I will attach all the documents for the essay. There is also a Paradigm that needs done which is part of the essay. The scenario is also included that is to be used to do this essay . You can use the sample to get an idea of format as you can see the questions can be in the paper. Part of the paper is the Questions Derived from that is in a separate file. It is more just answers to the questions

QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM

Course of Action One – Follow Bashir’s Wishes

 

A2. University of Washington Paradigm   

Course of Action 1- Follow Bashir’s Wishes

MEDICAL INDICATIONS
The Principles of Beneficence and Nonmaleficence

 

• What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

 

The patient suffers from the effects of heart attack, a severe chronic obstructive pulmonary disease. This condition could be reversed through surgery, such as coronary bypass and cardiac catheterization. Thus, the medical condition is not chronic because a heart attack can be treated.

 

• Using this course of action, describe, in full sentences, necessary considerations via

• 1. Beneficence – The medical team is ready to treat and provide healthcare to Shah. If Shah’s healthcare team decides to continue with her treatment, they risk a legal action with Bashir.

 

• 1. Non-maleficence – All medical practitioners and caregivers are mandated to save lives and do not harm patients. Administering medication against the family and patient’s will is an act of harm.

 

• 1. Autonomy – Shah’s autonomy is at stake, as Bashir feels she is not in a sound mind to decide on treatment.

 

• In what circumstances are medical treatments not indicated?

 

First, in case the patient had indicated earlier, she would not want further treatments. Another instance is if the patient communicated with the medical staff that she did not want the treatment.

 

• What are the probabilities of success of various treatment options?

 

There is a lower probability of various treatment options due to the age group and concomitants of the patient.

 

• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Shah can benefit only by extending her lifespan. The harm, which is death, can be avoided through effective treatment.

PATIENT PREFERENCES
The Principle of Respect for Autonomy

 

• Has the patient been informed of benefits and risks, understood this information, and given consent?

 

There was no effective communication between Shah and the doctors. This is because she arrived in the hospital without being accompanied by a close relative or a social worker who could translate to her in a language she could understand better. Moreover, if the patient had arrived in the hospital unconscious, it would be difficult to thoroughly understand the information disseminated and offer consent.

 

• Is the patient mentally capable and legally competent, and is there evidence of incapacity?

 

Shah is both mentally and legally competent to make sound decisions. Despite her old age, at 90, she has basic knowledge in English, and she has no history of mental instability.

 

• If mentally capable, what preferences about treatment is the patient stating?

 

Before the incident, Shah met and talked with a social worker about her medical condition and the need for help and survival.

 

• If incapacitated, has the patient expressed prior preferences?

 

Yes, the social worker states that on a visit with the patient, she had indicated clearly that she needed help and desired to live despite her not having Advance Directive.

 

• Who is the appropriate surrogate to make decisions for the incapacitated patient?

 

The designated surrogate should be her next of kin. This is because she lacked a spouse and an advance directive. In this context, Bashir is enlisted as an emergency contact; thus, he claims to make his mother’s choices.

 

• Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

 

Shah is willing to accept any treatment. The problem is a lack of effective communication with her medical team due to the language barrier.

 

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 Shah is denied treatment, her normal life is not remittable, as she will die. After successful treatment, the patient is likely to be physically inactive, have post-traumatic stress disorder, depression, and be more likely to have limited social interaction.

 

• 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?

 

Due to her inability to effectively communicate with the medical staff, her older age, her living in an extended care facility, one can make assumptions that she has lived long enough and would not wish to have further treatments to extend her life.

 

• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

 

Shah’s old age and the fact that she lives in an extended care facility may affect provider’s evaluation by assuming she does not wish treatment or extend her life, thus affecting her quality of life.

 

• What ethical issues arise concerning improving or enhancing a patient’s quality of life?

 

Autonomy. It is Shah’s sole decision on how she should be cared for and treated, and the healthcare staff should not make assumptions on how she should be cared for and treated without her consent.

 

Beneficence. Healthcare professionals and caregivers must help the patients and do everything in their power to help save the patient’s life.

 

• Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

 

Factors such as her age, economic and social, comorbidities that are within the Shah’s environment can be used to change treatment plans.

 

For instance, the patient’s case can be used to change her treatment with regards to her age, inability to communicate appropriately, comorbidities, and living in an extended care facility for future similar cases.

 

• What are plans and rationale to forgo life-sustaining treatment?

 

Bashir gives an order that the patient should have Do Not Resuscitate (DNR), which means there should be no other intervention apart from comfort care. After cardiology consultation, the recommended treatment could not be given due to this order.

 

• What is the legal and ethical status of suicide?

 

The legal status of assisted suicide varies among states. Despite these differences, ethical issues ought to be considered, such as beneficence, nonmaleficence, and autonomy.

 

CONTEXTUAL FEATURES

The Principles of Justice and Fairness

• Are there professional, inter-professional, or business interests that might create conflicts of interest in the clinical treatment of patients?

 

It is clear that on the previous visit of the social worker with Shah, they had a conversation, and the patient had made it clear that she wanted to live. There is a conflict of interest between the social worker and the decisions made by Bashir and the medical decisions resulting from DNR

 

• Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

 

Despite Bashir having two older brothers who could have different ideas and opinions about their mother’s treatment, he is the only one making the sole decisions for her mother’s treatment because he is the patient’s emergency contact.

 

• What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

 

If Shah consents to make known of her medical history treatment, current treatment, and future treatments among her family and the healthcare professions, then that would not be a breach of confidentiality, not until it is done contrary to her wishes.

 

• Are there financial factors that create conflicts of interest in clinical decisions?

 

Yes. Payment expected to be done in a long period after the treatment of the patient and payment of the patient’s care after treatment.

 

• Are there problems of allocation of scarce health resources that might affect clinical decisions?

 

No, as it is a conventional treatment for Shah, meaning there are no resources taken away.

 

• Are there religious issues that might affect clinical decisions?

 

 

There could be possibilities of religious issues affecting clinical decisions for Shah’s care, considering that her family is of Turkish culture; however, no specific religious concerns are prevalent.

 

 

• What are the legal issues that might affect clinical decisions?

 

First, the fact that Shah had made it clear she wanted to live, but that was not considered, as Bashir and the healthcare professionals went contrary to her wishes. Secondly, Bashir takes Shah’s role of decision-making, which is unverifiable.

 

• Are there considerations of clinical research and education that might affect clinical decisions?

 

Yes. Such as evidence-based practices that can help in Shah’s scenario.

 

• Are there issues of public health and safety that affect clinical decisions?

 

No cases of public health and safety affect Shah’s clinical decisions.

 

• Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare

 

The conflict of interest revolves around Shah’s social worker and Bashir, her son. The doctors are unable to administer treatment to Shah due to Bashir’s decision to discontinue treatment. In contrast, the social worker claimed Shah had given her wishes for treatment and care.

 

 

Course of Action 2- Refuse to Follow Bashir’s Wishes

MEDICAL INDICATIONS
The Principles of Beneficence and Nonmaleficence

 

• What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

 

Shah suffers from the effects of heart attack, a severe chronic obstructive pulmonary disease, and adult-onset diabetes mellitus. This condition could be reversed through surgery, such as coronary bypass and cardiac catheterization. Thus, the condition is acute, as a heart attack can be treated.

 

• Using this course of action, describe, in full sentences, necessary considerations via

 

1. Beneficence – Beneficence is outlined by the action of helping Shah comprehend the stakes of the treatment, including importance, relevance, and possible risks for maximum care and competence

 

1. Non-maleficence – All medical practitioners and caregivers are mandated to save lives and do not harm patients. If the team agrees with Bashir’s wishes and not treat Shah, they will be inflicting distress.

 

1. Autonomy – Shah wishes to live, which means the team should provide the treatment to wants. Moreover, if the team agrees with Bashir’s wishes and not treat Shah, they will be violating her autonomy.

 

• In what circumstances are medical treatments not indicated?

 

An advance notice indicating that Shah did not seek treatment.

 

• What are the probabilities of success of various treatment options?

 

There are fewer chances for successful treatment of Shah as a result of her old age and comorbidities.

 

• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

 

Medical and nursing care can be beneficial to Shah. Without it, she is susceptible to death. Abiding by her previous wishes, would help to save her life.

PATIENT PREFERENCES
The Principle of Respect for Autonomy

 

• Has the patient been informed of benefits and risks, understood this information, and given consent?

Shah cannot communicate effectively with the doctors as result of communication barriers. The medical team consults Bashir, as her emergency contact. However, he goes contrary to her mother’s consent of treatment and orders for comfort care only.

• Is the patient mentally capable and legally competent, and is there evidence of incapacity?

Shah had previously communicated that she wanted to live. This shows she knows what she wants, and she can make sound decisions. Furthermore, there is no prior evidence of her being mentally or legally incompetent.

• If mentally capable, what preferences about treatment is the patient stating?

Shah had previously stated she wanted to live and receive treatment.

• If incapacitated, has the patient expressed prior preferences?

No, Shah lacked prior or advance written directives and wishes.

• Who is the appropriate surrogate to make decisions for the incapacitated patient?

Shah’s kinsman. In this case, her three sons, as her husband passed on.

• Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

No.

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 Shah is denied treatment, her normal life cannot be reinstated, as she will die. After successful treatment, the patient is likely to be physically inactive, have post-traumatic stress disorder, depression, and be more likely to have limited social interaction.

• 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?

One can presume that Shah does not want to live longer due to her old age and the fact that she is living in an extended care facility.

• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

Yes, in terms of Shah’s age group and concomitants considerations.

• What ethical issues arise concerning improving or enhancing a patient’s quality of life?

It is unethical for Bashir to go contrary to her mother’s wish and provide only comfort care at a time when Shah cannot make her own decision on life-sustaining treatment.

• Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

Since Bashir is the sole decision-maker and he is the one assessing Shah’s life, we presume, therefore, that it is through his assessment on the quality of life that leads him to adopt comfort care and forgo life-sustaining treatment.

• What are plans and rationale to forgo life-sustaining treatment?

Since Bashir acts as the designated surrogate, he adopts only comfort care and forgoes life-sustaining treatment.

• What is the legal and ethical status of suicide?

The legal status of assisted suicide varies among states despite these differences; ethical issues ought to be considered, such as beneficence, nonmaleficence, and autonomy.

CONTEXTUAL FEATURES
The Principles of Justice and Fairness

 

• Are there professional, inter-professional, or business interests that might create conflicts of interest in the clinical treatment of patients?

There would be no conflict of interest if the medical staff had declined Bashir’s order and treated Shah.

• Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

Shah’s sons should take part of the clinical decision making, but since Bashir is her only emergency contact, he is making all decisions.

• What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

That Shah’s medical information should only be revealed and disseminated with people indicated in her file.

• Are there financial factors that create conflicts of interest in clinical decisions?

Payment expected to be done in a long time after the treatment of the patient, which can be very expensive, also there could be a conflict of interest after Shah dies, and the treatment suspended, where her sons could benefit.

• Are there problems of allocation of scarce health resources that might affect clinical decisions?

No. Heart attack treatment requires unlimited resources for each patient.

• Are there religious issues that might affect clinical decisions?

There are possibilities of religious aspects affecting clinical decisions for Shah’s care, considering that her family is of Turkish culture and still practice their culture.

• What are the legal issues that might affect clinical decisions?

The unavailability of an advanced directive and legal surrogate.

• Are there considerations of clinical research and education that might affect clinical decisions?

No.

• Are there issues of public health and safety that affect clinical decisions?

Currently, none.

• Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?

Conflict of interest occurs between the medical staffs acting in the favor of Bashir and the social worker who advocates for the wishes of Shah.

Course of Action #3- Delay Treatment

 

MEDICAL INDICATIONS
The Principles of Beneficence and Nonmaleficence

 

• What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?

Shah is taken to hospital with heart attack effects. She is diagnosed with an acute condition, which is only reversible with treatment. The status turns to terminal in case she does not get treatment.

• Using this course of action, describe, in full sentences, necessary considerations via

1. Beneficence – The medical team is ready to treat and provide healthcare to Shah. With the presence of treatment dilemmas and conflicting interests between Bashir and Shah through the social worker, it would be wise to delay any treatment.

 

1. Non-maleficence – All medical practitioners and caregivers are mandated to save lives and do not harm patients. The most effective and win-win course of action is temporarily delaying Shah’s treatment while gathering more information and evidence instead of complying or refuting Bashir’s wishes.

 

1. Autonomy – With the presence of treatment dilemmas and conflicting interests between Bashir and Shah through the social worker, it would be wise to delay any treatment.

• In what circumstances are medical treatments not indicated?

If there was an advance notice indicating that Shah did not seek medication.

• What are the probabilities of success of various treatment options?

If Shah is not treated, she will die. There are low chances of success for her treatment due to her age and concomitants.

• In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?

Medical and nursing care can be beneficial to Shah through treatment; without it, she will die.

PATIENT PREFERENCES

The Principle of Respect for Autonomy

 

• Has the patient been informed of benefits and risks, understood this information, and given consent?

Yes, the medical staff communicated to Shah the advantages, necessities, alternatives, and risks although she might not comprehend due to the language barrier; therefore, there is no consent, and she has not declined any treatment services.

• Is the patient mentally capable and legally competent, and is there evidence of incapacity?

Shah has neither been proven mentally nor legally incompetent.

• If mentally capable, what preferences about treatment is the patient stating?

Shah had previously stated the kind of treatment and care she wanted, and she did not want to die.

• If incapacitated, has the patient expressed prior preferences?

No Shah lacked prior or advance written directives and wishes on file.

• Who is the appropriate surrogate to make decisions for the incapacitated patient?

Since Shah’s husband passed on, her sons have the right to make decisions for her in case she is unable to, but since Bashir is the emergency contact, he makes decisions for her.

• Is the patient unwilling or unable to cooperate with medical treatment? If so, why?

Shah neither refutes treatment nor is she uncooperative.

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 Shah is not treated, she can succumb to death, but if she is treated, she will get well and improve her quality of life. However, she could take more time to recover due to her old age and other comorbidities.

• 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?

Bashir judges that Shah does not want any treatment based on her old age and the fact she lives in an extended care facility.

• Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?

Yes, including unconscious and conscious biases by her medical team based on factors such as Shah’s age, medical conditions and her residence.

• What ethical issues arise concerning improving or enhancing a patient’s quality of life?

Autonomy: the ability of Shah to make sound and independent decision decisions.

• Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?

Bashir is the one assessing Shah’s life. We presume that it is through his evaluation of the quality of life that leads him to adopt comfort care and forgo life-sustaining treatment.

• What are plans and rationale to forgo life-sustaining treatment?

Bashir gives an order to the medical staffs to adopt comfort care and forgoes life-sustaining treatment, but it is only just to delay and confirm the patient’s demands and wishes.

• What is the legal and ethical status of suicide?

The legal status of assisted suicide varies among states despite these differences; ethical issues ought to be considered include beneficence, nonmaleficence and autonomy.

CONTEXTUAL FEATURES
The Principles of Justice and Fairness

• Are there professional, inter-professional, or business interests that might create conflicts of interest in the clinical treatment of patients?

In this case, there would be no conflicts of interest in case the medical staffs delayed the decision for treatment to confirm Shah’s demand and wishes.

• Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?

Shah has three sons who could have different ideas and opinion about her treatment. However, Bashir is the only one making the sole decisions for her treatment since he is the patient’s emergency contact.

• What are the limits imposed on patient confidentiality by the legitimate interests of third parties?

Shah’s medical data should be revealed and dessiminated to those only she indicates on her medical file.

• Are there financial factors that create conflicts of interest in clinical decisions?

Payment expected to be done in a long time after the treatment of the patient, which can be very expensive, also there could be a conflict of interest between the sons as a result of Shah’s death that is why he wants her to die.

• Are there problems of allocation of scarce health resources that might affect clinical decisions?

Heart attack diseases are commonly treated; therefore, there is no problem in allocating scarce health care resources.

• Are there religious issues that might affect clinical decisions?

Shah’s family is of Turkish culture, and they still practice their culture, due to patriarchal nature Shah may not go against Bashir.

• What are the legal issues that might affect clinical decisions?

Delaying treatment minimizes Shah’s chances of recovery, whereby if she dies, Bashir can sue the hospital for negligence and malpractice

• Are there considerations of clinical research and education that might affect clinical decisions?

None specified.

• Are there issues of public health and safety that affect clinical decisions?

Currently, none specified.

• Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?

Yes. The conflict of interest revolves around Shah’s social worker and the medical staff. The doctors are unable to administer treatment to Shah due to Bashir’s decision, by stating that previously Shah had given her wishes for treatment and care, the social worker creates the conflict of interest.

 

 

 

 

 

Healthcare Values and Ethics: Jamilah Shah Case Study

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HealthCare Values and Ethics: Jamilah Shah Case Study

A1. Potential Ethical Dilemmas

The case involves Jamilah Shah, who was taken to the hospital after collapsing, and once tested; she was determined to suffer from a heart attack. Once she arrived in the hospital, a quick decision was necessary to develop an effective treatment plan that would save her life sustainably. Treating her requires considering many aspects, including personal preference and medical factors. However, many ethical dilemmas are presented due to conflicting wishes from Shah through a social worker and her Son Bashir. According to Bashir and family, no further treatment is allowed, while Shah told the social worker, she wished to live and be saved. The developed ethical dilemmas in this case that are discussed are beneficence, non-maleficence, and autonomy.

A1 a. Beneficence Ethical Principles Bashir’s Wishes

The medical team is ready to treat and provide healthcare to Shah. To give her effective care, they are required to determine her wants and treatment preferences, beliefs, and culture. Since she cannot communicate, the team and physicians are integrating their medical knowledge and treatment training to ensure Shah is provided with the best care and most effective treatment plan. Beneficence is outlined by the action of helping Shah comprehend the stakes of the treatment, including importance, relevance, and possible risks for maximum care and competence (Leo, 1999). When Shah’s family refutes her treatment, it results in a beneficence ethical dilemma among the healthcare team, as they are mandated to save lives and provide high-quality healthcare.

 

 

A1 a. Non-maleficence-Delay of Care

All medical practitioners and caregivers are mandated to save lives and do not harm patients. In Shah’s case, delaying or withholding treatment would result in possible death, which is harmful. Nevertheless, administering medication against the family and patient’s will is an act of harm. Shah wishes to live, which means the team should provide the treatment to avoid damage. Moreover, if the team agrees with Bashir’s wishes and not treat Shah, they will be inflicting harm to the patient.

A1 a. Autonomy- Jamilah’s Wishes

Shah’s autonomy is at stake, which forms the most conflicting ethical principle. Without for sure establishing Shah’s competency to make her medical decision, it becomes difficult for the medical team to follow her wishes or those of Bashir. Her age and living arrangement limits autonomy, as Bashir feels she is not in a sound mind to decide her course of treatment. Her cultural orientation places her sovereignty at stake due to the patriarchy system where her son seems to decide on her behalf. The dilemma is established when the medical team do not know whether to uphold Shah’s wishes or not.

A1 b. Analyze legal implications associated with each of the potential ethical dilemmas described

A1 b. Beneficence Ethical Principles Bashir’s Wishes

If Shah’s healthcare team decides to continue with her treatment, they risk a legal action with Bashir, who can choose to sue the hospital and the team based on negligence and malpractice. In the court, he could have the judicial system in his favor, which would decide to discontinue Shah’s treatment. This would delay his mother’s treatment and harm her chances of recovery.

A1 b. Non-maleficence-Delay of Care

Choosing to listen to the social worker on saving Shah’s life would result in legal action with her and Bashir. Continuing treatment against Bashir’s wishes and later realizing that Shah did not ask for a DNR (Do Not Resuscitate), the team and hospital would be sued because they violated Shah’s right to self-determination that they had voiced.

A1 b. Autonomy-Jamilah’s Wishes

It is Shah’s right to continue treatment if she wishes so, making it the responsibility of the treatment team to explain to her the risks, benefits, alternatives, and other related medical aspects of her case to understand what the treatment will entail. If Shah accepts and they agree on a treatment plan, she can sue them if they conduct a different treatment plan. Moreover, if communication was ineffective, which would result in adverse results, Shah and her son can decide to sue the doctors and team for ineffective communication, which resulted in conflicting decisions between her and her son.

A3. Role Play as Healthcare Administrator

As a healthcare administrator, it is essential to determine the most effective course of action in her treatment, which would require examining whether Shah is competent and well-structured to make her decision and if Bashir is the appropriate person to advocate and decide on her behalf.  

A3a. Two Resources

1. An advanced directive such as a living will is a legal document that specifies a personal and medical instruction indicating actions ought to be followed in response to health issues in case they cannot make the decision themselves (MedlinePlus, 2019).
2. A translator provides for an interpreter or translation document that helps patients understand their physicians and treatment plans regarding their health for effective communication.

A3b. Description

1. If Shah had a living will before her heart attack, it would direct her physician and family regarding her preferred decision. It would be a physical and undisputed proof leading the medical team to sustain her life and dilemmas presented in the case could be eliminated. If unconscious, her will would identify who decides on her behalf.
2. Having a translator would eliminate the presence of a communication barrier as a source of ethical and legal issues. Communication would be made efficient ensuring a consensus and absolute compression between Shah and her medical team.

A3c. Correct Course of Action

1. Follow Bashir’s Wishes

Before deciding to follow Bashir’s wishes, who is appointed as Shah’s emergency contact, it is crucial to speak to the other sons. It would help discover whom the designated surrogate is, their views, and understand Bashir’s primary motives of not letting his mother be treated. Consulting the other two sons would help determine if Shah had contacted them and left a directive on her medical care. This eliminates possible legal action incase these two sons sue the hospital for excluding them in decision making if anything goes wrong.

1. Refuse to Follow Bashir’s Wishes

In this case, communication barriers instigate confusion and an undeceive nature of the issue. It would require having a third party, with no interests with any involved party, to separately meet with Shah and Bashir to determine their motives and decisions. The third party, together with an interpreter and physician can meet with Shah, help her understand the risks and benefits associated with the treatment, and let her decide solely. She can also draft a living will, advanced directive to eliminate any confusions poised by Bashir’s wishes.

• Delay Action

With the presence of treatment dilemmas and conflicting interests between Bashir and Shah through the social worker, it would be wise to delay any treatment. This way interviews can be conducted on Bashir, the social worker, Shah to ensure consensus is reached, and motives identified to avoid overlooking vital information that may compromise the situation.

A3d. Alternate Course of Action

The most effective and win-win course of action is temporarily delaying Shah’s treatment while gathering more information and evidence instead of complying or refuting Bashir’s wishes. Following Bashir’s requests would mean ignoring Shah’s wish to live and disregarding comfort care, which is unethical. Moreover, ignoring Bashir’s wishes and treating Shah would result in legal action and confrontation with him. Hence, delaying the treatment briefly would help the medical team investigate and acquire adequate information from her other two sons, Bashir’s motives, and social worker’s instructions from Shah. This is important as Bashir is not his mother’s surrogate, just an emergency contact, and her husband is deceased. It would mean that Shah’s appointed surrogate is one of the other sons, which is essential for his consultations during this period. Shah can even draft her living will, whereby if it is determined she wishes to live, then her wishes are granted, and the hospital saved from any legal action, blame, or liability.

A4a. Three Policy Recommendation

1. Decision making among patients will be dependent on their sound mind and capabilities. If a patient lacks an advanced directive and are of sound mind, they can make their treatment decisions. If a patient lacks an advanced directive and is in no position to decide, the hospital’s Ethics Committee can help determine patient competency(Leo, 1999).
2. The hospital must provide a certified third party translator to every patient with a foreign language to eliminate communication and language barriers for sufficient comprehension and privacy.

• Patient education on the importance and description of an advanced directive to eliminate conflict of interest and confusion that derails effective decision-making(MedlinePlus, 2019).

A4b. Justification of each Policy 

1. Patients have the final and ultimate decision on the course of action of their medical care. Therefore, determining their competency in decision-making eliminates possible ethical and legal issues such as rushed and incorrect decisions. The Ethics Committee in the hospital must first determine the patient’s competence and cognitive abilities to ensure accurate and well-thought decisions. In Shah’s case, the EC would have helped decide on her cognitive abilities to decide before consulting Bashir or her other sons(Leo, 1999).
2. The presence of a third party translator maximizes objectivity and protects the interests of a patient and the hospital. The absence of family members helps patients make decisions as they prefer without pressure from their relatives. Having a translator in Shah’s case would eliminate communication barriers and promote a consensus.

• Educating patients will maximize self-determination among patients, as it is their right to choose their medical life and care plans. When they are educated on risks, benefits, and treatment alternatives, they can comfortably decide what they want precisely. In Shah’s case, the presence of a will of life would eliminate confusion regarding her treatment(MedlinePlus, 2019).

 

 

 

References

Leo, R. J. (1999). Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians. The Primary Care Companion Journal of Clinical Psychiatry, Vol 1(5), pp; 131-141.

MedlinePlus. (2019, August 20). Advance Directives. Retrieved from https://medlineplus.gov/advancedirectives.html