Based on the \”Case Study: Healing and Autonomy\” and other required topic study materials, you will complete the \”Applying the Four Principles: Case Study\” document that includes the following:
Part 1: Chart
This chart will formalize the four principles and four boxes approach and the four-boxes approach by organizing the data from the case study according to the relevant principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice.
Part 2: Evaluation
This part includes questions, to be answered in a total of 500 words, that describe how principalism would be applied according to the Christian worldview.
Applying the Four Principles: Case Study
Every single one of us, in my view, has value. Humans were created in God’s likeness and are tasked with carrying out God’s plan for the planet. Everything happens for a reason, and I think that God has a purpose for everyone of us, even if we don’t recognize it or comprehend it. Individuals, in my opinion, have the right to make their own decisions. Abortion, in my opinion, may be justified in extreme circumstances, such as when the mother’s life is endangered by pregnancy difficulties or when the pregnancy is the consequence of rape. I believe that when two consenting adults participate in an action that is known to result in pregnancy and that pregnancy occurs, the result should be acknowledged and supported as a matter of principle and duty. M
y position, on the other hand, cannot supersede an individual’s right to self-determination, therefore I am pro-choice. Because they have an influence on human life, bioethical concerns, abortion, designer babies, and stem cell research are all contentious. The issue is whether these things are good or destructive to God’s creation of human life. I support stem cell research because studies show that this science has the potential to heal or cure a wide range of ailments. When the issue of “designer babies” is discussed in the context of reducing the possibility of birth malformations and disabilities, it looks to be a promising one. On the other side, prospective parents are emotionally and financially committed in this therapy. Because of this investment and medical science’s expanding ability to modify gender and other physical features, we risk enticing people into fantasizing about and attempting to make the “ideal kid”. Therefore, I don’t support” designer babies”.
Part 1: Chart (60 points)
Healthcare providers need to uphold the biomedical principles when treating patients and incorporate their views, especially based on the concept of cultural competence. In this case, Mike and Joanne and their sick child, James, make decisions concerning his treatment based on these principles. The purpose of this assignment is to analyze how they apply the four principles and offer a Christian narrative based on concepts related to the case.
| Medical Indications
Beneficence and Nonmaleficence |
Patient Preferences
Autonomy |
| Medical indications denote to clinical information that is needed for diagnosing a patient to understand that level of severity of their medical or health condition. Beneficence acting in the best interests and intents for a patient to ensure that they attain positive outcomes (Gillon, 2018). Non-maleficence implores the physician not to do any harm to patients.
In this case, after the initial diagnosis, the physician recommended treatment interventions for James with the intent to improve his condition. However, the parents decided to take him to church for a miracle service but the intervention did not work. They brought him back and the physician placed James on immediate dialysis with the need for a kidney transplant as the long-term solution. The actions by the physician demonstrates that he based his decisions on medical indications of James condition. Further, he observed beneficence as his intents are to treat James and not to harm him. The decisions by the parents were exercised based on the principle of autonomy. |
Patient preferences entail the expressed choices of a patient or their substantive decision makers based on the principle of autonomy. The principle of autonomy is critical in medical and health as it implores the providers to respect patient’s preferences based on their right to make decisions. Patients have the right to exercise decisions and select the kind of care they want based on provided information by physicians and other healthcare providers (Gillon, 2018). In this case, James is a minor and cannot exercise autonomy rights, implying that his parents make decisions on his behalf.
James’ parents make the decisions to bring him to the nephrologist and later to their church without consulting him. The physician and his team do not interfere in the decisions but offer all information concerning the appropriate treatment interventions for James. The parents express their preferences when the physician gives them all available options that include immediate dialysis and later on when the condition worsens, a kidney transplant. |
| Quality of Life
Beneficence, Nonmaleficence, Autonomy |
Contextual Features
Justice and Fairness |
| Quality of life describes the relevant medical characteristics of life of a patient prior to and after getting treatment. Beneficence, non-maleficence and autonomy are essential in demonstrating the quality of interventions that care providers offer to patients (Owoc et al., 2018).
James’ condition was worse before the current intervention of having a dialysis. The physician recommends a kidney transplant as the intervention that will have a permanent impact on James’ quality of life. In this case, the previous actions by the physician show that he values the principles of autonomy, beneficence and non-maleficence (Singsuriya, 2018). The parents’ decisions also demonstrate their exercising of these principles as they make preferences based on autonomy and acted with the hope of best interests for their child. |
Contextual issues focus on the legal, social and familial aspects that influence one’s medical condition. Justice and fairness implore stakeholders to make decisions that demonstrate equity, and appropriate allocation of resources to patients without any discrimination (Young, 2017). For instance, distributive justice impacts a physician’s decisions and actions on patients using moral values and perspectives like equality and equity.
The case study demonstrates that despite the decisions that the parents took concerning James and brought him to church, he should continue treating him well. Fairness and justice mandate the physician to make best decisions and deploy necessary resources to treat James so that he gets better (Owoc et al., 2018). In this case, the physician recommends a kidney transplant as the most effective solution to James’ condition. |
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 considers medical interventions as essential in one’s life and demonstrate the power of God. The principle of autonomy implores adults to make treatment decisions based on their inherent abilities and dignity as human beings created in God’s image. Christians believe that faith should be based on action. However, Mike and Joanne misinterpreted the biblical teaching on faith and healing by taking their son to church for miracle prayers without medical interventions. Their decision was based on autonomy. They believed that seeking medical treatment showed lack of faith in God. The second principle is beneficence which requires physicians and other healthcare providers to have best interests of patients and offer interventions that benefit them. Every physician must consider the patient’s benefits before their own. The principle of non-maleficence is based on the need of not harming a patient, just like the Christian teaching on loving one’s neighbor and not inflicting any undesirable things in them (Carr & Winslow, 2017).
Physicians have a legal and professional obligation to protect patients’ health at all costs. The physicians have the responsibility to protect their patients from harm. The implication is that healthcare providers, including physicians, should ensure that they minimize harm that could jeopardize health. The final principle to be specified and weighted is justice which requires physicians and patients to treat each other fairly in their facilities and in society. Christian teaching emphasize the need to treat the afflicted fairly and ensure that they attain their needs. Physicians should uphold justice and fairness in their actions and decisions concerning patients. |
- 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)
| A Christian should balance the four core principles of autonomy, beneficence, non-maleficence, and justice. All these principles are bounded by the commandment of love as demonstrated in Mathew 22:39; Thou shall love thy neighbor as thyself (NIV). Every individual must demonstrate values like love, kindness, passion and faithfulness in their endeavors and actions in daily life. While principles like autonomy may contradict biblical teachings, Christians should illustrate their faith by accepting treatment and seeking God for healing. Christian must seek treatment with the faith and hope that they will be cured through God’s intervention (Carr & Winslow, 2017). The implication is that while they have the right to make decisions and choices, Christians must always ensure that their interventions confer benefits, do not create harm, are fair and just, and do not contradict existing Christian teachings as prescribed in the bible.
On their part, physicians and other healthcare providers should be guided by values of humanity and know that each decision they make has significant repercussions on patients, their families and society. physicians should guide their patients in making better decisions with their best interests and not causing harm to them. Such decisions should influence their health by ensuring that they have quality care outcomes. Physicians should dedicate their time and efforts to saving lives and exercising the ethical principles as outlined in their code of professional conduct. The implication is that both patients and physicians have a responsibility to observe ethical principles, especially from a Christian perspective, and get better outcomes from the medical interventions by balancing these principles well. |
References:
Carr, M. F., & Winslow, G. R. (2017). From conceptual to concrete. In World Religions for
Healthcare Professionals (pp. 31-45). Routledge.
Gillon, R. (2018). Principlism, virtuism, and the spirit of oneness. In Healthcare Ethics, Law and
Professionalism (pp. 45-59). Routledge.
Owoc, M. S., Kozin, E. D., Riemenschneider, A., Duarte, M. J., Hight, A. E., Clay, M., … &
Briggs, S. (2018). Medical and bioethical considerations in elective cochlear implant
array removal. Journal of medical ethics, 44(3), 174-179.
Singsuriya, P. (2018). Ethics of Caring Conversation and Dialectic of Love and Justice. Nursing
Ethics, 25(4), 436-443. doi: 10.1177/0969733016654313.
Young, G. (2017). The Five Core and the Five Supplementary Ethical Principles and Their Sub-
principles. In Revising the APA Ethics Code (pp. 63-91). Springer, Cham.
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.