Essay Sample on Borderline Competency: Deciding About Major Heart Surgery

I think Brian should tell Dr. Sander about the information he overheard from Esther concerning the patients' fate. This information can help Dr. Sander to carry out the surgery, thus saving the patients' life. Since Esther is the wife to the patient, she can become a surrogate as she wishes well for her husband. The principle of beneficence makes one become a surrogate decision-maker whenever a patient cannot make their own decisions. Proxies tend to act in a way that will ensure other benefits from their actions (Kelleher, 2014). The surrogate, in this case, makes proper decisions basing on what the patient could have decided for their treatment. It becomes challenging whenever a proxy acts selfishly, thus doing what he believes is best for their patient. Decision-making among surrogates has also guided the principles of promoting and respecting the patients' autonomy. Medical practitioners are warned against making their care for the welfare of patients end up becoming a paternalistic exercise ruling them. Also, substituted judgment can be reserved in making decisions for patients who experience the inability to communicate. Therefore, whenever a surrogate decides for the patient, it is said they are doing what the patient would have decided.

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Decision-making from a surrogate gets a leading role whenever there is no medical care power from the attorney document. Also, the surrogates' decision is considered if there is no court-appointed individual who has the authority to make medical care decisions. In cases involving adults, proxies are the next of kin since the state statutes give them the priority. The patients' spouse is considered first when the surrogate is being determined. For example, in Mr. Maxwells' case, Esther, who is his spouse, is the surrogate decision-maker. In a situation where there are many people with a similar position of becoming a surrogate, a consensus is conducted. Also, when patients who do not have a family or close friend, medical practitioners depend on lawyers and ethics boards to determine a surrogate (Kelleher, 2014). Therefore, proxies have the obligation of following the wishes made by the adult patient and account for their values.

Case Scenario 2

Somali Culture

It is okay for Julie not to ask about the burn marks on Hassan's body since it shows respect to the Somali culture. The National Institutes of Health states that cultural respect is essential in mitigating the medical care disparities, leading to an improvement in accessing the quality of preventive care for various patients. Healthcare practitioners should be aware of the cultural values and norms, thus helping them in disseminating quality medical services without discrimination (Arkansas State University, 2016). Failure of medical practitioners becoming culturally competent might cause dissatisfaction among patients. Healthcare providers might encounter barriers in the attainment of cultural competence if they do not understand the patients' cultural beliefs and cultures.

Additionally, in nursing, cultural competence allows the nurses to develop a better rapport with the patients. This action helps the patients to share their feelings about the sickness, thus causing nurses to determine the proper treatment for them. Culturally competent care might not be provided to every patient unless the medical nurses understand the diverse cultural history of people (Arkansas State University, 2016). Therefore, the medical programs in most states assist in teaching self-assessment through knowledge, awareness, and acceptance of the duties played by cultural issues in medical care systems.

Case Scenario 3

Narcotics Overdose

The emergency physicians conducted a crime by not providing any documentation of a re-examination by the new physician after changing shifts. The patient could have been observed for a while since individuals who abuse heroin tend to use it as they miss the "feel-good feeling." Individuals who use heroin tend to be addictive after using heroin since their brains cannot produce dopamine naturally, thus developing the urge for more heroin to release the chemical (Herndon, 2018). The symptoms portrayed by the patient showed that he was highly dependent on the substance.

Consequently, emergency physicians could have looked at the behavior of the patient to determine the actions and interventions to take. For example, individuals who abuse heroin can have memory loss, nose sores, and depression. In this case, the patient showed memory loss and acted depressed, which was significant evidence, he was using narcotics. Also, the needle marks on the patient's body acted as a proof they were injecting heroin into their system. The medical practitioners could have prevented the death of this patient by using either behavioral or medication treatments. If a person who is physically addicted narcotics stops using the substance, it can cause diarrhea pain and nausea. The medical practitioners could have used detox as the first step while the patient was still hospitalized for close medical supervision (Herndon, 2018). The behavioral treatment could have been used as individual therapy, contingency management, or as a group therapy. The behavioral treatment could have assisted the patient in developing coping skills if they encounter craving and establish appropriate strategies for dealing with relapse.

References

Arkansas State University, (2016). Importance of Cultural Competence. Retrieved from https://degree.astate.edu/articles/nursing/importance-of-cultural-competence.aspx

Herndon, J. (2018). Heroin Addiction: What You Should Know. Retrieved from https://www.healthline.com/health/heroin-addiction

Kelleher, J. P. (2014). Beneficence, justice, and health care. Kennedy Institute of Ethics Journal, 24(1), 27-49. Retrieved from https://www.researchgate.net/publication/262022268_Beneficence_Justice_and_Health_Care