Ethical Dilemma: Healthcare Administrator At A Loc

Ethical Dilemmayou Are The Healthcare Administrator At A Local Hospita

Ethical Dilemma you are the healthcare administrator at a local hospital. A social worker has come to you to discuss the case of Jamilah Shah, a patient who has recently been admitted to the hospital. Jamilah is a 90-year-old woman who was brought to the hospital after collapsing at the side of her bed. EKG and lab tests revealed a heart attack. More than 40 years ago, Jamilah emigrated with her wealthy husband (now deceased) and their three sons from Turkey to the United States.

Jamilah was a homemaker and learned only basic English, but her children are fluent English speakers. The children are now all in their 50s. The family retains Turkish culture and norms, including the sons acting as patriarchs for the family. Even though Jamilah is highly educated (in Turkey she was trained as a lawyer), the sons make many of the family decisions. Two of the three children are in successful careers.

The remaining child, the youngest son, Bashir, owns a small market and struggles financially. Until yesterday, the day of her 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. Jamilah has no advance directives on file. 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, listing 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 with concerns that this decision may not reflect Jamilah’s wishes. When the social worker was visiting with Jamilah alone, Jamilah reached for her hand and said, “Please help me. I want to live.” The social worker shares 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 requested a cardiology consultation, which was just completed. 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.

Paper For Above instruction

The scenario involving Jamilah Shah presents a complex ethical dilemma rooted in balancing respect for patient autonomy, beneficence, and non-maleficence within a culturally sensitive context. As a healthcare administrator, understanding these principles and their legal implications is essential for guiding decisions that uphold ethical standards while respecting patients’ wishes and rights.

Ethical Dilemmas in the Scenario

1. Autonomy

The primary ethical conflict here revolves around Jamilah’s autonomy—the right to make decisions about her own health care. Although her sons claim decision-making authority, her own expressed desire to live indicates she values life and wishes to survive. The absence of advance directives complicates the situation, but her verbal expression during the social worker’s visit suggests she has a preference that might differ from her sons’ wishes. Legally, respecting patient autonomy requires that healthcare providers honor her preferences, provided she has decisional capacity, which appears compromised due to communication difficulties. The legal implications include potential liability if her autonomy is overridden.

2. Beneficence

Beneficence involves acting in the patient’s best interest by promoting well-being and appropriate intervention. The healthcare team faces a dilemma: honoring the sons’ wish for comfort care aligns with respecting their authority but may not align with Jamilah’s best interest if her desire to live is genuine. Legally, withholding treatment based solely on family wishes without clear evidence of the patient’s preferences raises questions about whether the action promotes her overall benefit or neglects her right to pursue life-sustaining treatment.

3. Non-maleficence

The principle of non-maleficence emphasizes “do no harm.” Withholding potentially life-saving treatment may harm Jamilah by allowing her to die prematurely, which conflicts with her expressed desire to live. Conversely, aggressive treatments could cause her unnecessary suffering, especially considering her age and comorbidities. The legal aspect emphasizes avoiding harm through appropriate, ethically justified interventions, and ensuring that decisions are not influenced solely by family coercion or cultural biases.

Responses to Bashir’s Demands for Comfort Care

Course of action 1: Follow Bashir’s wishes

Following Bashir’s directive for comfort care would respect his authority as the designated decision-maker in the absence of advanced directives. However, this risks overriding Jamilah’s wishes if her verbal statement is a true reflection of her desires. Legally, this could lead to claims of neglect or assault if her autonomy is compromised. Ethically, it neglects the principle of respecting her capacity to make decisions, especially given her expressed wish to live.

Course of action 2: Refuse to follow Bashir’s wishes

Refusing Bashir’s demand respects Jamilah’s expressed desire to live. Legally, it aligns with the requirement to honor patients’ preferences when they have decisional capacity. Ethically, it upholds her autonomy and the principle of beneficence, but may cause familial conflict and could pose administrative challenges if Bashir contests the decision.

Course of action 3: Briefly delay decision to gather additional information

This approach involves consulting with the hospital’s ethics committee, obtaining a comprehensive mental capacity assessment of Jamilah, and possibly reviewing cultural factors affecting her decision-making. This allows healthcare providers to ensure that her current wishes are truly voluntary and informed. Legally, this cautious approach minimizes risk of substituting family bias for her set of preferences and ensures due diligence.

Justification of the best course of action

The most ethical and legally sound course of action is to delay immediate compliance with Bashir’s request to allow thorough assessment of Jamilah’s decisional capacity and wishes. This aligns with principles of respect for autonomy, beneficence, and non-maleficence. Ensuring her expressed desire to live is understood and respected is essential—provided she has the capacity to make informed decisions.

Consequences of ignoring her expressed wish

If the healthcare team proceeds solely based on Bashir’s decision and abandons Jamilah’s verbal plea to live, it risks violating her autonomy, potentially legal liabilities, and eroding trust. It could also set a harmful precedent where family wishes override patient preferences—especially in culturally sensitive situations—potentially leading to harm and loss of trust in the healthcare institution.

The Next Steps and Resources to Clarify Jamilah’s Wishes

To better understand Jamilah’s desires, two key resources should be utilized:

1. Formal Advance Care Planning

Encouraging and facilitating the creation of formal advance directives or living wills would provide clear guidance on her healthcare preferences. These documents would serve as legally binding expressions of her wishes, reducing reliance on family members’ interpretations.

2. Cultural and Language Competency Resources

Engaging cultural liaisons or professional medical interpreters can help clarify Jamilah’s preferences by ensuring effective communication. This reduces misunderstandings rooted in language barriers and cultural differences, helping the healthcare team understand her true wishes beyond her verbal statements.

Policy Recommendations for Future Handling of Similar Cases

1. Implement Mandatory Advance Care Planning Discussions upon Admission

Establish policies requiring healthcare providers to discuss and document patient preferences regarding life-sustaining treatments early in the admission process, especially for vulnerable populations. This will provide legal clarity and uphold patient autonomy, minimizing conflicts when critical decisions arise.

2. Provide Cultural Competency and Communication Training

Train staff to enhance understanding of diverse cultural norms and improve communication skills, including effective use of interpreters. This fosters trust and ensures patient wishes are accurately understood and respected, aligning care with cultural values and personal preferences.

3. Establish a Clear Protocol for Capacity Assessment and Family Involvement

Develop standardized procedures for assessing decisional capacity and involving ethics committees when conflicts emerge. This provides structured support for complex cases, ensuring decisions are ethically justified and legally sound.

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