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Introduction: Ethical and legal problems arise in healthcare organizations when the decision-making capacity of an elderly patient is uncertain, particularly when the patient’s decisions are at odds with the rest of the family’s preferences. The scenario provided here is about this type of situation.
This performance assessment will provide you with experience in sorting through the sometimes-competing issues related to a scenario such as the one described, as well as experience in formulating actions that can help guide a healthcare organization through ethical problems that arise in caring for elderly patients.
Note: Students may rely on conversations and notes gleaned from cohort lectures and Boot Camp.
SCENARIO
You are the healthcare administrator at a local hospital. A social worker has come to you to discuss the case of Jamilah Shah, a patient who has recently been admitted to the hospital. Jamilah is a 90-year-old woman who was brought to the hospital after collapsing at the side of her bed. EKG and lab tests revealed a heart attack.
More than 40 years ago, Jamilah emigrated with her wealthy husband (now deceased) and their three sons from Turkey to the United States. Jamilah was a homemaker and learned only basic English, but her children are fluent English speakers. The children are now all in their 50s. The family retains Turkish culture and norms, including the sons acting as patriarchs for the family. Even though Jamilah is highly educated (in Turkey she was trained as a lawyer), the sons make many of the family decisions. Two of the three children are in successful careers. The remaining child, the youngest son, Bashir, owns a small market and struggles financially.
Until yesterday, the day of her admission, Jamilah resided in an extended care facility (ECF), where she has lived since her husband’s death. She reportedly has severe chronic obstructive pulmonary disease and adult-onset diabetes mellitus.
Jamilah has no advance directives on file. 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, listing 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 with concerns that this decision may not reflect Jamilah’s wishes. When the social worker was visiting with Jamilah alone, Jamilah reached for her hand and said, “Please help me. I want to live.” The social worker shares 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 requested a cardiology consultation, which was just completed. 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.
REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The similarity report that is provided when you submit your task can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
Note: Complete these prompts by using complete sentences.
Note: The web links “Advance Directives” and “Determining Competency for Medical Decisions” found below may be used to assist you in completing this assessment.
A.   Write an essay (suggested length of 5–7 pages, not including attachments) analyzing the scenario by doing the following:
1.   Describe three potential ethical dilemmas presented in the scenario: one related to autonomy, one related to beneficence, and one related to non-maleficence.
a.   Analyze legal implications associated with each of the potential ethical dilemmas described.
2.   In response to Bashir’s demands for only comfort care, discuss each of the following three courses of action in the scenario as it relates to each ethical dilemma.
•   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
a.   Choose and justify the correct course of action (in response to Bashir’s demands for only comfort care).
b.   Choose one of the courses of action from part A2 that you did not justify in part A2a and explain how possible consequences show that it is not the correct course of action.
3.   Putting yourself in the role of a healthcare administrator, describe in the essay what should happen next within the scenario by doing the following:
a.   Describe two resources that could have made or could still make Jamilah’s wishes clearer.
i.   Explain how each resource could have made Jamilah’s wishes clearer.
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.
B.   Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
C.   Demonstrate professional communication in the content and presentation of your submission.
RUBRIC
A1:POTENTIAL ETHICAL DILEMMAS
NOT EVIDENT
Descriptions of 3 potential ethical dilemmas—1 related to autonomy, 1 related to beneficence, and 1 related to non-maleficence—are not provided.
APPROACHING COMPETENCE
Descriptions of 3 potential ethical dilemmas—1 related to autonomy, 1 related to beneficence, and 1 related to non-maleficence—are provided, but the descriptions do not have a significant and demonstrable relationship to the scenario.
COMPETENT
Descriptions of 3 potential ethical dilemmas—1 related to autonomy, 1 related to beneficence, and 1 related to non-maleficence—are provided. The descriptions are accurate and directly relate to the scenario.
A1A:LEGAL IMPLICATIONS
NOT EVIDENT
An analysis of the legal implications associated with each of the potential ethical dilemmas discussed in part A1 is not provided.
APPROACHING COMPETENCE
An analysis of the legal implications for each of the potential ethical dilemmas in part A1 is provided, but the analyses are partly or completely incorrect.
COMPETENT
An analysis of the legal implications for each of the potential dilemmas in part A1 is provided, and the analyses are correct and consistent throughout the response.
A2:COURSES OF ACTION
NOT EVIDENT
Discussions of each of the three given courses of action are not provided.
APPROACHING COMPETENCE
Discussions of each of the three given courses of action are provided, but the discussions are not accurate or do not directly relate to the scenario.
COMPETENT
Discussions of each of the three given courses of action are provided. The descriptions are accurate and directly relate to the scenario.
A2A:JUSTIFICATION OF COURSE OF ACTION
NOT EVIDENT
A justification of which of the courses of action is correct is not provided.
APPROACHING COMPETENCE
The correct course of action is chosen, but the justification for that course of action is not logical, not appropriate for the position of a healthcare administrator, or not relevant to the scenario.
COMPETENT
The justification for the correct course of action is logical, appropriate for the position of a healthcare administrator, and relevant to the scenario.
A2B:EXPLANATION OF WRONG COURSE OF ACTION
NOT EVIDENT
An explanation of how possible consequences show that the course of action chosen is not correct is not provided.
APPROACHING COMPETENCE
An explanation of how possible consequences show that the course of action chosen is not correct is provided, but the explanation is not logical, not appropriate for a healthcare administrator, or not relevant to the scenario.
COMPETENT
An explanation of how possible consequences show that the course of action chosen is not correct is provided, and the explanation is logical, appropriate for a healthcare administrator, and relevant to the scenario.
A3A:RESOURCE
NOT EVIDENT
Descriptions of 2 resources that could be used to make Jamilah’s wishes more clear are not provided.
APPROACHING COMPETENCE
Descriptions of 2 resources that could be used to make Jamilah’s wishes more clear are provided, but the descriptions of 1 or both of the resources is not accurate.
COMPETENT
Descriptions of 2 resources that could be used to make Jamilah’s wishes more clear are accurately provided.
A3AI:RESOURCE EXPLANATION
NOT EVIDENT
An explanation of why the resources in part A3a would be helpful is not provided.
APPROACHING COMPETENCE
An explanation of why the resources described in part A3a would make Jamilah’s wishes more clear is provided, but the explanation of 1 or more of the resources is not logical.
COMPETENT
The explanation of why each resource described in part A3a would make Jamilah’s wishes more clear is logical.
A4:POLICY RECOMMENDATIONS
NOT EVIDENT
The 3 policy recommendations are not created.
APPROACHING COMPETENCE
The 3 policy recommendations are created, but 1 or more of those recommendations would not be helpful to employees and staff in similar situations in the future.
COMPETENT
The 3 policy recommendations that could help employees and medical staff handle similar situations in the future are created.
A4A:POLICY RECOMMENDATION JUSTIFICATION
NOT EVIDENT
Justifications for 1 or more of the policy recommendations are not provided.
APPROACHING COMPETENCE
A justification is provided for each of the policy recommendations, but 1 or more of the justifications are inaccurate or not relevant.
COMPETENT
The justifications provided for each of the policy recommendations are accurate and relevant.
B:APA SOURCES
NOT EVIDENT
The submission does not include in-text citations and references according to APA style for content that is quoted, paraphrased, or summarized.
APPROACHING COMPETENCE
The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized but does not demonstrate a consistent application of APA style.
COMPETENT
The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized and demonstrates a consistent application of APA style.
C:PROFESSIONAL COMMUNICATION
NOT EVIDENT
Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic.
APPROACHING COMPETENCE
Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.
COMPETENT
Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.