In the scenario, Jamilah Shah is admitted to the hospital after collapsing at the side of her bed. Upon arrival at the hospital, tests are performed, and it is determined that she has experienced a heart attack. In this case, a decision must be taken quickly regarding the treatment that should be provided and the care providers must consider every health aspect as well as the quality of life. It can be seen that there are conflicts between the healthcare team and Jamilah’s family members. The healthcare providers are facing the dilemma of agreeing to the patient’s wish of being treated and saved from the condition or listening to Bashir’s request of a Do Not Resuscitate (DNR). Dilemmas related to beneficence, non-maleficence, and autonomy are present in this case.
Potential Ethical Dilemmas and Legal Implications
Beneficence is a principle of doing good, demonstrating kindness and compassion, and helping others (Pozgar, 2013). The health care team has the responsibility of taking care of Jamilah and showing her kindness and compassion. To do good to her, they must know what she wants and act according to her wishes. A social worker who attending the patient has taken the initiative of knowing her preferences and the person is committed to saving her life. This is an act of beneficence. However, the interest of the healthcare providers is at a conflict with the wishes of Jamilah’s family that does not want her to be treated. By ignoring the patient’s wishes in favor of the family members’ request, the healthcare team could be held legally responsible for going against the principle of beneficence. From a legal perspective, the healthcare team must do everything possible to meet the patient’s wishes.
Non-maleficence in healthcare is about avoiding causing harm (Pozgar, 2013). In the scenario, the health care team has a duty not to endanger the life of the patient by delaying or withholding treatment, both of which could conflict with the principle of non-maleficence. The dilemma in the scenario is that the family of the patient has requested the care providers to withhold treatment, a decision that could cause harm to the patient. At the same time, giving a medication that is against the patient’s wishes could inflict harm to some extent. The healthcare team and the hospital as a whole can be fined for maleficence in the case they ignore the patient’s wishes. Additionally, the care providers can be exposed to litigation, or the hospital’s license can be revoked if they do not abide by the principle of non-maleficence.
Autonomy in the context of healthcare refers to allowing one to make his/her own decisions (Pozgar, 2013). However, in this case it is an uphill task to determine whether the patient can make her own decisions. On the one hand, she has directed the social worker to help her as she wants to live. On the other hand, given her age and the fact that she has been residing in an extended care facility, the hospital assumes that she cannot make decisions on her own and have contacted her family to help in decision-making. The situation gets even more confusing while considering her cultural beliefs that insist that her sons should act as patriarchs and make critical decisions for their sick mother. Hence, there is an autonomy-related ethical dilemma due to these aspects. The healthcare team is faced with the options of considering the patient’s decision to have her life saved or accepting the family’s request to have a Do Not Resuscitate (DNR). Failure to abide by the principle could expose the care providers to litigation, thus triggering license revocation or closure of the hospital. Besides, the healthcare team could be charged or fined by a court of law for failing to allow the patient autonomy.
Questions from the University of Washington Paradigm Related to the Scenario
For the course of action 1 (following Bashir’s wishes), various issues could arise regarding the principles of beneficence, non-maleficence, and autonomy. The healthcare team must abide by the principle of beneficence by showing kindness and compassion and taking good care of the patient. However, following Bashir’s wishes could see the team fail to take care of the patient, thus going against the principle of beneficence. The care providers have to follow the principle of non-maleficence too by not inflicting any harm to the patient. There is the likelihood that by following Bashir’s wishes they will withhold treatment and inflict harm to the patient. Concerning autonomy, the medical team is required to consider and allow patients to make their own decisions when it comes to the provision of care. In this case, Jamilah has indicated that she should be treated as she wants to live. Following Bashir’s wishes will lead to denying the patient autonomy.
For the course of action 2 (refusing to follow Bashir’s wishes), specific issues might arise regarding the principles of beneficence, non-maleficence, and autonomy. The welfare and quality of life of the patient are essential in the scenario. Thus, by refusing to follow Bashir’s wishes, the healthcare team will be abiding by the principle of beneficence as they will be showing kindness and compassion and providing excellent care to the patient. Moreover, they will be avoiding inflicting possible harm to the patient, thus pursuing the principle of non-maleficence as required of healthcare experts. By refusing to follow Bashir’s wishes they will decide to give treatment in line with the patient’s wishes. This means that they will be considering the patient’s decisions thereby allowing her autonomy.
Course of action 3 (delaying the decision to gather additional information and other perspectives) could indicate that the healthcare team will not be showing compassion or doing any good to the patient and thus, going against the principle of beneficence. Care providers must always act swiftly when it comes to the provision of care. The delay in treatment can also inflict harm to the patient. Through this, the health care team will be not be following the principle of non-maleficence. Moreover, the patient has requested to be helped as she needs to live. Hence, by delaying treatment the care providers will be acting against the autonomy principle, which is unacceptable in the healthcare context.
A resource that could have made or could still make Jamilah’s wishes clearer is a Power of Attorney (POA). She could have appointed someone else, other than her family members, to make decisions on her behalf (Scott, 2009). The healthcare team could have considered the statements of the attorney regarding Jamilah’s treatment. A living will could have also made her wishes clearer and guided the health care team to provide the necessary treatment. The POA could have outlined and explained Jamilah’s wishes. It is clear that her main wish is to live. Through the POA, the healthcare team could have considered the requests and offered the necessary treatment. Besides, in her living will Jamilah could have put down what should be done to her in such a scenario. In many cases, people use living wills to indicate their desire to live and the need for healthcare experts to do everything possible to realize this.
Correct Course of Action
The right course of action in the scenario is refusing to follow Bashir’s wishes. As already mentioned, the most important aspects are the welfare and quality of life of the patient (Carvalho, Reeves, & Orford, 2011). Jamilah has indicated that she needs help to live, and the healthcare team must do everything possible to help her realize this. By not fulfilling Bashir’s wishes, the hospital will be in extension showing some love and kindness to the patient, thereby abiding by the principle of beneficence. Bashir’s desire could cause harm to Jamilah which goes against the law of non-maleficence. To comply with this principle, the healthcare team should not follow Bashir’s wishes.
Explanation of the Wrong Course of Action
Following Bashir’s wishes is an unacceptable course of action in the scenario that could result in the healthcare team failing to take care of the patient, thereby going against the principle of beneficence. Additionally, following this direction could cause harm to the patient and that will be against the principle of non-maleficence. There is the likelihood that failing to provide treatment in line with Jamilah’s wishes could cause her harm. Furthermore, following Bashir’s wishes will mean that the health care team does not allow the patient autonomy which is one of their obligations.
My concern as an administrator will be to make a policy that would guide the hospital even in future when identical situations that involve ethical dilemmas arise. From an ethical perspective, I would expect the medical staff to focus more on the patients’ well-being and quality of life by following the core principles of nonmaleficence, beneficence, and autonomy (Carvalho, Reeves, & Orford, 2011). I would also come up with a code of conduct stipulating how employees are expected to handle similar situations in the future. Such a move will prevent conflicts or dilemmas such as those witnessed in the scenario. For instance, the code of conduct would stress the need to prioritize patients’ wishes or demands. Moreover, I would educate and inform the staff about the existing government laws on what is expected of healthcare facilities when it comes to handling patients. According to the legal sources, the care providers must perform their duties in line with the core principles of nonmaleficence, beneficence, and autonomy. Awareness of these laws would avert similar occurrences in the future.
Carvalho, S., Reeves, M., & Orford, J. (2011). Fundamental aspects of legal, ethical and professional issues in nursing. 2nd Edition. Luton, Bedfordshire: Andrews UK. Retrieved from https://books.google.co.ke/books?id=aYy_BAAAQBAJ&printsec=frontcover&dq=Legal+and+Ethical+Issues+for+Health+Professionals&hl=en&sa=X&ved=0ahUKEwiw1NLnqtvcAhUB3xoKHefDDLsQ6AEIWzAJ#v=onepage&q=Legal%20and%20Ethical%20Issues%20for%20Health%20Professionals&f=false
Pozgar, G. D. (2013). Legal and ethical issues for health professionals. Burlington, MA: Jones & Bartlett Learning. Retrieved from https://books.google.co.ke/books?id=bzb3BQAAQBAJ&printsec=frontcover&dq=Legal+and+Ethical+Issues+for+Health+Professionals&hl=en&sa=X&ved=0ahUKEwiw1NLnqtvcAhUB3xoKHefDDLsQ6AEIJzAA#v=onepage&q=Legal%20and%20Ethical%20Issues%20for%20Health%20Professionals&f=false
Scott, R. W. (2009). Promoting legal and ethical awareness: A primer for health professionals and patients. St. Louis, Mo: Mosby Elsevier. Retrieved from https://books.google.co.ke/books?id=PS1-X6cjcpYC&printsec=frontcover&dq=Legal+and+Ethical+Issues+for+Health+Professionals&hl=en&sa=X&ved=0ahUKEwiw1NLnqtvcAhUB3xoKHefDDLsQ6AEIPDAE#v=onepage&q=Legal%20and%20Ethical%20Issues%20for%20Health%20Professionals&f=false