Jamilah Shah's Autonomy: An Ethical Dilemma for Health Admin - Essay Sample

Introduction

In the scenario, an ethical dilemma involving autonomy involves the possible disregarding of Jamilah Shah's decisions. The dilemma involves whether her choices about her health should be considered in making decisions regarding her prospective future even though he has issues with communicating her ideas. An ethical dilemma relating to beneficence is whether considering Jamilah's wishes would be ensuring her own best interests as a patient or not. In this case, as the health administrator, taking into account Jamilah's requests and ensuring they are the best decisions for her that moment would be pragmatic. An ethical dilemma that relates to non-maleficence is whether going with Jamilah's or her son's decisions would be the best option for the patient and her future in handling her heart condition. As a health administrator, decisions relating to the patient must be efficient and free of any error that could be fatal to the patient either currently or in the future.

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Legal Implications

Health policy and the law requires that patient ideas and their health should always be considered while making decisions in a health setting (Duncan, 2009). Patients have a right to their own choice of treatment. Every patient, therefore, has a right to autonomy and self-determination when he or she is in a position to make such decisions. Health administrators are required by law to ensure that they act in mercy, kindness, and directive to do good for the patients based on their perceptions of different medical scenarios. As a health administrator, it is required by law that any decisions that are made in a medical setting will not do any harm to the patient. The health administrator should, therefore, ensure that either of the possible decisions from all parties is well thought out and would lead to no harm to Jamilah in the future.

Questions From the University Of Washington Paradigm Following Bashir's Wishes

Following Bashir's order will limit patient preferences that are a violation of patient's rights. This decision is a violation since Jamilah had previously informed the social worker that her choice was to live. Therefore, such as decision violates the principle of autonomy since this decision does not put Jamilah's interests first. Furthermore, there is no indication of the influence of religious or cultural factors in this decision; however, information from the social worker indicates that her sons have been unsupportive in the past. All parties are well informed on the implications on Jamilah's life, but Bashir has decided she failed to put his mother's interests into consideration.

Refusing to Follow Bashir's Wishes

Such a decision will need careful consideration of the reasons as to why Bashir's wishes do not hold the best outcomes for Jamilah. As a health administrator, after making this decision, it is required that the best medical intervention is decided to ensure that the patient's medical condition is stabilized and within her own needs and would advance the quality of life. Since Jamilah, previously informed the social worker that her choice was to live together with the fact that her family was unsupportive, denial of a DNR is definitely against Jamilah's choices and therefore invalid according to medical ethics regarding autonomy. Furthermore, due to the communication problems, it is crucial that Jamilah's thought on the medical intervention considered.

Briefly Delay the Decision to Gather Additional Information and Other Perspectives

A history of an unsupportive family is an indication of a lack of coherence in the decision that Bashir and Jamilah would make regarding the issue at hand. This indicates the possibility of religious and cultural influence in the clinical decisions made by Bashir. Gathering additional information will involve an analysis of Jamilah's past health decisions and how each health outcome played out regarding the decision makers. Getting perspectives on how the issue should be handled will involve making inquiries from other health administrators and how they would handle the issue at hand. Such perspectives will build competency in the kind of decision that would make and why it would be the best for the patient since she has communication issues.

Resources

One of the resources that could have made Jamilah's wishes clearer is a living will. A will is a legally written document that clarifies a person's wishes when he or she in a situation where they cannot communicate or function to what is required. For Jamilah's case, she is incapable of expressing her choices for medical intervention. Furthermore, in the will, Jamilah can state that a translator that she trusts could be used to help make decisions in such cases primarily when her family may be found to be unsupportive of the decisions to be made. Another resource that would be useful in this case is a Healthcare Power of Attorney. This document stipulates the choice of an individual that would make any healthcare decisions in cases where a patient is incapable of making such choices. This file would mean that Jamilah would be able to select her healthcare decision maker that makes decisions that are right and in line with her needs.

Resource Explanation

If Jamilah had written and presented a living will before such a health situation, she would have her own decisions about her health well stipulated for healthcare administrators to take in several cases (Eneanya, 2018). Jamilah could, therefore, have a voice in the healthcare decision-making the process even though she was incapable of making her perceptions known at the time. Making it clear that she decides to live to propagate her thoughts on why she would want to live and why her son's wishes went against her wishes. Any arguments would, therefore, be prevented and add control to the situation since her premeditated thoughts would be considered.

A Healthcare Power of Attorney would prove that the Bashir was the chosen decision maker and that the decision to only provide comfort care was one that Jamilah would have wanted (Paola, 2010). This document would verify Bashir's wishes in the case and confirm Bashir's position in making medical decisions for Jamilah. Moreover, this document would be proof that Bashir and Jamilah had the same intentions for Jamilah's health hence alleviate any kind of doubts on why comfort care was the best healthcare intervention for the case.

Justification of Course of Action

The best action is to delay the decision and gather information and other perspectives since no written document is available to confirm Bashir's wishes as to the best for Jamilah at that moment. Gathering information would ensure that each of the interests in the parties involved in the case is considered. Due to the communication problem that Jamilah encounters, the best way to deal with the situation is to collect as much information from the social worker and the individuals around her in the care center to review perspectives and the kind of decision that Jamilah would have made. This will make an ethical decision that would ensure the best decision is made.

Explanation of the Wrong Course of Action

The denial of a DNR and resorting to comfort care as the only medical intervention applicable is fatal and could lead to death. From the information presented by the social worker, it is clear that Jamilah wanted to live. This invalidates Bashir's wishes since such wishes could be fatal to what Jamilah would have wanted for herself. It is unethical to go on with such a decision considering no legal document was provided to prove Bashir as the decision maker and therefore there is a possibility of a lack of coherence in the decisions that could be made from the reports of an unsupportive family.

Policy Recommendations

A recommended policy for this case is compulsory patient awareness on advance directives. Another recommended policy is a mandatory assessment of patient's health regarding the competency of the decisions made by family members or stated decision makers. A policy to ensure the best medical intervention for the patient based on health administrators perspectives in cases where no legal documentation is provided to prove the stated healthcare decision-makers role in a patient's life.

Policy Recommendations Justification

An obligatory patient edification on advance directives reduces the chances of a patient falling in Jamilah's cases. Any visits to health care facilities should be coupled with a review of an advance directive on the kind of decisions that a patient would want in various types of situations. Such a policy is critical with a patient that has past cases of certain conditions such as heart disease. On the other hand, a review of competency in the decision made based on the patient's health ensures patient's rights are kept at the center of any decision making process. This policy also ensures that a patient's wellbeing in the healthcare center is protected and not affected by cultural or religious constraints influenced by family members. Making decisions based on a health administrator's choice of medical intervention will ensure that patients are kept healthy as further investigation is done on the relationship that the decision maker has with the patient.

References

Duncan, P. (2009). Values, Ethics and Health Care. Thousand Oaks, CA: SAGE.

Eneanya, A. (2018). Human Rights, Public Values, and Leadership in Healthcare Policy. Hershey, PA: IGI Global.

Paola, F. A., Walker, R., & Nixon, L. L. (2010). Medical Ethics and Humanities. Burlington, MA: Jones & Bartlett Learning.