Competency 3048.1.4: Ethical Dilemmas – The graduate evaluates ethical dilemmas in healthcare.

Introduction:

A common ethical problem arising in healthcare organizations occurs when the decision-making capacity of an elderly patient is uncertain, particularly when the patient’s decisions are at odds with the rest of the family’s preferences. The included scenario explores this issue, as well as several other legal and ethical considerations that can complicate the healthcare decision-making process. This performance assessment will provide you with experience in sorting through the sometimes competing priorities and issues and in formulating actions that can help guide the healthcare organization through ethical problems that arise in caring for patients.

Scenario:

Jamilah Shah is a 90-year-old Turkish female who immigrated to the United States over 40 years ago with her wealthy husband (now deceased) and their three young children. Jamilah was a homemaker and learned only basic English, but her children are fluent and are all in their 50s. The family still retains Turkish culture and norms, including the sons acting as patriarchs for the family making many decisions even though Jamilah is highly educated and trained as a lawyer in Turkey. Two of the three children are in successful careers; the remaining child, the youngest son, owns a small market and is struggling financially. Until yesterday—the day of admission—Jamilah resided in an extended care facility (ECF), where she has lived since her husband’s death. She reportedly has severe chronic obstructive pulmonary disease and adult-onset diabetes mellitus. She was brought to the hospital after collapsing at the side of her bed. EKG and lab tests revealed a heart attack. She has no advance directives on file, and because of her communication difficulties, the emergency department physician started her on anticoagulants while trying to contact her next of kin. The ECF sent paperwork to the hospital that listed the youngest son, Bashir, as the emergency contact. Bashir was contacted and is now at the hospital with his two brothers. He has informed the care team that he is the decision maker, and he wants his mother to have a Do Not Resuscitate (DNR) order with no intervention of any kind other than comfort care. The social worker has come to you, as administrator, with concerns that this decision may not reflect Jamilah’s wishes. When the social worker was visiting with Jamilah alone, Jamilah reached out for her hand and said, “Please help me. I want to live.” The social worker expresses concerns about the interactions observed between Jamilah and her sons, stating that the relationships seem unsupportive. The hospital’s ethics committee has not yet been involved. The social worker also reports that the emergency physician had requested a cardiology consultation, which was just completed, and the consultant documented that “because the family has requested only comfort care, and due to the patient’s multiple comorbidities, the patient will be managed medically, with no intervention, and will not receive cardiac catheterization or be considered for coronary bypass surgery.” If nothing is done, Jamilah will likely die within days.

Requirements:

A. Write an essay (suggested length 5–7 pages, including attachments) by doing the following:

1. Discuss three potential ethical dilemmas in the given scenario.

a. Analyze the ethical principles and any legal implications associated with each of the potential ethical dilemmas discussed in part A1.

2. Complete the attached “University of Washington Paradigm Template” for each of the following courses of action:

• course of action 1: Follow Bashir’s wishes

• course of action 2: Refuse to follow Bashir’s wishes

• course of action 3: Briefly delay the decision to gather additional information and other perspectives

Note: The “University of Washington Paradigm Example” found in the web links section below may be used to guide your completion of the “University of Washington Paradigm Template.”

Note: When completing the four quadrants for each “University of Washington Paradigm Template,” some quadrants may not be applicable to a course of action. If a quadrant is not applicable for a given course of action, be sure to include an explanation of why it is not applicable.

Note: The three completed “University of Washington Paradigm Templates” should be included as attachments to your essay rather than in the body of the essay itself.

3. Decide on a course of action for this scenario, as an administrator, by doing the following:

a. Explain the additional information that would be needed to make a decision.

b. Describe one resource that could have made or could still make Jamilah’s wishes more clear.

i. Explain why the resource described would be helpful.

c. Propose one of the possible courses of action from part A2 (responding to Bashir’s demands for only comfort care).

i. Justify your proposed course of action.

ii. Compare one of the other courses of action from part A2 with your proposed course of action.

4. Create three policy recommendations that you could make as an administrator to help your employees and the facility’s medical staff handle similar situations in the future.

a. Justify each policy recommendation.

Note: You may use laws, regulations, and/or ethical principles as recommendations in part A4 and as part of your justification in part A4a.

Note: The links below may be used to assist you in completing this performance assessment.

B. When you use sources, include all in-text citations and references in APA format.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in an assessment, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the assessment.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from outside sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the APA Guidelines section.

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