Healthcare Ethics
hunterbooth
QuestionsDerivedfromtheUniversityofWashingtonParadigm.edited.docx|
ASSESSMENT DEPARTMENT WESTERN GOVERNORS UNIVERSITY |
QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM
Course of Action One – Follow Bashir’s Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
· What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
· 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.
· Using this course of action, describe, in full sentences, necessary considerations via
1. beneficence
1. non-maleficence
1. autonomy
· 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.
· In what circumstances are medical treatments not indicated?
· 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.
· What are the probabilities of success of various treatment options?
· The probabilities of success are very low
· In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
· 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.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
· Has the patient been informed of benefits and risks, understood this information, and given consent?
· The patient is not told about the benefits or drawbacks of the procedure as due to old age, she is unable to understand properly.
· Is the patient mentally capable and legally competent, and is there evidence of incapacity?
· 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
· If mentally capable, what preferences about treatment is the patient stating?
· The patient is unable to express her preferences as she doesn't know.
· If incapacitated, has the patient expressed prior preferences?
· The patient has no prior preference she only wanted to live.
· Who is the appropriate surrogate to make decisions for the incapacitated patient?
· Bashir is the only surrogate to make decisions for the patient.
· Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
· The patient is willing and wants to cooperate for treatment as she wants to get better (McIntyre, 2019).
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, 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 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.
· 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?
· 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
· Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
· There are biases that might prejudice the provider’s evaluation of the patients quality of life, as it is against her freedom to decide for her life, comfort therapy is not the solution and delayed treatment will certainly cause death.
· What ethical issues arise concerning improving or enhancing a patient’s quality of life?
· The patient is unaware of the dangers that are linked with treatment. She wants to enhance her life quality, but no one can take the risk of doing her surgery in this condition which imposes ethical issues from the patient's scenario who wants to get better.
· Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
· 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.
· What are the plans and rationale to forgo life-sustaining treatment?
· The plans were to provide Jamilah comfort therapy only as other procedures include risk.
· What is the legal and ethical status of suicide?
· Suicide is ethically, legally, and morally wrong.
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 aren't any business or professional issues that might create conflict.
· Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
· 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.
· What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
· There was no limitation imposed on the patient, apart from Bashir's decision.
· Are there financial factors that create conflicts of interest 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.
· Are there problems of allocation of scarce health resources that might affect clinical decisions?
· No, there isn't a scarcity of health resources that might affect the clinical decisions other than Jamilah’s present health condition and age factor which was a hindrance for proper treatment.
· Are there religious issues that might affect clinical decisions?
· There are no religious issues
· What are the legal issues that might affect clinical decisions?
· Legal issues might affect clinical decisions as the patients want to live.
· Are there considerations of clinical research and education that might affect clinical decisions?
· There are no clinical research or conflict issues of public health that may affect clinical decisions.
· Are there issues of public health and safety that affect clinical decisions?
· No there aren’t issues of public health and safety involved.
· Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?
· There is no conflict of interest in an organization and patient welfare as well.
Course of Action Two - Refuse to Follow Bashir’s Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
· What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
· The patient medical problem is heart attack with multiple comorbidities, and the medical problem is critical.
· Using this course of action, describe, in full sentences, necessary considerations via
1. beneficence
1. non-maleficence
1. autonomy
· 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
· In what circumstances are medical treatments not indicated?
· Medical treatment is not indicated when the patient s terminally ill or treatment can possess treat to the life of the patient.
· In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
· This patient can be benefitted if the proper medical treatment is given and if her physical condition is managed well by nursing care.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
· Has the patient been informed of benefits and risks, understood this information, and given consent?
· The patient has not been informed of the benefits and risks of the procedure as she is unable to speak or understand the language properly.
· Is the patient mentally capable and legally competent, and is there evidence of incapacity?
· The patient is mentally capable and legally competent but she is unable to speak the foreign language properly and can't quite understand it as well.
· If mentally capable, what preferences about treatment is the patient stating?
· Although the patient is mentally competent but due to the age factor is unable to understand properly yet she said that she wanted to live.
· If incapacitated, has the patient expressed prior preferences?
· The patient preference was to live and get healthy life.
· Who is the appropriate surrogate to make decisions for the incapacitated patient?
· Although his son is a surrogate to make decisions as for the patient, the doctor is appropriate for deciding according to her present health.
· Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
· The patient preference is only to live and is willing to cooperate with the medical treatment (Davis, 2011).
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, 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?
· 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.
· 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?
· 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.
· Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
· 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.
· What ethical issues arise concerning improving or enhancing a patient’s quality of life?
· Ethical issues of autonomy will arise if the patient wants to get treated but she is unable to understand her declining health state.
· Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
· Yes, the quality of life assessment may raise questions as her condition is critical, and going for life-sustaining treatment will cause death in few days.
· What are the plans and rationale to forgo life-sustaining treatment?
· The plans were to provide her comfort therapy only to provide her basic relief from the pain.
· What is the legal and ethical status of suicide?
· It is wrong to commit suicide in any possible scenario.
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?
· No, there aren't any conflicts by other interests
· Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
· No, no one has an interest in clinical decisions.
· What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
· Limits imposed on the patient was, only to get comfort therapy.
· Are there financial factors that create conflicts of interest in clinical decisions?
· Yes, there are financial factors as Bashir is not able to support her mother's treatment financially and she has multiple comorbidities as well.
· Are there problems of allocation of scarce health resources that might affect clinical decisions?
· No, there isn't any problem in the allocation of scarce health resources.
· Are there religious issues that might affect clinical decisions?
· There are no religious issues.
· What are the legal issues that might affect clinical decisions?
· Legal issues that might affect clinical decisions are the patient's desire to get treatment, and the son recommended comfort therapy.
· Are there considerations of clinical research and education that might affect clinical decisions?
· No, there isn’t any consideration present in this case.
· Are there issues of public health and safety that affect clinical decisions?
· No there aren’t issues of public health and safety included in this scenario.
· Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare?
· No, there isn't any conflict of interest present.
A course of Action Three- Delay Treatment
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
· What is the patient’s medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Terminal?
· The patient's medical problem is heart attack with diabetes and COPD, and the illness is of terminal type.
· Using this course of action, describe, in full sentences, necessary considerations via
1. beneficence
1. non-maleficence
1. autonomy
· 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.
· In what circumstances are medical treatments not indicated?
· 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
· In sum, how can this patient be benefited by medical and nursing care, and how can harm be avoided?
· The patient can be benefitted relying upon the medical condition and how effective a treatment plan can be helpful to regain health back.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
· Has the patient been informed of benefits and risks, understood this information, and given consent?
· 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.
· Is the patient mentally capable and legally competent, and is there evidence of incapacity?
· Yes, the person is mentally and legally capable but due to present in a foreign country and age issue, she is unable to understand well.
· If mentally capable, what preferences about treatment is the patient stating?
· The patient's only preference is to get her healthy life back and she wants to live.
· If incapacitated, has the patient expressed prior preferences?
· Her desire to live is her only preference.
· Who is the appropriate surrogate to make decisions for the incapacitated patient?
· His son is a surrogate to make decisions on her behalf.
· Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
· The patient is willing to cooperate with the treatment as she wants to live.
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, 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?
· After treatment, if the patient recovers from Cardiac bypass, she still will have 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?
· No one on any ground can judge that or express judgment on the patient's behalf.
· Are there biases that might prejudice the provider’s evaluation of the patient’s quality of life?
· Provider knows about multiple comorbidities and also considers her very low chances of survival.
· What ethical issues arise concerning improving or enhancing a patient’s quality of life?
· 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
· Do quality-of-life assessments raise any questions regarding changes in treatment plans, such as forgoing life-sustaining treatment?
· Yes, the quality of life assessment may raise the question as it will be leading to patient's death but only using comfort therapy.
· What are the plans and rationale to forgo life-sustaining treatment?
· Plans for life-sustaining treatment should be done if the patient has more chances to lead a healthy life after getting the treatment.
What is the legal and ethical status of suicide?
· 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.
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 professional or any kind of conflicts in the treatment of the patient
· Are there parties other than clinicians and patients, such as family members, who have an interest in clinical decisions?
· No there aren’t other parties apart from Bashir who is not financially stable to manage proper treatment.
· What are the limits imposed on patient confidentiality by the legitimate interests of third parties?
· The only limit is imposed by Bashir, none other.
· Are there financial factors that create conflicts of interest in clinical decisions?
· There are financial factors that are present in this scenario as Bashir is not financially strong to provide all expensive procedures for her mother.
· Are there problems of allocation of scarce health resources that might affect clinical decisions?
· No there aren't problems with the allocation of scarce health resources.
· Are there religious issues that might affect clinical decisions?
· No, there aren’t religious issues.
· What are the legal issues that might affect clinical decisions?
· 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).
· Are there considerations of clinical research and education that might affect clinical decisions?
· No there aren’t considerations of clinical research or education that might affect clinical decisions.
· Are there issues of public health and safety that affect clinical decisions?
· No, there aren’t issues of public health and safety.
· Are there conflicts of interest within institutions or organizations (e.g. hospitals) that may affect clinical decisions and patient welfare
· No, there aren’t such conflicts within the institution present.
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.
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