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
TASK OVERVIEW SUBMISSIONS EVALUATION REPORT
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.