PHI 413 Case Study on Biomedical Ethics in the Christian Narrative GCU
Case Study on Biomedical Ethics in the Christian Narrative GCU
The case study on “healing and autonomy” presents perspectives that physicians and families of a patient, especially when minor, should consider a host of aspects to attain expected outcomes in any health situation. The case shows that while physicians can make effective decisions and choices, principalism take precedent based on beneficence, non-maleficence, autonomy and justice (Gillon, 2018). The purpose of this assignment is to complete a two-part analysis of the case that addresses different aspects of care and the Christian perspective of the case.
Good post. Bioethics is a subfield of ethics that concerns the ethics of medicine and ethical issues in the life sciences raised by the advance of technology. The issues dealt with tend to be complex and controversial (i.e., abortion, stem cell research, euthanasia, etc.). In addition, bieothics usually also involves questions of public policy and social justice. As such, the complexities of bioethical discussion in a pluralistic society are compounded. There have been several different approaches to bioethical questions put forth that have to do with the theory behind ethical decision making (Fathallah et al., 2020). Three positions have been prominent in the discussion principalism (also known as the four principle approach), virtue ethics, and casuistry. For this lecture, it will be useful to outline principalism and to describe the general contours of a Christian approach to bioethical issues
Part 1: Chart (60 points)
| Medical Indications
Beneficence and Nonmaleficence |
Patient Preferences
Autonomy |
| Medical indications show diagnoses, prognoses and proposed measures in evaluation and treatment interventions as well as anticipated results. On its part, beneficence prioritizes the best interest of and intentions for a patient by care providers. Beneficence ensures that one gets the best outcomes. Non-maleficence is ensuring that no harm occurs to a patient based on a medical decision by a providers using the medical indications (Gillon, 2018). The implication is that providers focus should be the attainment of better outcomes to meet the principles of beneficence and non-maleficence.
In this case, James’ parents acted in his best interests as they took him to the hospital before making the decision to have him in their church for miracle healing. When it failed, they brought him back to the doctor for management of the condition. As Christians, they believed that miracle healing will restore his health. The physician’s evaluation indicated a better prognosis after conducting a diagnosis of the boy’s condition. These imply that medical indications are essential when applying the four principles of biomedical ethics in any situation |
Patient preferences entail the choices, decisions, and actions that patients and their families take regarding possible treatment interventions. Preferences are founded on the principle of autonomy where a patient has the right to make decisions based on their conditions and the recommended treatment interventions. Patients with capacity to make decisions use autonomy to choose the kind of treatment interventions that they want. Based on autonomy, healthcare providers must get informed consent to carry out any medical intervention or procedure on a patient. autonomy protects the rights of a patent and improves their understanding of conditions affecting them (Gillon, 2018).
In the case on “healing and autonomy” the patient is a minor and his parents make decisions on his behalf because he lacks the capacity. James needs treatment and all decisions come from his parents who dictate what should happen to him. The parents are also not willing to let his brother, Samuel, donate a kidney to save his life. The physician and his team cannot make any decisions as they have no power to exercise autonomy over James, except his parents. |
| Quality of Life
Beneficence, Nonmaleficence, Autonomy |
Contextual Features
Justice and Fairness |
| The quality of life denotes the medical and health condition of a person before and after attaining treatment (Teven & Gottlieb, 2018). Health providers offer treatment with the aim of improving the quality of life for an individual. However, while their intention is based on the principles of beneficence and non-maleficence, a patient exercises autonomy to determine if they will accept or not the treatment intervention.
James’ condition is worsening and requires urgent intervention to improve his quality of life. Having a dialysis is a temporary solution that will enhance the quality of his life. The physician and his team are categorical that only a kidney transplant will offer a long-term solution to the minor’s condition. The implication is that the parents must make a decision to have his brother be a kidney donor. This demonstrates that they have autonomy and are the main decision makers in this case. |
In their article, Teven et al. (2018) assert that clinical situations exist within certain contexts that impact the overall decision-making process and allocation of resources. These contextual features refer to social, cultural, economic, philosophical, and even political issues that impact clinical interventions, decisions and actions, especially by a physician and patients. These aspects affect patient care and should be factored when applying the principles, especially justice and fairness.
Justice and fairness focus on equitable allocation and use of health resources to enhance quality of life and patient outcomes. James’ parents should make a decision in a just and fair manner to improve his life. The patients should focus on the available options and take measures that will improve the quality of life for James and his sibling, Samuel. They should allow him to have a kidney donated by his brother. |
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Part 2: Evaluation
Answer each of the following questions about how about how the four principles and four boxes would be applied:
- In 200-250 words answer the following: According to the Christian worldview, how would each of the four principles be specified and weighted in this case? Explain why. (45 points)
| Service to people is the core principle in Christianity based on the Golden Rule. Making decisions in any situation implores one to consider the Christian moral code as a guide to each action, even the most complex one (Cherry, 2019). In this case, the principles of beneficence and non-maleficence are at the core of providing better service to others. Christianity advances that serving one another entails benefits to man and God. Having the best interest implores Christians to focus on the benefits that the individual being helped would get to make the world a better place (Iltis, 2020). In this case, James’ parents acted in the best interest of their son based on their faith and took him to a physician before taking him to church and back to the facility. All these endeavors to attain healing demonstrate their best interest and intention for their son.
The principles of autonomy and justice should be specified and weighted based on the decisions by parents focused on the best interest of James. The principle of autonomy gives the parents the right to make decisions on behalf of their son. However, the principle shows that engaging James, even at the least level, would be beneficial to him and his brother so that they can find the most optimal solution. The implication is that the parents must consider James’ situation, their Christian teachings and faith, and the best course of action for better outcome for the boy. |
- In 200-250 words answer the following: According to the Christian worldview, how might a Christian balance each of the four principles? Explain why. (45 points)
| The four principles are essential and form the foundation of ethical behavior among providers in healthcare settings. Based on the Golden Rule, Christianity advances the need to show love to others through serving them in their best interests. A Christian can balance each of the four principles based on Christian teachings and what one is expected to demonstrate in society (Carr & Winslow, 2018). Christians also are co-creators with God and have an obligation to protect lives; even if it means making sacrifices for the benefits of others. In this case, a Christian can balance these principles by considering beneficence and non-maleficence as core to their teachings and what is expected from them. for instance, the actions by James’ parents and the church demonstrate their selflessness and sacrifices that one can make as a Christian for the benefit of others. The church members were willing and ready to donate their kidneys as long as it matched with James’.
Justice and fairness are essential aspects for any Christian believer as the religious norms implore one to show equality and equity. The concept of Imago Dei means that man is created in God’s image and should therefore show love to others. The last principle is autonomy (Cherry, 2019). God created man free and with inherent ability to make decisions on what is good and bad. In this sense, autonomy allows one to determine what to do as a Christian when faced with a situation. Therefore, these principles show that James’ parents should allow their son to donate a matching kidney to save the life of his brother. Through faith, God will ensure that they all live. |
Conclusion
The analysis of the case study shows that the four principles and the four boxes approach are essential in understanding complex medical and health situations that physicians encounter. As such, these events lead to decisions by patients and their families with far-reaching impacts. As demonstrated through the case study, the application of the four principles in Christian perspective offers a different approach to decision making by all stakeholders.
References:
Carr, M. F. & Winslow, G. R. (2018). From Conceptual to concrete. In World Religions for
Healthcare Professional (pp.31-45). Routledge.
Cherry, M. J. (2019). Bioethics without God: The transformation of medicine within a fully
secular culture. Christian Bioethics, 25(1), 1–16. https://doi.org/10.1093/cb/cby015
Gillon, R. (2018). Principlism, virtuism, and the spirit of oneness. In Health Ethics, Law and
Professionalism (pp.45-59). Routledge.
Iltis, A. (2020). Christian bioethics: From foundations to the future. Christian Bioethics, 26(1),
1–11. https://doi.org/10.1093/cb/cbz015
Teven, C. M., & Gottlieb, L. J. (2018). The four-quadrant approach to ethical issues in burn care.
AMA journal of ethics, 20(6), 595-601. doi: 10.1001/journalofethics.2018.20.6.vwpt1-1806
The case study, “Healing and Autonomy” demonstrates the importance of providers understanding different components of care provision to help their patients attain quality care by incorporating the ethical principles of beneficence, non-maleficence, autonomy and justice. The four-box method is a critical model that can help healthcare providers to offer care by making ethical decisions (Teven & Gottlieb, 2018). The method is practical as it allows one to sort out salient issues and focus on what really matters (Beauchamp & Childress, 2019). The purpose of this paper is to deploy the four-box method and the relevant principles of biomedical ethics to the case study about James and the decisions that his parents make concerning his treatment.
Part 1: Chart (60 points)
| Medical Indications
Beneficence and Nonmaleficence |
Patient Preferences
Autonomy |
| Medical indications denote diagnosis and proposed measures to evaluate and treat a condition, the prognosis and expected outcomes. Gathering information on the medical conditions allows providers to offer beneficial care and do no harm to patients in their facilities and who require their interventions based on the principles of beneficence and non-maleficence (Teven & Gottlieb, 2018). In this case, James suffers from kidney failure and reversible acute glomerulonephritis. The physician and his team have recommended dialysis as a short-term measure to help address the issue of kidney failure as the parents had taken him for healing services at their church that worsened his acute glomerulonephritis. The medical indications show that James can only have a good prognosis through a kidney transplant with his brother having a matching kidney. The implication is that medical indications implore physician to make decisions in the best interests of a patient for better outcomes. | Patient’s preferences are important from both a medical and an ethical perspective, especially when they have decision-making abilities (Teven & Gottlieb, 2018). Upholding patient preferences aligns with the ethical principle of autonomy which advances that physicians and other healthcare providers should respect the decisions that patients make concerning the type of treatment to have or to decline any treatment. Imperatively, healthcare providers should not influence such decisions due to undue influence.
In this case, James is a minor and his parents assume the responsibility of exercising autonomy and make decisions on his behalf. The physician does not interfere, even in situations where such decisions seem irrational like taking James to the healing service that worsened his condition. The physician provided sufficient information for Mike to make the right decisions but could not stop them from taking him to church. The physician was doing this based on the concepts of autonomy and patient preferences. |
| Quality of Life
Beneficence, Nonmaleficence, Autonomy |
Contextual Features
Justice and Fairness |
| Disease conditions have negative effects on quality of life. The quality of life is essential as it shows the prospects of one leading a better life after interventions or not. The principles of beneficence, non-maleficence, and autonomy are essential here as the decisions of the providers will either demonstrate effective measures to correct the present condition or not (Teven & Gottlieb, 2018). Factors that contribute to positive influence about this aspect include early interventions and familial support.
In the case of James, his quality of life continues to deteriorate because of the kidney failure problem. James had acute glomerulonephritis that could have been treated by effective antibiotics and allowed him to resume his normal functioning. However, the decision by his parents, based on the principle of autonomy, to take him for a healing session exacerbated his quality of life and made it worse. This implies that James should now get a transplant as opposed to the current dialysis that has negative effects on his quality of life. Medical and healthcare ethics advance that interventions which seem unlikely to offer benefits to patients should not be provided. In this case, the healing service never offered positive outcomes for patients. |
Clinical and medical situations are linked to larger contexts which are essential when conducting ethical analysis. The contextual aspects like family dynamics, financial resources, possible legal ramifications of care provision and religious or cultural issues also impact care provision (Gillon, 2018). These components impact patient care and should be considered by providers.
Contextual factors align with the principle of justice where providers and other stakeholder must ensure access to available resources without any bias or discrimination. In this case, one of the contextual factors is the religious perspective of James’ family, especially his father. He believes that a healing service can offer healing to the son. His faith makes him take James for the service at the expense of conventional interventions. The effect of this action is a worsened state of James who now must be on dialysis before a kidney transplant occurs. The physician recommends Samuel, James’ twin brother to donate his kidney because it is the only matching. However, the parents are hesitant because of their religious faith and other concerns, especially the possibility and fear of losing both sons in case the procedure goes bad. |
Part 2: Evaluation
Answer each of the following questions about how the four principles and four boxes approach would be applied:
- In 200-250 words answer the following: According to the Christian worldview, how would each of the principles be specified and weighted in this case? Explain why. (45 points)
| The Christian worldview advances the need for respect for decisions that people make concerning their health and other aspects of their life since they are inherently free and created in God’s image. They are also independent to make decisions and choices that are pleasing to their lives and circumstances (Torry, 2018). In this case, the principles of autonomy, beneficence, non-maleficence, and autonomy are specified weighted differently. Christian worldview advances that man is a free being because he was created with the inherent freedom from God. Imperatively, he can exercise his rights based on his preferences and existing cultural beliefs, including faith. James’s parents exercise autonomy by making preferences concerning his treatment. They forego early recommendations by the physician and opt for healing service. However, the decision is weighted when their action leads to poorer outcomes for James. Mike fails to make an effective decision and takes advantage of the principle to negatively affect the treatment process of his son.
The principles of beneficence and non-maleficence are specified when the physician and his team make suggestions about the treatment interventions for James with the best interests to improve his condition (Gillon, 2018). However, the parents, especially Mike, declines the plan of treatment and takes him to a healing service at their church. The decision leads to deterioration of his health and escalation of his condition that now requires a kidney transplant due to failure of his kidneys. The last principle to be specified and weighted is justice. The physician recommends that Samuel, James’s twin brother, is the only person who can donate the required kidney as it matches. However, the parents weigh on this recommendation and find it difficult to allow Samuel have his kidney donated to James. |
- In 200-250 words 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)
| The Christian worldview proposes modeling of sacrificial love which entails one foregoing their interests and issues for the sake of others, like Jesus Christ’s death for human salvation and restoration. The Christian belief system is based on ethics and attaining a balance of these principles needs one to focus on the ethical approaches as taught in the bible. Christian balances by focusing on the principle of autonomy. God has given everyone free choice and freedom. James parents choose to take him for a healing service as a first option implying that Christians will consider the decisions that they make at a personal level (Torry, 2018). The parents deal with autonomy but find it difficult to balance justice when the physician recommends that Samuel is the only person whose kidney matches with James.
A Christian can balance these principles when they understand their circumstances and their overall roles in such matters, especially the ability to make decisions (Superdock et al., 2018). The case shows this approach as relevant since the physician recommends interventions based on beneficence and non-maleficence. The physician and his team are keen on giving the best care based on patient interest and benefits as well as reducing the harm caused by the condition. His recommendations show no harm directed to the patient. The implication is that Christians should model their responses based on Christ’s teachings. They should balance all the principles equally as they carry similar importance and demonstrate the expectations of the individuals in attaining better care. |
Conclusion
The four quadrant box method is a core component of understanding how providers can make effective and ethical decisions in healthcare that impact overall care delivery of patients. The paper shows that biomedical principles are essential and providers must use appropriate approaches like the four-box method to make salient care decisions. The Christian worldview considers these principles as critical based on its teachings.
References
Beauchamp, T., & Childress, J. (2019). Principles of biomedical ethics: marking its fortieth
anniversary. The American Journal of Bioethics, 19(11), 9-12.
DOI: 10.1080/15265161.2019.1665402.
Gillon, R. (2018). Principlism, virtuism, and the spirit of oneness. In Healthcare Ethics, Law and
Professionalism (pp. 45-59). Routledge.
Teven, C. M., & Gottlieb, L. J. (2018). The four-quadrant approach to ethical issues in burn care.
AMA journal of ethics, 20(6), 595-601. https://journalofethics.ama-assn.org/article/four-quadrant-approach-ethical-issues-burn-care/2018-06
Torry, M. (2018). Ethical religion in primary care. London Journal of Primary Care, 9(4), 49-53.
DOI: 10.1080/17571472.2017.1317407
Superdock, A. K., Barfield, R. C., Brandon, D. H., & Docherty, S. L. (2018). Exploring the
vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC palliative care, 17(1), 1-14. DOI: 10.1186/s12904-018-0360-y.