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Jan 9, 2024

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Crystal Pearce Student ID: 011335180 Healthcare Values and Ethics – C426 8/29/23

A1: The first potential ethical dilemma that is presented in the scenario, which is related to Autonomy, appears to be where Bashir acting to ignore his mother’s (Jamilah – the patient) wishes – demonstrating paternalism; this is where Bashir is acting on his mother’s behalf. Bashir stated upon his arrival, that he would be the decision-maker in his mother’s care and would like his mother to have a Do Not Resuscitate (DNR) in place, and no other interventions performed other than comfort-care. Jamilah stated to the social worker during their visit together, “Please help me, I want to live.” The social worker was concerned with the dynamic between Jamilah and her sons, during their interactions at the hospital. It appears he is acting as if he thinks that applying the DNR is in his mother’s best interest; this could be due to the fact that she has multiple comorbidities or her age (90). Since Jamilah is only trained in basic English, and her sons are proficient in the language, there could be a language barrier involved as well. The family appears to be retaining their Turkish culture and norms, whereas the sons would act as patriarchs for the family, making many of the family's decisions – including their mother’s health care decisions. Currently, there are no formal legal documents set in place for Jamilah’s healthcare decisions. If Jamilah wishes to move forward with the family’s cultural wishes/norms, then she needs to place this information in an Advance Directive; this way, her wishes are expressed in a legal document that the family could use to support the Turkish cultural wishes/norms, for her sons to make the family decisions. The second potential ethical dilemma that is presented in the scenario, is related to beneficence and appears to be present when the social worker approaches the administrator with the information from her visit with the patient, as well as her concerns with the relationship between the patient and her son(s). The social worker believes she is doing something good,

while she could be unaware of the cultural norms and beliefs of the family. Demonstrating beneficence means you are trying to do good, demonstrate kindness, show compassion, and assist others. Unfortunately, demonstrating beneficence can even be harmful, when you think you are doing good. A legal implication in this situation, involves the family, where they are making the decision for the patient – even though she would be able to effectively make the decision for herself if provided an interpreter. This is a complex situation with the patient, the son(s), the social worker, and the cultural beliefs/norms all involved with this patient’s case. The third potential ethical dilemma that is presented in the scenario, is related to non- maleficence, which appears to be present with the Cardiologist consultant’s recommendations. Non-maleficence, in summary, is to do no harm. The consultant’s recommendations are based on the family's (the son’s) wishes, which in return can harm the patient – in this case, death is the likely end result as stated in the scenario. The cardiologist should not be acting in coordination with the son, just because he is verbalizing HIS wishes for his mother. The cardiologist’s recommendations is exactly what would harm the patient, and it would not take long. A1a: For the three ethical dilemmas I had spoken about, comes with possible legal implications for each. The first possible legal implication, would be related to Autonomy. It appears that Jamilah has the sufficient ability to make her own decisions, which means she could agree to or deny her own treatment, as she appears competent. There is no POA legally set in place, therefore her son is not the legal dictator. Jamilah can make her own legal, healthcare decisions, as long as she is competent. Since Jamilah is not English proficient, the hospital should provide her with an interpreter, so she can communicate her wishes directly to the hospital in her language. The legal implication in this case, would be that the patient does not have any legal

documents in place. The patient has not decided Kashir as her POA and is not wishing for a DNR. The patient does not have an Advance Directive in place. If the healthcare facility moves forward without the legal documents, then the healthcare staff can face legal consequences. This would be considered neglect and can result in criminal actions against the hospital and its staff. This neglect could also put the healthcare facility at risk for a civil lawsuit. The second possible legal implication would be related to non-maleficence. This would be a negative legal implication, which could result in death – and the end result would be losing the patient, as well as criminal charges against the hospital and the Cardiologist. He is knowingly recommending for the patient to not receive any procedures or surgery, which is negligence and will result in the patient’s death. Legally, this is not following the patient’s wishes – as she has verbalized she would like to be saved. Again, there are no legal documents in place for Kashir to be the patients POA. The third possible legal implication would be related to beneficence. This legal implication is actually a positive one – remember, legal implications can be negative OR positive. The social worker is attempting to do good while approaching the hospital administrator. In return, this can help the hospital avoid negative implications. The patient does not have any legal documents in place, indicating that her son is her POA, or that she wants a DNR. The social worker informing the administrator of the patient’s wishes also avoids negative legal implications from the patient versus the hospital, as since there are no legal documents in place – there is no legal reason to listen to the son. If the patient were to die, there could be negative legal implications against the hospital due to the patient passing away. This could result in criminal actions again the hospital and staff. A2:

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