Referencing the scenario, complete the attached “Questions Derived from the University of Washington Paradigm.

Referencing the scenario, complete the attached “Questions Derived from the University of Washington Paradigm.” 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 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.

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