The health care workers face various obstacles in tackling ethical dilemmas in the course of their profession in this changing world. Conflicts always arise between the practitioners and the patients in regards to the best procedure to follow when treating them. The tool that the health care workers rely on when tackling the difficulties is mainly the process of ethical decision making. This paper discusses the ethical dilemmas, legal implication, courses of action and recommendation in regards to Jamilah Shah's scenario.
Ethical dilemmas
The three potential ethical dilemmas in the scenario include the autonomy principle, the principle of beneficence and the principle of non-maleficence. The principles are as discussed below:-
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The principle of autonomy
The autonomy principle of applies in the case of Jamilah Shah since it states that, the patient should make the decision regarding their medical treatment, and the decision should not be influenced or affected by someone's limitations like inadequacy of communicating (Bhanji, 2013). In the scenario, Jamilah Shah's health decision is passed on to her son because she cannot communicate properly. Bashir decides that his mother should be placed on a ‘Do Not Resuscitate’ with no involvement but only comfort care, yet her mother can make the decisions of her health by herself even though she understands only basic English. Also, Jamilah Shah tells the social worker that she wants to live reflecting her decision.
The beneficence principle
The beneficence principle mandates the health workers to treat the sick in the best way so that they can acquire the maximum benefit (Bhanji, 2013). In the scenario, due to Jamilah’s difficulties in communication the physician starts her on anticoagulants. Also, since the family had decided on only comfort care and because of her comorbidities, the health care workers decide to manage her medically without intervention, cardiac catheterization or a chance to be surgically operated for coronary bypass. All this decisions might kill her within days hence the maximum benefit was not considered.
Non-maleficence principle
Non-maleficence principle states that the health care workers should avoid causing harm to the sick. Meaning that protection of patients is the responsibility of the healthcare workers (Bhanji, 2013), in the scenario, the decisions the physician takes might kill Jamilah Shah within days hence causing harm.
Legal implications
The legal implication in on-maleficence means causing harm to the patient as a result of negligence. In that, Jamilah Shah will die if the wish of Bashir is followed and this means causing damage which results from negligence in the part of the physician. In that, the physician does not inquire from Jamilah Shah what she wants. Health care workers have generated protocols and rules to be followed in that if one fails to engage them it will be referred as an omission. The law body and ethics claim that failure to adhere to the protocols is negligence. Meaning that the healthcare personnel has not performed her/his duty diligently (Summers, 2009).
The legal implication in autonomy means that Jamilah's wish of staying alive is not followed bwcause the hospital will use the substituted judgment from Bashir and this violates the principle of autonomy (Summers, 2009).
The legal implication in beneficence means that the physician has not provided the maximum benefit to Jamilah. Which means he fails to perform beneficent actions to Jamilah hence, the healthcare worker is deficient which might result in Jamilah's death (Summers, 2009)
Courses of action
The first course of action entails following Bashir's wishes;
Following Bashir's decision will make the health workers provide only comfort care to Jamilah Shah, and she will have a Do Not Resuscitate without the nurses intervening, and as a result, Jamilah will be dead within days.
The second Course of action involves refusing to go by the wishes of Bashir.
Refusing to follow Bashir's wishes will mean that her mother will get a cardiac catheterization and she will be considered for coronary bypass surgery.
The third Course of action involves putting on hold the decision so as to gather more
information and other perspectives. Delaying the decision will mean that the committee for ethics in the hospital will get involved in the ethical issues and Jamilah’s wishes to live will be considered.
Resources that could make Jamilah Shah's wishes more clear involve the use of the principle of autonomy and maleficence. Autonomy principle gives her the right to decide on how she wants to be treated and also frees her from her difficulties in communication. Also utilizing the principle of maleficence makes her wish to be more explicit in that she will be subjected to no harm and as per the scenario she states that she wants to live.
The correct course of action in regards to the demands of Bashir to provide her mother with only comfort care will involve delaying the demand to acquire more information and other viewpoints. Since Jamilah Shah said that she would want to stay alive it's a good idea to consult with her regarding the comfort care plan and how she will want to get treated. Also, the ethics committee of the hospital should be included to get their perspectives. Following Bashir's wish is not the correct course of action since her mother will get treated medically without intervention from the health workers, Jamilah Shah will not get cardiac catheterization, and she will die. Also, following Bashir's wishes will mean that her mother will not get consultations on how she would like to be treatment, and her desire to live will be contravened, which is very wrong since the patient should be the decision maker.
Recommendations
The recommendations to make as an administrator will involve utilization of the principle of autonomy in that the patients' rights to make their own decisions are adhered to during their treatment after they have been provided with the entire, precise and comprehensive information in regards to their health (Bhanji, 2013). In the case of Jamilah Shah, if the health care workers had tried to know the wishes of Jamilah Shah, they would have known what treatment she would want and that she wanted to live as opposed to Bashir's suggestion that would have killed her in a matter of days.
The employees need follow the principle of beneficence which provides that they need to treat and care for sick in a manner that they get the maximum benefits (Bhanji, 2013). In the scenario the physician picks the procedure that will lead to the death of Jamilah. Using beneficence, employees will choose procedure and treatment that will result in benefits on the part of the patient.
Lastly, to adhere to the principle on non-maleficence which requires them to cause no harm to the patient (Bhanji, 2013), in that the employees will carefully treat the patients. In Jamilah Shah's scenario death is the outcome when Bashir's wish is followed, meaning causing harm to Jamilah Shah. Injury or harm to the patient, which is death in this case, will be avoided if the principle of non-maleficence is applied.
ATTACHMENT
3ai. Utilizing the principle of autonomy which gives Jamilah Shah the right to decide on how she wants to be treated and also frees her from her difficulties in communication. Also utilizing the principle of maleficence makes her wish to be more evident in that no harm will be done to her and as per the scenario she states that she wants to live.
MEDICAL INDICATIONS
The Principles of Beneficence and Nonmaleficence
What is the patient's medical problem? Adult-onset diabetes mellitus and pulmonary disease that is obstructive
Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal? The obstructive pulmonary disease is chronic
What are the goals of treatment? Comfort care
In what circumstances are medical treatments not indicated? The medical circumstances are not applicable to Jamilah Shah’ scenario since they have not been indicated.
What are the probabilities of success of various treatment options? Zero success which means death in a few days when following comfort care without intervention.
In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided? She gets advantages from the hospital when they follow the ethical principles.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
Has the patient been informed of benefits and risks, understood this information, and given consent? No, the information was not availed to Jamilah, hence not given any approval.
Is the patient mentally capable and legally competent, and is there evidence of incapacity? She is mentally and lawfully able, and there isn’t indication showing that she is incapable.
If mentally capable, what preferences about treatment is the patient stating? The patient only reports that she desires to live and she does not give any specific treatment.
If incapacitated, has the patient expressed prior preferences? The question is not applicable to Jamilah's scenario since she is capacitated.
Who is the appropriate surrogate to make decisions for the incapacitated patient? Since Jamilah is not incapacitated the question is not applicable.
Is the patient unwilling or unable to cooperate with medical treatment? If so, why? Jamilah is willing to work with the practitioners, and the only problem is that her wish is contradicting Bashir's request who is her contact for emergencies and hence decision maker.
QUALITY OF LIFE
The Principles of Beneficence, Nonmaleficence, and Respect for Autonomy
What are the prospects, with or without treatment, for a return to normal life, and what physical, mental, and social deficits might the patient experience even if treatment succeeds? If Bashir's wish is to be followed Jamilah dies in a few days so mental, physical and normal life for Jamilah's scenario is not known.
On what grounds can anyone judge that some quality of life would be undesirable for a patient who cannot make or express such a judgment? Since Jamilah can decide on her own the question does not apply.
Are there biases that might prejudice the provider's evaluation of the patient's quality of life? The social worker says that Jamilah's sons are unsupportive and since Bashir is the one making the decision, this creates prejudice in the manner in which the physician evaluates the quality of health of Jamilah.
What ethical issues arise concerning improving or enhancing a patient's quality of life? The moral issue arising in Jamilah's case involves the principle of autonomy, Beneficence, and Non-maleficence
Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment? Quality of life assessment does not apply to Jamilah's scenario in that Bashir made the decision which will kill her after some few days.
What are plans and rationale to fore-go life-sustaining treatment? Not applicable to Jamilah's case since the remedy chosen by Bashir will kill her.
What is the legal and ethical status of suicide? Suicides’legal and moral status does not apply to the scenario since Jamilah Shah desires to live.
CONTEXTUAL FEATURES
The Principles of Justice and Fairness
Are there professional, interprofessional, or business interests that might create conflicts of interest in the clinical treatment of patients? There are no interests which are contradicting with the treatment of Jamilah Shah.
Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions? Jamilah's sons are interested in the clinical decisions and Bashir decides on behalf of the other boys the type of treatment their mother should undergo.
What are the limits imposed on patient confidentiality by the legitimate interests of third parties? Patient secrecy is not evident in Jamilah's case since she has her sons.
Are there financial factors that create conflicts of interest in clinical decisions? There are no financial issues creating interest that conflict in the decision made by the hospital.
Are there problems of allocation of scarce health resources that might affect clinical decisions? Limited resources in health are not applicable to Jamilah's scenario since the limited health resources, if there are any, they have not been mentioned.
Are there religious issues that might affect clinical decisions? There is no mention of religious matters in the case hence not applicable.
What are the legal issues that might affect clinical decisions? The legal issues affecting the clinical choices involve not following the principles of ethics to the later.
Are there considerations of clinical research and education that might affect clinical decisions? Education and research on regards to clinics does not apply to Jamilah's case.
Are there issues of public health and safety that affect clinical decisions? The health of the public and their safety does not apply in the case of Jamilah.
Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare? There are no interests that conflict mentioned in Jamilah Shah’s story hence not applicable.
References
Bhanji, S. M. (2013). Health Care Ethics. J Clinic Res Bioeth , 4 (142), 2. https://www.omicsonline.org/health-care-ethics-2155-9627.1000142.pdf
Summers, J., & Morrison, E. (2009). Principles of healthcare ethics. Health Care Ethics. 2nd ed. Sudbury: Jones and Bartlett Publishers , 41-58.
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