A1. Scenario- Potential Ethical Dilemma Jamilah Shah is a 90- year old woman who was brought to the hospital from an extended care facility after collapsing at her bed side. An EKG and lab test have later revealed that she had suffered a heart attack. She is originally from Turkey, knows very little English, and suffers from multiple health conditions. She is a widow, has three sons’, and no advance directives on file. She had listed her youngest son, Bashir, for emergency contact at her extended care facility. While the emergency department physicians attempted to locate her next of kin, she had been given anticoagulant. Jamailah found herself almost in a helpless situation. As a healthcare administrator, you could be confronted with three ethical dilemmas as it relates to Jamailah in this case, thus: Autonomy: This means the right or condition of self-rule. This implies that we are obligated to respect the decisions made by capable and persons of age about their own lives. As an ethical principle and an extension of the principle of human dignity, It gives us a negative duty not to interfere with the decisions of competent adults, and a positive duty to empower others for whom we’re responsible. In the case of Jamailah, although she had no advance directives on file regarding her care, also no record of her waiving her right of selfdecision making regarding her own health. The social worker stated that Jamailah reached for her hand and said, “Please help me. I want to live, when she was attending to her alone. This shows that Jamailah ultimate wish was to live. Beneficence: refers to actions that are done for the benefit of others. Beneficent actions can help prevent or remove harm or to simply improve the situation of others. In other words, beneficent actions include rescuing a person from harm or danger or helping a person to improve his situation. The principle of beneficence mandates us to bring about good in all our actions. To always take positive steps to prevent harm. Although very often, adopting the principle of beneficence usually places us in conflict with respecting other people’s autonomy. But this is not the case with Jamailah. She consented for care and expressed her wish to live at all cost, yet the hospital was unethical by denying her care or disregarding her right of self-decision and adhering to the Do not resuscitate (DNR) order by her son. Non-maleficence: A Latin word that translates to “first, do no harm”. Thus, nonmaleficence basically means do no harm. Examples of nonmaleficence include not saying hurtful things to another person and not giving harmful drugs. In the practice of medicine, examples of nonmaleficence include stopping a medication that is shown to be harmful or refusing to provide a treatment that has not been shown to be effective. The principle of non-maleficence mandates us to:  Where harm cannot be avoided, we are obligated to minimize the harm we do.  Don't increase the risk of harm to others.  It is wrong to waste resources that could be used for good. In the present context, the hospital violated the principle of non-maleficence. They knew how harmful it could be to deny Jamailah care but went ahead and denied her care anyways. Legal Implications. Autonomy Autonomy is the basis for informed consent and means that the patient has the capacity to act voluntarily and with an understanding of the consequences of his or her action. A competent individual has the constitutional right to refuse or accept medical treatment regardless of his or her medical condition. Jamailah exclusively expressed her will to live to the social worker and this will should supersede any other order or medical choices. Since Jamilah has no advance directives on file, it would be illegal, unethical and unlawful to enter the DNR order as requested by her son against her wish. Beneficence This ethical principle mandates that the care given to patients should be care that will benefit the patient. Although Bashir is listed as Jamailah next of kin, it could be argued that he is not a designated surrogate to enter a living will for her mother since she did not expressly delegate such authority to him in writing. Jamailah made a verbal wish to live at all cost. The hospital has to evaluate her treatment options to see if there’s a chance of recovery from her illness and if resuscitation would be beneficial to her.