Jamilah Shah is a 90-year-old Turkish female who immigrated to the United States over 40 years ago with her wealthy husband (now deceased) and their three young children. Jamilah was a homemaker and learned only basic English, but her children are fluent and are all in their 50s. The family still retains Turkish culture and norms, including the sons acting as patriarchs for the family making many decisions even though Jamilah is highly educated and trained as a lawyer in Turkey. Two of the three children are in successful careers; the remaining child, the youngest son, owns a small market and is struggling financially. Until yesterday—the day of admission—Jamilah resided in an extended care facility (ECF), where she has lived since her husband’s death. She reportedly has severe COPD and adult-onset diabetes mellitus. She was brought to the hospital after collapsing at the side of her bed. EKG and lab tests revealed a heart attack. She has no advance directives on file, and because of her communication difficulties, the emergency department physician started her on anticoagulants while trying to contact her next of kin. The ECF sent paperwork to the hospital that listed the youngest son, Bashir, as the emergency contact. Bashir was contacted and is now at the hospital with his two brothers. He has informed the care team that he is the decision maker, and he wants his mother to have a Do Not Resuscitate (DNR) order with no intervention of any kind other than comfort care. The social worker has come to you, as administrator, with concerns that this decision may not reflect Jamilah’s wishes. When the social worker was visiting with Jamilah alone, Jamilah reached out for her hand and said, “Please help me. I want to live.” The social worker expresses concerns about the interactions observed between Jamilah and her sons, stating that the relationships seem unsupportive. The hospital’s ethics committee has not yet been involved. The social worker also reports that the emergency physician had requested a cardiology consultation, which was just completed, and the consultant documented that “because the family has requested only comfort care, and due to the patient’s multiple comorbidities, the patient will be managed medically, with no intervention, and will not receive cardiac catheterization or be considered for coronary bypass surgery.” If nothing is done, Jamilah will likely die within days.
A. Write an essay (suggested length 3–5 pages, not including attachments) by doing the following:
1. Discuss three potential ethical dilemmas in the given scenario.
a. Analyze the ethical principles and any legal implications associated with each of the potential ethical dilemmas discussed in part A1.
3. Decide on a course of action for this scenario, as the healthcare administrator, by doing the following:
a. Explain the additional information that would be needed to make a decision.
b. Describe one resource that could have made or could still make Jamilah’s wishes more clear.
i. Explain why the resource described would be helpful.
c. Propose one of the following courses of action (responding to Bashir’s demands for only comfort care):
• course of action 1: Follow Bashir’s wishes
• course of action 2: Refuse to follow Bashir’s wishes
• course of action 3: Briefly delay the decision to gather additional information and other perspectives
i. Justify your proposed course of action.
ii. Compare one of the other courses of action from part A3c with your proposed course of action.
4. Create three policy recommendations that you could make as an administrator to help your employees and the facility’s medical staff handle similar situations in the future.
a. Justify each policy recommendation.