Write a 4-6 page executive report that analyzes ethical dilemmas presented in a case study, identifies the ethical principles that guide decision making and describes the external and internal factors that must be considered in ethical dilemmas. Explain evidence-based strategies to resolve ethical dilemmas and how personal moral integrity influences decision-making.
INTRODUCTION
The health care system in the United States is in the process of being transformed from a patriarchal health care system to the currently emerging patient-centered care model. The patient cultural revolution, boosted by technological advances and increased access to health-related information, presents tremendous change and managerial challenges throughout the entire health care system. These changes affect direct patient care facilities as well as the organizations and administrative departments related to, and supporting, their efforts. The patient-centered care model has increased the need for a solid leadership understanding of the patient experience and an enhanced ability to measure, interpret, and report it accurately. Ethical challenges related to patient-centered care present additional considerations to the existing managerial task of balancing quality care and fiscal responsibility.
PREPARATION
Suppose you are the new health care administrator at Brookside Hospital. Brookside Hospital is in the process of strategically aligning with patient-centered care principles, which are founded on ethics and represent a major transformation away from the patriarchal health care system of the past. End-of-life care and death with dignity are two important aspects of patient-centered care.
Read the patient-centered care Case Study Scenario [PDF]
. Within the case study provided are three distinct ethical dilemmas:

An internal or organizational dilemma.
A formal process dilemma.
A discharge and end-of-life planning dilemma.

You must now prepare an executive report for the hospital’s board of directors to explain the situation and how you handled it. 

INSTRUCTIONS
In your executive report and for each of the ethical dilemmas, be sure you include the following:

Analyze the ethical dilemmas presented in the case study.

Describe each of the ethical dilemmas.
Explain the factors that contributed to each dilemma.

Identify the ethical principle that you used for each ethical dilemma to help guide your decision making.
Describe the external forces and internal organizational factors you considered for each dilemma.

Describe any legal or regulatory forces.
Describe any organizational policies and/or processes.

Explain the evidence-based strategy you used to resolve each ethical dilemma. (Hint: another way to think of this is to imagine that you did take action on each of the dilemmas. With that in mind, what strategy would you use and what supporting evidence do you have that the strategy is sound and effective?)
Explain how an awareness of your own personal integrity helped you decide on a strategy.
BUS-FPX4121 Case Study
Case Study Scenario
You are the health care administrator at Brookside Hospital, a privately owned, 250-bed facility
located in a rural town in West Virginia. You receive an emergency call from the hospital director
of security at 7:00 a.m. on a Thursday morning, just as you are preparing to leave your home for
your 20-minute commute. Apparently, there has been a disturbance in the ICU waiting room
involving family members of a new patient admitted through emergency services during the
night. Security is attempting to de-escalate the situation and 911 has been called with law
enforcement on the way.
When you arrive, you are met in your office by the director of nursing services and director of
security for debriefing on the situation. The family members have been somewhat calmed and
are located in the ICU family waiting area and the cafeteria of the hospital with security officers
present. The daughter of the patient has demanded to meet with you immediately.
Back Story
Joseph and Barbara Nichols have been married for 56 years. They have two children and five
grandchildren. Both are in their late 80s and currently reside in a small home they purchased 30
years ago. Their home is located in the same suburban Pennsylvania neighborhood as their
daughter, Mary, and her family. Mrs. Nichols suffers from advancing dementia and is easily
upset and confused, but she is otherwise in good health. Mr. Nichols has suffered two heart
attacks, yet is still able to care for himself and his wife with help from his daughter and a
housecleaning and lawn service. Neither drives. Both are very independent individuals and have
made it clear to their children that they wish to live out their lives and die peacefully in their own
home.
This has been an issue between Mary and her brother, John, who resides in West Virginia.
Mary defends her parents’ independent living choice and plans to help with securing increased
home care as needed. Her brother repeatedly argues that it is in everyone’s best interest,
especially with his mother’s dementia and father’s medical history, that the house be sold and
his parents placed in a senior care living facility. At their parents’ request, Mary is designated as
health care agent if needed, and they both have living wills. Both Mary and John are aware of
their parents’ advance directive wishes. The couple relies on Medicare coverage for their
medical needs and do not have long-term care insurance. Their source of income is adequate
and includes social security and Mr. Nichols’ modest retirement pension. Neither are veterans.
Three days ago, Mary and her family left for an annual vacation to New York. They dropped off
Mr. and Mrs. Nichols at her brother’s home to visit with his family for the week. As always, Mary
left contact and medical information in a file with her brother.
On the evening prior to the early morning call, John and his wife had gone out, leaving their 14year-old daughter at home alone with her grandparents. At 10 p.m., after retiring for the night,
she was awakened by her grandmother crying out in the hallway, frantically searching for her
husband. She was also highly agitated and confusedabout where she was. Together, they
found Mr. Nichols unconscious on the bathroom floor. The granddaughter called 911 but was
unable to reach her parents directly. The emergency personnel arrived to chaos, with both
women hysterical. Mr. Nichols was treated by paramedics and rushed to the Brookside
emergency department, where it was determined that he had suffered another heart attack and
was placed in the intensive care unit. Mrs. Nichols and her granddaughter were escorted to the
hospital by the local police.
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BUS-FPX4121
When John and his wife finally checked their phones, they rushed to the hospital to find Mr.
Nichols unresponsive and on extensive life support. Mrs. Nichols and her granddaughter had
been unable to communicate medical history. Neither remembered or mentioned the daughter
Mary during all of the disturbance and emotional confusion. Mr. Nichols’ advance directives
included a do-not-resuscitate (DNR) order, a do-not-intubate (DNI) order, and his stated
preference for no life-sustaining equipment or devices.
After John called to give her the news, Mary and her family immediately drove straight through
the night to the hospital. Upon their arrival, everyone in the family was stressed, afraid, hungry,
and overtired. When Mary spoke to the charge nurse, she was short and curt, informing her that
she would have to wait until after the shift change to get complete information and speak with an
attending physician. Mary then discovered her father on life support and was unable to control
her fear and frustration, lashing out in anger toward her brother.
Just as the nursing change of shift meeting began, a loud, verbal argument between Mary and
John erupted in the ICU waiting area. The charge nurse briefly attempted to calm the families
but called in Security, as the argument appeared to be escalating toward physical violence
between Mary’s husband and her brother John.
Security has calmed the family and Mary is impatiently waiting to speak to you, the Brookside
administrator, as she cannot understand how her father’s wishes were not respected and
blames the facility for not taking more extensive efforts to research her father’s medical history
and paperwork further. She also plans to lodge a formal complaint against the charge nurse for
what she considers rude and unethical behavior toward her.
Post Script
Two weeks later Mr. Nichols has gained consciousness and is on minimal life support at
Brookside Hospital. However, without the life support, he is expected to live no more than a
week or so. He is requesting to return to his home in Pennsylvania. His children and wife are
divided and conflicted the over next steps to be taken. His daughter Mary is distraught. She
feels that if her father is not taken home, he will not experience the death with dignity he wishes
and deserves. She has taken a leave of absence from her job and is staying at her brother’s
home with her mother to enable them to be at Brookside each day. This is straining her family’s
finances and emotional well-being. She is also shouldering a burden of guilt for being on
vacation when crucial decisions were made that compounded the situation. Her brother, John, is
very frustrated and angry, as he feels that it is more appropriate to move his father to a hospice
facility. He is increasingly vocal and adamant about selling the house and securing an
appropriate placement for his mother. With all the stress and disruption, Mrs. Nichols’ level of
confusion and anxiety has increased significantly and she is unable to fully understand and
contribute to discussions and decisions.
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