example, despite the healthcare team initially starting anticoagulants when first arriving at the hospital, they must respect Jamilah’s family’s culture of a patriarchal society and respect her son's wishes of only providing comfort care. Also, despite the social worker having Jamilah’s personal interests to save her life, without an advanced directive on file, the healthcare team is bound to follow Bashir’s wishes. Non-maleficence-Delay of Care Nonmaleficence requires caregivers to avoid causing harm to patients. The doctor can try to take medical intervention; however, if the doctor is unsuccessful and the intervention does not benefit Jamilah, the act would be considered as harming. On the other hand, if the doctor does not inform the family about potentially life-saving interventions, this could also be harming the patient by delaying care. The healthcare providers and social worker are aware that Jamilah would like to live; However, not having an advanced directive and Jamilah's limited English vocabulary, the decision must be made by her next of kin. A1a. Legal Implications – Autonomy The healthcare team caring for Jamilah is experiencing a dilemma. Jamilah’s son Bashir has advised the team he wants his mother to have a Do Not Resuscitate order with no intervention of any kind other than comfort care. On the other hand, Jamilah has expressed to her social worker that she would like to live. Due to Jamilah’s; age and lack of an advance directive or legal documentation that states what steps to take regarding her health, the healthcare team neglects to offer Jamilah assistance, such as a translator, to communicate her own medical decisions. If the healthcare team decides to follow through with Bashir’s wishes, the hospital and staff could face a legal situation. In so far as being sued for violating Jamilah’s autonomy by allowing Bashir to decide her care without having proper documentation. A1a. Legal Implications - Beneficence Bashir is acting on paternalism based on his mother's age, and because of their cultural beliefs, the sons make family decisions. He has decided that Jamilah would not be receiving additional care to help her live. Despite Jamilah not having an Advanced Directive, the hospital staff decides to respect his wishes. However, with the lack of an Advanced Directive, the hospital staff is obligated to follow Jamilah's wish to live. Additionally, because the hospital did not have a translator for Jamilah, and they have no evidence that proves Jamilah is unable to make her own decisions, the hospital and healthcare workers could face a civil case against them for failure to follow the duty of care. A1a. Legal Implications - Non-maleficence Due to the conflicting information the provider has received, there is a delay in treatment for Jamilah. Bashir has requested a Do Not Resuscitate order for his mother; On the other hand, Jamilah has expressed to the social worker that she wishes to live. The treatment Jamilah must receive is time-sensitive, and if Jamilah continues to wait, the hospital may be sued for negligence. A2. See attachment. A3a. Two resources that could make Jamilah’s wishes more clear would be an advance directive to explain how she wants medical decisions be made for her; and a translator for her to understand what is occurring and not only make an informed decision but to express her thoughts and opinions. Ai. An advanced directive is a legal document with a set of instructions prepared in advance of ill health that states a patient’s healthcare wishes. If Jamilah had completed an advance directive before her medical emergency or had been given the opportunity to complete a directive, the medical team would have known to take every measure possible to save her life. Nevertheless, Bashir would not have been able to make a medical decision on her behalf despite their culture. On top of preventing Bashir’s ability to make her healthcare decisions for her,