The primary goal of any healthcare administration is to offer the best quality medication to the clients (patients). Meanwhile, ethics has become one of the most critical aspects of consideration when taking a patient through any medical process. The healthcare professionals are left with the biggest task in an aspect where there involve any ethical dilemma. They have to make the decision that meets the ethical standard set by American Medical Association among other bodies. However, there involve some instances where the AMA standards are controversial and the nurses have to violate them in order to administer the proper medication to a patient (Leo, 1999). Most ethical dilemmas in the healthcare environment occur in the instance where the patient is incapable of making a decision of the course of action he or she would want due to incompetency created by their health conditions.
Case summary
In the scenario provided, Jamilah Shah is critically ill and incapable of telling the doctor of the kind of care she would wish to have. Her son, Bashir, who is the next of kin, wants Jamilah not to be intervened medically but instead wants a comfort care. A social worker, however, reports that Jamilah wanted to live and her son’s, next of kin, decision would not be her wish (Advance Directives, 2016). The social worker further states that Jamilah did not have a supportive relationship with her sons. Meanwhile, Jamilah’s belongs to the culture where patriarchy is upheld and has, together with the family, still retains the culture.
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Potential ethical dilemmas in the case
Based on the case, there are several ethical dilemmas involved in the case. They can be categorized into, those related to anatomy, beneficence and non-maleficence. The dilemmas include;
According to EKG and lab tests, heart attack was the cause of Jamilah collapsing by her bedside. The elderly woman is also reported to have a chronic obstructive pulmonary disease which is apparently the cause of her heart condition. The elderly woman’s life can be saved through performing a cardiology consultation and using tubes to help her breathe while medical process is underway. However, her family, through the youngest son, Bashir, has issued a Do Not Resuscitate for her mother. He also does not want any intervention to be performed on his mother. Ethically, if a patient is incapacitated due to incompetence created by their condition, then the next of kin, often family, makes the decision. In the case, a decision is to be made by the doctors on whether to observe the recommended process of consulting with the next of kin, and have the patient’s life in danger or ignore the patient’s culture and the wishes of her family and go ahead to save her life .
Another ethical dilemma in the case is where, nurses are required to offer care services to patients with good will and best motives which include saving the patient’s life. Medical professionals are obliged to taking a care action that promotes the health of a patient. The nurses taking care of Jamilah are supposed to take a care action that will promote her healthcare status. However, the patient’s family have given an order that only comfort care should be administered. However, the patient would die if only comfort care is administered as she needs to be resuscitated and proper intervention is done. Ethically, the next of kin should be making the decision ( Jahn, 2011) . However, the kind of decision that Bashir has arrived to does not conform to the beneficence principle.
Thirdly, when administering care, it is recommended that the type of care leaves the patient with least pain. This involves taking an action with least pain, both long term and short time. According to Jamilah’s medical history, she lives with a chronic obstructive pulmonary disease. The 90 year old woman also has adult-onset diabetes mellitus. Both of the diseases that the patient lives with cause serious pain and have no cure. This implies that the patient will forever be living with pain for the rest of her days. However, the patient can live for several months even with the diseases. Meanwhile, there is an alternative that the patient can be taken for comfort care without resuscitation. However, this implies that the patient would die lowly without feeling pain within just a few days. Also, according to the report given by the social worker to whom the patient reached, she does not want to die and might prefer to live with the pain. Meanwhile, it is illegal to deprive a patient from obtaining medication against his or her will . The dilemma in this situation is that the medical professionals taking care of the patient have to decide whether to go for the action that leave the patient suffering pain for the rest of her life but save her following her current condition.
Options for course of action in the Scenario
Follow Bashir’s Wishes
In Bashir’s opinion, the no intervention or resuscitation should be performed to the patient. If his opinion is decided upon as the cause of action, the patient, Jamilah will die within several hours. Bashir also insists that comfort care should be delivered to the patient. Therefore, although the patient will die, there won’t be pain while she is dying. The care action will not conform to the beneficence principle as the patient’s health will not improve. Meanwhile, the patient will be safe from pains due to the chronic diseases she is suffering.
Refuse to follow Bashir’s wishes
If the medical professionals rejects the wishes of Bashir and takes an alternative cause of action, it means that the patient will be resuscitated and medically intervened her treatment will begin. At this point, there won’t be the need for the comfort care. The implications of ignoring Bashir’s wishes include, saving the patient’s live. This cause of action, therefore, implies that the nursing care will be conforming to the beneficence principle which recommends taking a nursing action that improves the patient health condition. However, the action will have violated the patient patriarch culture which grants the male members power to make family decision. Also, the cause of action will expose the patient to a lifelong pain because of the underlying chronic diseases she has been diagnosed with before. Therefore, it will violate the principle of non-maleficence ( Jahn, 2011) . Thirdly, ignoring Bashir’s wishes will meet the patient’s reported want of living. Therefore, it will grant the patient her wishes. However, it is not clear if that is what she would want because she is in no capacity to speak what she wants.
Briefly delaying the decision to gather additional information and other perspectives
Delaying the decision implies that the patient remains in her position for some time while the information relevant to decision of her health is being gathered. However, since tests have revealed that the patient collapsed due to heart attack, she is undergoing intense pain following the squeezing in the chest that accompanies heart attack. Clearly, it will be violating the non-maleficence principle. Also, since comfort care is not considered, the patient may die before the ideas collected are ready for use for her medication. Meanwhile, the ideas that are collected might be more effective and might be used to manipulate either of the options available. Due to the research, quality ideas might result and a more informed decision will be made with all possible perspectives put into consideration. It would therefore, be a wrong decision to consider going by the wish of Bashir because it is wrong to deprive a patient from medication unless it is the will of the patient him/herself
Resources that clarify Jamilah wish
According to the case, Jamilah’s wish can be clarified by two major sources. Firstly, Jamilah’s relationship with Bashir can be intervened to understand if the son really knows what is best for her. This involves seeking how often the two have been communicating in the recent past, the contribution of Jamilah on helping her son overcome the financial struggles. If a positive feedback is obtained, then it means that Bashir could be having an idea of what his mother wants . Also, the level of pain she is undergoing can be measured to establish whether she could withstand living with the pain . Although she could have reached the social worker and told her what she wishes, high levels of pain could easily make her change her mind on what she wants .
Correct cause of action
Of the three options, I believe that delaying the decision to collect more information and ideas for making the most appropriate decision stands the most correct cause of action. This is because, it will result to making the decision that is agreed upon and concurs with all the principles of medical ethics. It will also result to arriving a conclusion that is best for all the stakeholders of the case, i.e., the patient, her family, the social worker and the medical professionals in charge of her issue. Waiting for more time will also provide the entire stakeholder to think critically regarding the situation and make a stable decision that best suits the patient.
Policy recommendation
Firstly, I would recommend that independent advice is sought when making any medical decision . Through soliciting independent advice, it is possible to find an idea that is best for a unique situation like one in the scenario. Secondly, I would recommend that in case of a controversial medical issue, a proper communication should be held among all the stakeholders in the situation . For instance, the social worker, patient’s family and medical professionals handling the case should have an intense communication before finally deciding the case. Thirdly, I would recommend that a continuous learning on ethical decision making among the staff members. Through proper learning, the professionals would develop better skills of managing a controversial medical condition and can comfortably serve as advisors to the other stakeholders involved in a case ( American College of Healthcare Executives, 2016) . Continuous learning also enables them interact with more related issues and how they have been addressed previously, thereby, making them more confident at making a medical decision . I therefore believe that continuous learning is most effective as it can help where advice is required urgently to manage a patient’s condition.
References
Advance Directives. (2016). Retrieved from https://medlineplus.gov/advancedirectives.html
American College of Healthcare Executives. (2016, November). Ethical Decision Making for Healthcare Executives . American College of Healthcare Executives. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/ethical-decision-making-for-healthcare-executives
Hedge, S. (2019). What is an Ethical Dilemma. Retrieved from https://www.scienceabc.com/social-science/what-is-an-ethical-dilemma-definition-examples-real-life.html
Jahn W. T. (2011). The 4 basic ethical principles that apply to forensic activities are respect for autonomy, beneficence, nonmaleficence, and justice. Journal of chiropractic medicine , 10 (3), 225–226. https://doi.org/10.1016/j.jcm.2011.08.004
Leo R. J. (1999). Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians. Primary care companion to the Journal of clinical psychiatry , 1 (5), 131–141. https://doi.org/10.4088/pcc.v01n0501
