Healthcare Ethics

Running Head: HEALTHCARE ETHICS 1

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HEALTHCARE ETHICS

Healthcare Values and Ethics

Hunter Parces

WGU

Introduction:

Jamilah was admitted to the hospital after she collapsed due to a heart attack. She had multiple comorbidities, which included diabetes and chronic obstructive pulmonary disease and at the age of 90, going for bypass or cardiac catheterization was also a great risk as the survival rates are low. Not only this, but the procedures are also extremely painful. When extended care facility paperwork reached the hospital where she was admitted, her son Bashir was contacted as her guardian who visited with his brothers. As a decision-maker, he moved forward with Do Not Resuscitate (DNR) and ordered no interventions apart from comfort care. His decision was against Jamilah's wishes as she wanted to live more and wanted to get proper treatment.

Potential Ethical Dilemmas:

Potential ethical issues occur when we have to make some hard choices, and we don't have ideal options to go through as we want. These dilemmas occur when we know what we can do to make things right but aren't able to process it. In this case, three potential ethical dilemmas in this scenario were autonomy, beneficence, and non-maleficence

Autonomy is the ability of a person to make their own choice and decisions regarding own self. A potential ethical dilemma in autonomy occurs when the person is very old or has mental health issues due to which that person is unable to make their own choice. Jamilah, in this case, was facing a potential ethical dilemma as she was very old and unable to make decisions for herself. Legal implications will arise when Jamilah decides to get treatment while her son ordered DNR therapy only for his mother (Rosenbaum, 2011).

Beneficence means the act of benefiting without any harm, and non-maleficence means that the caregiver needs to protect the patient from harm. In this scenario, the ethical dilemma of beneficence and non-maleficence is present is as Jamilah is making a hard choice for herself; her decision could be life taking but as she is not in a suitable position of taking a decision, his son moved on with the comfort therapy for her which can apply legal implications, as well as they, are against Jamliah's wish of getting treated for her heart attack.

The course of Action 1; Follow Bashir's Wishes

· Jamilah had a heart attack, due to which she was admitted to the hospital. She had other comorbidities as well. Her medical problem was critical as she was suffering from multiple diseases at the same time, and her condition was very difficult to bring it back to a completely normal stage. Necessary consideration that should be made related to patient's autonomy, non-maleficence, and beneficence is that she is allowed to make decisions for her own life, but it was a difficult choice as well as she doesn't know the outcomes and on the other hand, Bashir wasn't that much financially stable to opt for so expensive treatments which are not promising as well to give her back her complete health, so he ordered only DNR therapy as he was his caregiver. Medical treatments are not indicated when the patient is not in stable condition, or the survival chances after attaining those procedures are very low, and they possess a threat to the patient's life. The probabilities of success are very low. This patient can be benefited from medical and nursing care, and harm can be avoided if there are no comorbidities and the rate of recovery after the procedure is high.

· The patient is not told about the benefits or drawbacks of the procedure as due to old age, she is unable to understand properly. She doesn't seem mentally challenged, but she isn't good at making decisions as she wants to live and wants help to do so. The patient is unable to express her preferences as she doesn't know. The patient is not unwilling for treatment as she wants to get better (McIntyre, 2019).

· If the patient is given the treatment, she will be in a physically painful condition and won't be mentally stable as well because the pain will elevate the symptoms of other comorbidities as well. No one can judge the desire of life for any patient on any ground, but ethical issues may arise as Jamila doesn't know if those medical procedures can be helpful or save her. Quality of life will be decreasing for her as she will be in physical pain until the bypass is done, which itself is a very dangerous process. Suicide is ethically, legally, and morally wrong.

· There aren't any business or professional issues that might create conflict. Apart from family, no one is involved in clinical decisions. Although there are financial matters that arise conflict as Bashir is not much financially strong, that's why he can't afford proper and expensive treatment for her mother. There are no religious issues, but legal issues might affect clinical decisions as the patients want to live. There are no clinical research or conflict issues of public health that may affect clinical decisions. There is no conflict of interest in an organization and patient welfare as well.

The course of Action 2: Refuse to follow Bashir wishes

· The patient medical problem is heart attack with multiple comorbidities, and the medical problem is critical. Necessary consideration should be made for beneficence, no maleficence, and autonomy, as it's Jamilah's right to decide for her life and treatment tough ethical dilemma for these is also present in this scenario. medical treatment is not indicated when the patient s terminally ill or treatment can possess treat to the life of the patient. This patient can be benefitted if the proper medical treatment is given and if her physical condition is managed well by nursing care. The patient has not been informed of the benefits and risks of the procedure. Although the patient is mentally competent but due to the age factor is unable to understand properly. The patient preference is only to live and is willing to cooperate with the medical treatment (Davis, 2011).

· The prospects of returning to normal life with or without treatment are low because treatment consists of painful procedures that, if successful, can give a better life, but the age factor induces hindrance in many medical procedures at this age. No one can judge the quality of life for a patient who cannot express on any ground. If the patient wants treatment, but it isn't given by the caregiver, then ethical issues may arise. It is wrong to commit suicide in any possible scenario. Yes, quality of life does arise questions regarding treatment plans because if one can recover after given the proper treatment, it should be provided t improve the quality of life for the patient.

· No, there aren't any conflicts by other interests; there are no other groups interested in clinical decisions. There are no religious or legal issues or any other kind of conflict apart from the patient's desire to get treatment, and the son recommended comfort therapy.

The course of Action 3: Delay treatment

· The patient's medical problem is heart attack with diabetes and COPD, and the illness is of terminal type. Necessary considerations via beneficence, non-maleficence, and autonomy are that patient can decide if she wants to get treatment, the caregiver should follow the instructions to give her healthy life. Treatment plans should be told to the patient, and his/ her consent should be taken as well. This is their legal right. Medical treatment is not indicated if the patient is terminally ill, or treatment can be harsh to the patient; the patient can be benefitted relying upon the medical condition and how effective a treatment plan can be helpful to regain the health back.

· The patient is not informed about the treatment plan and is mentally stable but not able to decide due to less fluency in English and due to age factors as well. The patient preference is to lead a better a healthy life as she said that she wants to live. The patient is willing to cooperate with the treatment as she wants to live; his son is a surrogate to make decisions on his behalf.

· Returning to normal life is a bit tough for patients with multiple comorbidities. After treatment, if the patient recovers from Cardiac bypass, she still will have other comorbidities. No ethical issues will arise as far as the patient wants that treatment as she will solely be responsible, but in our scenario, Jamilah is unable to make decisions due to the age factor. Plans for life-sustaining treatment should be done if the patient has more chances to lead a healthy life after getting the treatment. The legal and ethical status of suicide is a violation of moral law. And people responsible for it would be held accountable for driving the person to commit suicide.

· There are no professional or any kind of conflicts in the treatment of the patient. There are financial factors that are present in this scenario as Bashir is not financially strong to provide all expensive procedures for her mother. Legal issues that affect clinical decisions are that everyone is allowed to choose to live anyhow they want to live, and they are provided all facilities when getting sick. In Jamilah’s case, she is not financially strong to get those treatments for herself; neither Bashir can afford it (Blumenthal, 2015).

Resources for Jamilah’s wish:

Jamilah, upon her encounter with a health care worker, said that she wanted to live. This shows her desire to recover from the illness she was facing. Two resources that could make Jamilah wish come true and more clear are:

· If Jamilah was able to communicate properly and had no comorbidities, then it would have become easy to fulfill Jamilah's wishes because when the person can communicate, healthcare staff try to understand her situation well and can help her in speedy recovery.

· If Bashir was more financially strong and was able to cover the expenses that her mother's treatment could cost and also was able to give her tension free life, then he could have struggled, but because of Jamilah's age factor and low chances of recovery, he ordered comfort therapy for her. If Jamilah was given the right to choose treatment and the procedure was if explained to her with both pros and cons for getting treatment, her wish of getting recovered from illness would have become clear (Rosenbaum, 2011).

The correct course of action:

The correct course of action in response to Bashir's demand of only comfort care was a delay in the treatment to get additional information about the patient's whole body responses and to check if the surgery or catheterization was effective for her or not. Due to age and comorbidities, giving anesthesia to these patients is also tough, while diabetes also imposes great risk factors. Due to COPD, it was tough to go through heart bypass surgery; hence close observation and comfort care was the best thing to provide her initially till her reports confirm that she was able to go into surgery.

The course of action that I don't justify or think is a good course of action is going forward with immediate treatment of the patient as she is old and have co-morbidities it will impose a threat to her life if any surgical procedure is done without carefully keeping her under the observation and running all-important tests.

Recommendation policy:

Three recommendation policies that I would make to facilitate my health worker areas:

· Help the patients in old age and try to comfort them whenever needed. Explain the treatment plan clearly so that they could be able to decide for their own lives as this is their right.

· After explaining the treatment plan patient should also be told all the possible outcomes, whether it is life-threatening or not, or either the patient would be able to get recovered completely after that processor would all that expenditure will be in vain, and the patient won't be recovered up to the desired level (Ho, 2011).

· Proper counseling of the patient should be done if the survival chances are low. This should be done in the presence of the caregiver so that both should know the reason and consequences that are going to happen in the future.

References Blumenthal, D. (2015). The Affordable Care Act at 5 Years. The journal of Medicine, 1-12. Davis, K. (2011). How the Affordable Care Act Will Strengthen the Nation's Primary Care Foundation. SAGE journal, 1201–1203. McIntyre, A. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLOS MEDICINE, 11-27. Ho, V. (2011). The Affordable Care Act: A New Way Forward. AMA Journal of Ethics. Rosenbaum, S. (2011). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Public Health journal, 130–135.