QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM Course of Action One – Follow Bashir's Wishes
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Clinical ethics
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Clinical Ethics
QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM
Course of Action One – Follow Bashir's Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
• What is the patient's medical problem? Is the problem acute? Chronic? Critical? Reversible? Emergent? Termin...
questions derived from the university of washingto
western governors university
principles of beneficence and non maleficence
what is the patients medical problem is the pr
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ASSESSMENT
DEPARTMENT
QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON PARADIGM
Course of Action One – Follow Bashir's Wishes
MEDICAL INDICATIONS
The Principles of Beneficence and Non-maleficence
What is the patient's medical problem? Is the problem acute? Chronic? Critical?
Reversible? Emergent? Terminal?
Jamila has a severe chronic obstructive pulmonary disease and onset adult diabetes
mellitus. Jamila was admitted because of a heart attack.
Using this course of action, describe, in full sentences, necessary considerations via
1. Beneficence- They should respect Jamila's culture and follow Bashir's choice to give
DNR with only comfort care.
2. Non-maleficence- Prevention of harm to Jamila, in this case, means the physician
must withhold treatment since it would be against Bashir's wishes.
3. Autonomy- Jamila is a 90-year old living in an extended care facility, leaving the
facility no choice but to assume that she cannot be autonomous.
In what circumstances are medical treatments not indicated?
Bashir requested DNR, meaning no medical treatment will be provided.
What are the probabilities of success of various treatment options?
Due to Jamila's age and multiple comorbidities, no treatment is given since Bashir opted
for DNR with only comfort care.
In sum, how can this patient be benefited by medical and nursing care, and how can harm
be avoided?
Harm to Jamila can be evaded by using Bashir's decision to handle her with no
intervention, being kind and compassionate while offering only comfort care.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
Has the patient been informed of benefits and risks, understood this information, and
given consent?
Due to communication barriers, Jamila is not informed of her benefits or risks, does not
understand the info, or gives approval.
Is the patient mentally capable and legally competent, and is there evidence of
incapacity?
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, ASSESSMENT
DEPARTMENT
The patient is able and capable, there is no evidence of incapability, but she does not
speak English.
If mentally capable, what preferences about treatment is the patient stating?
Jamila states her desire to live.
If incapacitated, has the patient expressed prior preferences?
Jamila has no prior directions or preferences.
Who is the appropriate surrogate to make decisions for the incapacitated patient?
Here, they consider Bashir as the appropriate surrogate.
Is the patient unwilling or unable to cooperate with medical treatment? If so, why?
Jamila desires to live, but it is against Bashir's decision to put her on DNR.
QUALITY OF LIFE
The Principles of Beneficence, Non-maleficence, and Respect for Autonomy
What are the prospects, with or without treatment, for a return to normal life, and what
physical, mental, and social deficits might the patient experience even if treatment
succeeds? If Jamila receives cure, she will likely get back to her usual life. However, it
would be against her family's wishes to put her on DNR.
On what grounds can anyone judge that some quality of life would be undesirable for a
patient who cannot make or express such a judgment? Bashir's assessment of Jamila's life
quality indicates DNR is necessary.
Are there biases that might prejudice the provider's evaluation of the patient's quality of
life? Jamila's age and multiple diagnoses might possibly influence an individual's
assessment of her life quality.
What ethical issues arise concerning improving or enhancing a patient's quality of life? It
is against Bashir's (proxy) choice to treat her and enhance her life quality.
Do quality-of-life assessments raise any questions regarding changes in treatment plans,
such as forgoing life-sustaining treatment? Yes, a person’s treatment plan may be
changed if it is discovered that their life quality is threatened by the treatment or changed
by the prognosis.
What are plans and rationale to forgo life-sustaining treatment? Bashir wished for DNR
removing the need for life-sustaining cure.
What is the legal and ethical status of suicide? It varies in different countries with
weighty ethical issues.
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