This case involves a woman who was brought to the hospital after collapsing. The medical staff is willing to provide her with proper services, but the decisions made by her family and the social worker are conflicting. Her son does not want the doctors to treat his mother, for he believes that his mother is old and cannot make informed decisions. On the other hand, the social worker states that the sick woman confided in her that she would love to live, but her family does not trust her. The medical staff is in a dilemma, the health care system wants to take care of the woman, but they cannot do it. The medical staff is wondering what is best for the woman.
A1
Duty to care refers to the responsibility workers are tasked with to ensure that patients are not exposed to harm by promoting non-maleficence . On the other hand, a breach of duty to care refers to situations where a medical practitioner fails to meet the appropriate standards in their practice (Lawshelf, 2020). Breach of duty to care can be characterized as medical negligence, and four factors must be proven by the law to ascertain that a medical practitioner breached their duty to care. Medical practitioners must ensure that they do not cause any harm to the patient. However, an ethical issue may arise when a doctor encounters a situation such as Jamillah's that require them to withhold treatment might cause death, and this conflicts with the duty to care. The principle of duty to care is broken when a doctor is asked not to save the life of their patient. Also, another ethical dilemma arises when the patient is provided treatment against their wishes; this act can inflict harm on a patient, thus raising a legal issue.
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The patient's autonomy also poses an ethical dilemma. The medical team is faced with a dilemma, for they are unable to ascertain whether the patient is capable of making her health decisions. Before the patient became incapacitated, she had expressed her desire to live and requested for help. Also, the patient is old and lived in the extended care family; for this reason, her family assumes that the patient cannot make an informed decision about her health. Since the patient comes from a patriarchal family, her culture emphasizes that her sons make decisions for the patient. The sons making decisions for Jamillah creates a legal issue, like the breach of duty to care, for it is not clear whether Jamillah chooses them to be her agents.
Another ethical dilemma arises from Bashir's wishes, and this affects theat act of beneficence. The health practitioners wish to help Jamillah, and their intent is to show her compassion and kindness. However, for the health care team to do what is best for her, they need to know what their patient wants. The health team is equipped with knowledge and skills that will enable them to provide the patient with the best care. The medical team needs to understand the patient's beliefs, culture, and other issues that might affect the patient's treatment. When the medical team helps the patients to understand the benefits and risks of the patient's treatment, they will be promoting beneficence. However, since Bashir wants to discontinue his mother's treatment, his wishes conflict with the wishes of the health care practitioners who have been trained to save the lives of people. A legal issue will arise the medical team exposes Jamillah to harm’s way. If the health staff follows Bashir's wishes, they may be sued for negligence, and they will be required to compensate the patients for the damages they have caused her. Following Bashir's wishes will also put the health practitioners' careers in jeopardy, for they might lose their medical licenses.
The legal issues arise from in this case since the health practitioner will be required to receive a patient's advance directive indicating her wishes. .
3 A. Two Resources
POA
Deciding to treat a patient when there is a conflict between their family and the social worker of the patient can be difficult. The best way to ensure that the patient has received the treatment is through the use of a power of attorney. An enduring power of attorney is a legitimate document where a patient appoints an agent to make medical decisions for them; this involves allowing a medical practitioner to continue the treatment of a patient who is incapacitated (Findlaw, 2020). The patient must sign this document, and there should be a witness during the signing process. POA document is useful when an individual has fallen into a coma caused by stroke or brain injury.
Also, when a patient's mental health has lapsed, it is essential to use the power of attorney document. Loss of communication guarantees an agent to make medical decisions for the patient. This document gives an agent the right to refuse treatment that may cause the patient distress, and when they believe that the treatment is unnecessary. One can choose an agent when they are eighteen years old and above. Children cannot choose an agent. In the case of Jamilah, her family should provide the legal document for the medical practitioners to ascertain that Jamilah had selected one of them to be an agent in the case she becomes unable to make decisions. If Jamillah has the POA order, her wishes to get treatment will be fulfilled.
Do-Not-Resuscitate Order
Jamillah’s wishes will be clear if her doctor has DNR order which was signed by her since it will indicate whether she wished to discontinue treatment.The doctors can use the do not resuscitate order; this is a medical document penned down by the doctor. The order implores the health practitioners not to perform cardiopulmonary resuscitation if the heart of the patient stops beating, or the patient stops breathing (MedlinePlus, 2020). The DNR order is set up before the occurrence of an emergency. This order allows the patient to choose whether they want CPR. The order only focuses on the CPR and does not instruct doctors to perform other medical procedures; for example, doctors are not allowed to provide a patient with pain medicine. Do Not Resuscitate Order can only be written if the patient has talked with the doctor or the patient's relatives. CPR refers to a treatment one receives when the flow of the blood stops. CPR comprises of simple procedures like pressing the chest of the patient or mouth to mouth breathing. It can also be offered through electric shock, which facilitates the restarting of the heart. The doctors can also insert breathing tubes on the airways of the patient to ease breathing. It also involves the administration of medicines to a patient with breathing difficulties. This order can be written when a person believes that they have reached the end of their life, and the patient's illness does not improve. The DNR order can be included in a hospice care plan. The concern of this care does not pertain to prolonging life but treating signs of shortness in breath and maintaining comfort. If a doctor had written the DNR order, it would make the wishes of Jamillah clear to the health practitioners.
3B. Course Action 3 -Briefly delay the decision to gather additional information and other perspectives
Medical practitioners are tasked with the responsibility of ensuring that they have fulfilled their duties to care. This act involves giving their patient the autonomy to continue or discontinue treatment. Autonomy is achieved through informed consent; a doctor should ascertain that their patient understands the treatment they are going to receive, and if the patient agrees, the doctor has the right to start or continue treatment (Coggon, 2016). The medical staff is also supposed to ensure that they are acting on the interests of the patients, not their families or the medical personnel. Also, the medical staff is supposed to take care of the patient diligently and not harm them. For a doctor to achieve these goals, they need to briefly delay the decision to gather additional information that will facilitate proper actions regarding Jamilah's case. Her family should provide evidence that one of them is Jamilah's agent; this information will be helpful for POA is authorized by the law, and the medical practitioners will not be held liable for decisions of Jamilah's family. Also, the social worker's information will allow the medical practitioner to come up with the best solution for Jamilah.
A3bi. Explanation of Wrong Course of Action
3. Following Bashir's Wishes
Following Bashir's wishes is not the correct course of action. Bashir has been listed as the next of kin in Jamillah's medical records at the extended care facility; however, there is no indication that Jamillah had requested Bashir to make medical decisions for her if she became incapacitated. The fact that Jamillah confided in the social worker that she wished to live implies that her family was not listening to her. Jamillah's family believed that she could not make a medical decision because of her age; this claim is not true since Jamillah was capable of expressing her views to the social worker before she became incapacitated. Bashir's does not have a valid proof that indicates that his mother had wished to discontinue treatment; therefore, his wishes could be motivated by his financial problems. His decisions to discontinue his mother's treatment may have resulted from his struggling business, which does not provide him profit at the same time he supposed to take care of his mother. Following Bashir's wishes will be unethical, for he cannot provide valid evidence about the mother's wishes.
A4. Policy recommendations: Firstly, the medical practitioners should ensure that they have obtained a patient’s consent that was written before their admission to the hospital since this will allow the medical practitioners to understand the wishes of the patient. Secondly, medical practitioners need to protect the patient from danger by fulfilling the wishes of the patient. Jamillah comes from a patriarchal family that believes that she cannot make proper decisions for her health. The medical practitioners should provide Jamillah with the best care services and not rely on the decisions made by the men in her family by doing this they will be protecting the rights of the patient. It will be discriminating for the doctors to listen to Bashir’s wishes and avoid Jamillah’s requests because she is a woman. Finally, Medical practitioners also need to rely on the decision of the agent appointed by the patient. This action will help them avoid dilemmas since advanced directive documents have granted the agent the power to make the patient’s medical decisions.
In one paragraph state the three policy recommendations (name the three policy recommendations here).
A4a. Policy Recommendation Justification
Improved Communication
4. PoliciesState the policy recommendation name and explain how these will improve or prevent the scenario (i.e. the lack of being able to communicate with the patient).
The medical staff should ensure that they follow the patient's interest to avoid dilemmas. The doctors can understand the patient's wishes by looking at their advanced directives, which must be provided upon the admission of the patient to the hospital. Following a patient's preference will create satisfaction in the patient; they will happy with the care they received at the hospital (Health care value hub, 2019). Also, they are less likely to regret the decision they made about their treatment. A patient who understands what they want gives health practitioners confidence, for they understand what is required of them other than guessing what is best for the patient. Also, different treatments are performed at different costs, once the patient decides on the treatment they are going to receive, they will fully understand the costs that come with it, therefore, settling their medical bills will not be a problem. Adhering to the patient's preference towards treatment leads to better health outcomes; a patient is highly likely to adhere to the therapies recommended for them, thus facilitating a quick recovery. Also, if a patient wants to discontinue the treatment, the health practitioners should fulfill their wishes. The social worker clearly indicated the patient preferred to live; for this reason, it will be good for the health staff to ensure that they have taken good care of the patient and ascertain that their health problem is controlled and it is not getting worse.
A verified Agent
The health staff should ensure that anyone claiming to be an agent of the patient provides valid proof. The medical practitioners should ensure that the person making decisions for the incapacitated patient is the patient's as indicated in the patient's advance directives. Bashir was listed as the next of kin in the ECF records; however, Jamilah did not bestow him the power to make medical decisions for her since she knew that her sons did not believe that she was capable of making sound decisions. People like Bashir should only be taken seriously if they show a legal document indicating that he was given the power by Jamillah to make medical decisions for her. The legal document may include the power of attorney document; this document is powerful, for it indicates where the patient signed while transferring her powers to the agent. The POA gives the medical practitioners the power to perform the wishes of the agent (Findlaw, 2020). The medical staff should also scrutinize all the resources brought before them to ascertain that they are all true before making a medical decision. If any of the parties involved in the patient's situation do not provide valid documents, the doctors should perform an act of charity by ensuring that the patient has not been exposed to any harm.
Protection of a patient’s rights
The medical facilities should ensure that the rights of their patients are protected. The medical practitioners should ensure that they have obtained the patient's consent, and they are receiving the best care. Every individual has the right to live if the medical staff decides to discontinue her treatment; she may lose her life. Bashir's wishes may have been driven by selfishness since his business was failing, and his mother's medical bills are overburdening him. Therefore, Bashir's wishes may be directed to getting rid of his mother so that she does not overburden him. Following Bashir's wishes without concrete prove would deprive the patient of their rights. Health staff, as well as health facilities, should adhere to provision 8 of the nursing code, which protects human rights (Vcuhealth, 2020). Bashir depicts that he has control over Jamilah since he is the matriarch of the family; for this reason, the wishes of Jamillah may not be achieved. The medical staff should ensure that Jamillah is in good health, and this can be achieved when there are no hindrances to the provision of quality health care. Medical practitioners should ensure that people receive treatment regardless of their gender, race, religion, or socioeconomic status. If Bashir's wishes are driven by selfishness, his mother might lose her life; therefore, her wishes might not be granted. This act will create a rift between those who knew that Jamillah wanted to live, and the health facility. Protecting human rights will save health practitioners from unnecessary dilemmas.
References
Coggon, J. (2016). Mental Capacity Law, Autonomy, and best Interests: An Argument for Conceptual and Practical Clarity in the Court of Protection. Medical Law Review , 24 (3), 396-414. https://doi.org/10.1093/medlaw/fww034
Findlaw. (2020). Health Care Power of Attorney - FindLaw . Findlaw. Retrieved 2 June 2020, from https://estate.findlaw.com/living-will/healthcare-power-of-attorney.html.
Health care value hub. (2019). The Consumer Benefits of Patient Shared Decision Making :: Altarum - Healthcare Value Hub. Retrieved 12 June 2020, from https://www.healthcarevaluehub.org/advocate-resources/publications/consumer-benefits-patient-shared-decision-making
Lawshelf. (2020). Tort Law: The Rules of Medical Malpractice . Lawshelf.com. Retrieved 2 June 2020, from https://lawshelf.com/shortvideoscontentview/tort-law-the-rules-of-medical-malpractice/ .
MedlinePlus. (2020). Do-not-resuscitate order: MedlinePlus Medical Encyclopedia . Medlineplus.gov. Retrieved from https://medlineplus.gov/ency/patientinstructions/000473.htm .
Vcuhealth. (2020). American Nurses Association Code of Ethics | VCU Health . Vcuhealth.org. Retrieved 2 June 2020, from https://www.vcuhealth.org/for-health-professionals/nursing/about-nursing-at-vcu/ana-code-ethics .
