QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON
PARADIGM
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? The patient has been admitted for a heart attack.
The patient also has severe chronic obstructive pulmonary disease and adult onset
diabetes mellitus, which is also chronic.
Using this course of action, describe, in full sentences, necessary considerations via
1 Beneficence For the healthcare team to be beneficent in this scenario, they must
respect the patient’s culture and follow through with Bashir’s decision to only
provide comfort care for his mother.
2 Non-maleficence To not cause harm to this patient, the healthcare team must
withhold the treatments they had planned because it would go against Bashir’s
decision to cease medical interventions.
3 Autonomy In this scenario, because of the patient’s age and residency in an extended
care facility, the healthcare team can only assume she cannot make her own
decisions. Therefore, the patient cannot be autonomous.
In what circumstances are medical treatments not indicated? Because Bashir has
requested a Do Not Resuscitate order, the healthcare staff will not provide treatment
to the patient.
What are the probabilities of success of various treatment options? The physician
consulted that because of the patient’s age and comorbidities, she will be
managed medically with no intervention and not be considered for treatments.
In sum, how can this patient be benefited by medical and nursing care, and how can harm
be avoided? Harm can be avoided for this patient if the healthcare team manages her
medically with no intervention the kindest and most compassionate that they can be.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
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, QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON
PARADIGM
Has the patient been informed of benefits and risks, understood this information, and
given consent? No the patient has not been informed of benefits, risks, information, or
given consent because she does not speak English, so they have contacted her family to
help translate.
Is the patient mentally capable and legally competent, and is there evidence of
incapacity? The patient is capable and competent, but she does not speak English, so the
staff has contacted her next of kin to translate.
If mentally capable, what preferences about treatment is the patient stating? The patient
states that she wishes to live, but that conflicts with what is to be carried out for her.
If incapacitated, has the patient expressed prior preferences? The patient does not have
any advance directives, so she has no prior preferences.
Who is the appropriate surrogate to make decisions for the incapacitated patient? The
patient’s son Bashir has informed the staff that he is the surrogate decision maker for
his mother.
Is the patient unwilling or unable to cooperate with medical treatment? If so, why? The
patient has expressed that she wishes to live, which would go against the surrogate’s
decision for the patient in this scenario.
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 the patient receives treatment she may return to a normal life at the extended
care facility, but at the age of 90 it may not be for very long. If the treatments are
undergone and succeed, Jamilah’s family who requested there be no intervention, may
not be happy.
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? With Bashir subjectively
assessing his mother’s life quality, he believes that her comorbidities and prognosis
make a DNR order necessary.
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of
life? The patient’s age and comorbidities may influence the physician’s evaluation of
the patient’s quality of life.
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PARADIGM
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? The patient has been admitted for a heart attack.
The patient also has severe chronic obstructive pulmonary disease and adult onset
diabetes mellitus, which is also chronic.
Using this course of action, describe, in full sentences, necessary considerations via
1 Beneficence For the healthcare team to be beneficent in this scenario, they must
respect the patient’s culture and follow through with Bashir’s decision to only
provide comfort care for his mother.
2 Non-maleficence To not cause harm to this patient, the healthcare team must
withhold the treatments they had planned because it would go against Bashir’s
decision to cease medical interventions.
3 Autonomy In this scenario, because of the patient’s age and residency in an extended
care facility, the healthcare team can only assume she cannot make her own
decisions. Therefore, the patient cannot be autonomous.
In what circumstances are medical treatments not indicated? Because Bashir has
requested a Do Not Resuscitate order, the healthcare staff will not provide treatment
to the patient.
What are the probabilities of success of various treatment options? The physician
consulted that because of the patient’s age and comorbidities, she will be
managed medically with no intervention and not be considered for treatments.
In sum, how can this patient be benefited by medical and nursing care, and how can harm
be avoided? Harm can be avoided for this patient if the healthcare team manages her
medically with no intervention the kindest and most compassionate that they can be.
PATIENT PREFERENCES
The Principle of Respect for Autonomy
V 1.0
02201
6
, QUESTIONS DERIVED FROM THE UNIVERSITY OF WASHINGTON
PARADIGM
Has the patient been informed of benefits and risks, understood this information, and
given consent? No the patient has not been informed of benefits, risks, information, or
given consent because she does not speak English, so they have contacted her family to
help translate.
Is the patient mentally capable and legally competent, and is there evidence of
incapacity? The patient is capable and competent, but she does not speak English, so the
staff has contacted her next of kin to translate.
If mentally capable, what preferences about treatment is the patient stating? The patient
states that she wishes to live, but that conflicts with what is to be carried out for her.
If incapacitated, has the patient expressed prior preferences? The patient does not have
any advance directives, so she has no prior preferences.
Who is the appropriate surrogate to make decisions for the incapacitated patient? The
patient’s son Bashir has informed the staff that he is the surrogate decision maker for
his mother.
Is the patient unwilling or unable to cooperate with medical treatment? If so, why? The
patient has expressed that she wishes to live, which would go against the surrogate’s
decision for the patient in this scenario.
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 the patient receives treatment she may return to a normal life at the extended
care facility, but at the age of 90 it may not be for very long. If the treatments are
undergone and succeed, Jamilah’s family who requested there be no intervention, may
not be happy.
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? With Bashir subjectively
assessing his mother’s life quality, he believes that her comorbidities and prognosis
make a DNR order necessary.
Are there biases that might prejudice the provider’s evaluation of the patient’s quality of
life? The patient’s age and comorbidities may influence the physician’s evaluation of
the patient’s quality of life.
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02201
6
