Ethical and Spiritual Care (Due 24 hours)

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Applying the Four Principles: Case Study

Part 1: Chart (60 points)

Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible.

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

The patient’s medical problem is acute glomerulonephritis or kidney failure. The medical condition develops suddenly from infections in the skin or throat. A patient can heal without medical intervention but if the kidneys are affected the patient requires immediate medical attention. The goal of treatment is to prevent the condition from turning chronic and to prevent kidney failure. Chronic glomerulonephritis develops slowly with minor symptoms such as foamy urine, swelling ankles, and blood in the urine. Medical treatment may not be indicated by the clinician if they determine the condition will go away by itself or if the patient chooses another treatment route such as spiritual care. The treatment option for acute glomerulonephritis is medication. The probability of success is high if the disease is detected early and the patient follows through with treatment. The patient will benefit from medical and nursing care by receiving the necessary information about the disease to make a decision.

The medical decisions of the patient in the case study are made by his parents since he is a minor. The parents have been informed of the patient’s condition and are aware of the risks involved in the treatment suggested by the attending physician. The parents understood the information and opted to trust in religion instead of science. The patient is not legally competent to make decisions due to his age. There is evidence the patient is incapacitated because they are incapable of comprehending and taking the required action. Owing to the patient’s incapacitated nature, he did not convey medical preferences (Carr & Winslow, 2017). Parental authority in the case study is authorized by the constitutional right to privacy and the ability of the parent to act in the child’s best interest.

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

gIf the patient is diagnosed with all conditions and treated early, there is a high possibility they will be fully healed and return to normal. However, if the patient is not treated early, there is very little probability their life will return to normal. The patient’s physical state will deteriorate with dialysis treatment and will thereby require a kidney transplant in the future. The quality of the patient’s life may be deemed undesirable because there wasn’t respect for autonomy. The child was too young to dictate if he wanted treatment or religious intervention (Carr & Winslow, 2017). The attending physician may show bias while evaluating the patient’s condition due to the parent’s belief in faith over science and evidence-based research. The attending physician cannot interfere with the parent’s decision to forgo immediate dialysis because they have authority under the law.

Other than clinicians and patients, family members are also involved in clinical decisions. For instance, in the case study, James's parents are the primary decision-makers. James’ parents are not limited by confidentiality because they are his guardians and responsible for making all the decisions until he is capable to make them. Legal factors may influence the clinical decisions since Samuel, who the doctors suggest become a donor for James, is only 8 years old imposing legal ramifications. Religious issues also affect a clinician’s decisions, for example, James's parents prefer to take him to a healer first before seeking medical treatment. This limits the attending physician's influence over the patient’s wellbeing. If the condition is chronic, the hospital may intervene to prevent the parents from seeking faith healing procedures that won’t cure the illness.

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Part 2: Evaluation

Answer each of the following questions about how the four principles and four boxes approach would be applied:

1. Ansthe following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)

Q1: According to the Christian worldview, the prominent principle in the case is beneficence. The principle states that an individual must act for the benefit of another and their best interests (Medindia, 2019). Due to their faith, James's parents chose to pray for him because they had seen other people get healed from faith and prayer. They trusted that trusting in God and turning to a healing service would yield better results than dialysis. The parents chose this option after being informed of the risks and benefits of dialysis by the attending physician. They cannot be blamed for the deterioration of James's health because they chose a treatment option while considering James's best interests.

The principle of non-maleficence also holds weight in this case. Non-maleficence means that no harm should come to a person (Abeo, 2021). The parents did not consider James’ twin brother as a kidney donor because they did not want any harm to come to him. The parents also wanted to avoid dialysis due to the possible risk and harm that would face James. Instead of choosing dialysis, they chose a less painful option and took their son to a healing service. The principle of respect for autonomy weighted because it created a dilemma whereby the parents were unable to choose the best medical intervention for James without his consent. It is important to consider the patient’s decision since it helps them accept treatment risk. Lastly, justice did not weigh in the clinical decisions made because they decided not to risk one son’s health to save the other.

2. Answer the following: According to the Christian worldview, how might a Christian balance each of the four principles in this case? Explain why. (45 points)

Q2: According to the Christian worldview, God is the creator of everything and he has the power to take life away. He has given human beings the authority to use scientific knowledge and cure illness. The four principles would be ranked from autonomy, non-maleficence, beneficence, and justice. Respect for autonomy represents a choice. According to the Bible, God has given human beings freedom and choice (Birch et al., 2018). The attending physician gives the parents free will to choose a medical intervention and releases the child when they reject dialysis. Non-maleficence is a caregiver’s obligation to ensure no harm to the patient. The scripture states that God commands us to love and protect each other. He also commands that we should do unto others what we wish done to us (Langerak, 2021). The parents acted in the best interest of their children by trying to prevent harm from arising. They protected James by rejecting dialysis and turning to faith and trusting God’s master plan and protected Samuel by preventing him from becoming a kidney donor.

The third principle would be beneficence. Caregivers are required to demonstrate kindness and charity to patients. God commands us to love our neighbors and always show kindness in the face of adversity and suffering. Kindness strengthens the patient-caregiver relationship thereby improving the patient’s physical and emotional state. The attending physician was kind to James and his parents and respected their treatment choices. The last principle is justice. Every patient in a healthcare setting should be treated with fairness and dignity. Resources should be distributed fairly and equally and favoritism should be avoided. This principle was not well demonstrated in the case, therefore, ranking last.

References:

Abeo. (2021). 4 Principles of Biomedical Ethics. Retrieved July 21, 2021, from https://www.abeo.com/4-principles-biomedical-ethics/

Birch, B. C., Lapsley, J. E., Moe-Lobeda, C. D., & Rasmussen, L. L. (2018). Bible and Ethics in the Christian Life: A New Conversation (3rd ed.). Minneapolis, Minneapolis: Fortress Press.

Carr, M. F., & Winslow, G. R. (2017). From conceptual to concrete. In World Religions for Healthcare Professionals (pp. 31-45). Routledge

Langerak, E. (2021). What is Christian Ethics? | A Guide to Ethics. Retrieved July 21, 2021, from https://pages.stolaf.edu/ein/christian-ethics/what-is-christian-ethics/

Medindia. (2019). An Introduction to Biomedical Ethics. Retrieved July 21, 2021, from https://www.medindia.net/education/familymedicine/biomedical-ethics.htm