A1. In the given scenario there are multiple ethical dilemmas, but I will only focus on three of them in this essay. The first ethical dilemma I noticed is that there is no advanced directive on file. Jamilah the patient only knows Basic English, so she is unable to fully communicate with the physicians regarding her medical care. The physicians are doing what they can to treat her medical conditions without an advanced directive on file but without her history and inability to communicate it, they are struggling.
The second ethical dilemma is the fact that there is no release of medical information on file and the hospital released confidential information to Jamilah’s children without it. The youngest son is the emergency contact on file with the extended care facility, but this does not give authorization to release medical information to the patient’s son. There is no mention of the extended care facility having a signed release of medical information for Jamilah’s children on file. The third ethical dilemma I will discuss in this essay is the Do Not Resuscitate (DNR) order.
Jamilah’s youngest son informed the care team that he is the decision maker, and he wants his mother to have a DNR or order with no intervention of any kind other than comfort care. This alone can be an ethical dilemma for any situation, but it becomes even more of an ethical dilemma because Jamilah expressed to the social worked that she wants to live. Ala. The first ethical dilemma has caused major conflict between the patient and her family. Since there is no advanced directive on file, Jamilah’s youngest son Bashir, has informed the care team that he is the decision maker.
Yet, his statements conflict with the wishes of the patient. The information provided in the scenario leads me to believe that the patient is still mentally stable, and should be able to make her own decisions. The principle of autonomy is the right of a person to make his or her own decisions, but this family, or more specifically, her son Bashir, is not honoring Jamilah’s wishes. When the social worker visited her alone, the patient stated that she wants to live, and she asked for help.
The social worker expressed concern about the relationship between the patient and her sons and said it appeared to be an unsupportive relationship. In the second ethical dilemma the patient’s privacy has been violated because there is no release of medical information on file to allow the patients family access to her medical information. The patient’s privacy was breached when her medical information was discussed with her family members without her consent. Health Insurance Portability and Accountability (HIPAA) is a law that was enacted to protect patient’s medical information.
When HIPAA is violated the hospital can be fined for each individual violation, and they must immediately make corrections to prevent any future violation from happening. The third ethical dilemma is the Do Not Resuscitate (DNR) order with no intervention. Bashir informed the care team that he wants his mother to have this order in place with only comfort care. Once again the ethical principle of autonomy is being violated because the patient is not being allowed to independently make decisions regarding her medical care.
The patient has not signed a living will to allow Bashir to make decisions regarding her healthcare care plan. A3a. There is additional information I would need to make a decision for Jamilah’s situation. I would need to know if Bashir has legal documents allowing him to make medical decisions for his mother because there are none on file. There is no mention of legal documentation in the scenario, so I’m under the assumption that he does not have the legal authorization to make medical decisions for his mother.
I would also need someone from the hospital to discuss things further with Jamilah to determine what her personal wishes are for the dilemma she is involved in because her decision is the final decision until she is no long competent. I would also need an Advanced Directive on file to better guide the physician’s decisions for medical care for the patient. A3b. The one resource that could make Jamilah’s wish clearer is a Living Will. A Living Will is a legal document that allows a person to decide their medical wishes once they are no longer capable of making medical decisions.
This document would allow the patient to have a voice even if she was not mentally competent. A3bi. The Living Will would be helpful in Jamilah’s situation because her son Bashir would not have authority to override the signed document since it is legally valid. If a Living Will were on file it would remove the potential ethical dilemma that is described in the scenario given. Jamilah’s son Bashir would not be able to make decisions that contradicted the wishes of his mother once she becomes mentally incompetent, or unable to speak for herself. A3c.
Propose one of the possible courses of action from part A2 (responding to Bashir’s demands for only comfort care). A possible course of action to respond to Bashir’s demands for comfort care only would be to have a medical conference involving the entire medical care team. In this conference they can create a proposed action plan for Jamailah’s treatment, and determine a prognosis. In the medical conference they would need to consider several factors including the following. What would her quality of life be if they continue with the cardiac catheterization?
Is she stable enough to be considered for a coronary bypass surgery? Would she survive a surgery at the age of 90-years old? What will her quality of life be after recovery? A3ci. Justify your proposed course of action. This course of action is justified because it’s not ethical to allow a patient to die without offering all available treatment options when they are requesting to live. If there is chance of survival the medical care team should do everything possible to help the patient survive. A3cii. Compare ONE of the other courses of action from part A2 with your proposed ourse of action. The second course of action would be a patient/family conference to discuss the patients care plan and determine how it will benefit the patient. This will allow the entire family to openly express their thoughts and concerns. It will also allow Jamilah to have a voice, and to express her desires as the patient. In both courses of action you have the opinions of others. In the conferences all the pros and cons will be considered and discussed among the patient, family and medical care team. In both courses of action the patients’ wellbeing is the center of the discussion.
A4. The first policy would recommend is a privacy policy. This policy would have detailed information protecting a patient’s medical information, and the protocols that are necessary to release the patient’s medical records. Once this policy is in place a patient’s medical information cannot be released to anyone, including the patient, without a signed authorization on file. The authorization must be completed and signed by the patient or by a legal power of attorney. The second policy I would recommend is a patient’s rights policy.
This policy would have detailed information to provide the patients with the resources needed to express their concerns or complaints regarding their care at the hospital. Patients are encouraged to express their concerns or complaints to the staff immediately, so they can be addressed and corrected. This would also include the patient’s right to request an interpreter and to have any religious restrictions placed into their chart. The third and final policy I would recommend is a compliance policy. This policy would have detailed information regarding compliance issues that the medical staff must follow.
This would help ensure that all the same guidelines are being followed throughout the hospital, and would also help eliminate confusion when problems or questions arise regarding a patients care. A4a. A privacy policy must be in effect to adequately protect the patient, hospital, and staff. A patient’s privacy should be a priority with every interaction to preserve the integrity of the care they receive. Without a privacy policy, sensitive patient informed could be leaked to other sources where it could be detrimental and in some cases, cause the patient harm.
Every person has rights, but as a patient the feeling of helplessness becomes intensified. By informing patients of their rights and allowing them to take part in their care, that feeling may decrease. In this scenario, with a patient that speaks English as a second language, simply giving them access to an interpreter and allowing them to freely express themselves would help the situation tremendously. This is a policy that every medical facility needs to have to allow the patients the comfort of knowing that there are guidelines around the care they will receive if they are ever incapable of speaking for themselves.
Most employers have a compliance policy, and a hospital should ensure that they have one that it is accessible to all of their employees. They should not only provide their employees with it, but also educate them on it. In a healthcare setting, one mistake can lead to a patient’s death. One mistake can also be rectified if a standard protocol is set and followed to eliminate mistakes. This is all part of a compliance policy and something that is critical for every hospital to have. There were no resources used in this essay.
