PHI 413V Week 3 Healing and Autonomy

PHI 413V Week 3 Healing and Autonomy

The given case study is about Mike and Joanne. They are Samuel and James parents. James has been diagnosed with acute glomerulonephritis, kidney failure. According to James’s physician, James requires to undergo dialysis as a way of maintaining his kidney functions. However, James’s parents are of the opinion that he seeks religious healings from his pastor. The physician agrees to their decision only for James to be brought back two days later with worsening health status. He was started on dialysis and requires urgent kidney transplant. Therefore, this research paper examines the case study with a focus on the various aspects that should be considered for the health and wellbeing of James.

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

Should the Physician Allow Mike to Continue Making Decisions that Seem to him to be Irrational and Harmful to James?

The physician should not allow Mike to make decisions that irrational and harmful to James. Firstly, healthcare providers have the obligation of ensuring that the safety of the patient is protected. They make decisions that aim at optimizing the wellbeing, health, and recovery of the patients from their conditions (Scott, 2017). Healthcare providers also play the role of patient advocates. This implies that they fight for their patients in situations where their health and lives are at risk. An example is the case study where it is evident that Mike’s decisions are causing more harm to James than promoting his recovery.

The physician also has knowledge on issues that cause ethical dilemmas in his practice. An example of such issue is the conflict between respecting the autonomy of the caregivers and taking decisions that promote the health and wellbeing of the patient. In such situations, healthcare providers are expected to make ethical decisions that will not only protect the health of the vulnerable but also demonstrate prioritization of the health issues affecting the population. Consequently, the physician should not allow Mike to make decisions in a way that facilitates the understanding of the family. This includes explaining to the family about the prognosis of their son and possible outcomes if immediate interventions are not adopted.

The decision of not allowing Mike to make decisions concerning James’s health is not a violation of the autonomy of the patient. The physician will instead be promoting his autonomy by ensuring that the best interventions are used to promote his health. Healthcare providers often experiences ethical dilemmas in their practice. In such situations, they are expected to prioritize the needs of the patient, hence, the soundness of the decision made.

How Ought Christians Think about Sickness and Health? How should a Christian Think about Medical Intervention? What Should Mike as a Christian do? How should he Reason about Trusting God and Treating James?

There exist significant differences in the way in which Christians and physicians view or understand a disease. For healthcare providers, a disease arises from a change in the normal physiological processes in the body. However, this view might be different according to religion. For example, it can be seen from the case study that Mike and Joanne are strong believers of Christianity. They believe that everything that happens in their lives is attributed to God. According to some Christians, a disease is a symbol of God’s test of their faith or believes. They consider that a disease is something that God sent to them to know if they have strong faith in him. The best approach to an illness to such Christians is holding to a belief that the disease will heal by itself once God is through testing them. God is therefore the healer. Some Christians also perceive a disease to be God’s punishment. According to them, God sends a disease to human beings as a way of showing his dissatisfaction with their behaviors. As a result, they must live in ways that align with God’s teachings for the disease to be healed. The last group of Christians perceives physicians or healthcare providers to be sent by God to help them manage their diseases. In this case, the healthcare providers assist God in promoting the health and wellbeing of his creations. Mike’s family perceives James’s condition as God’s test of his faith in him. Therefore, the strongly believe that God will heal him once he has finished testing their faith.

It is therefore important that Christians consider medical interventions as part of the ways in which God’s efforts to promoting health and wellbeing are promoted. They should believe that medical interventions would enable them to see the doings of God through their recovery from the disease. Based on this, Mike should allow medical interventions to be utilized for the recovery and wellbeing of his son. He should have faith in God that the dialysis and kidney transplant will restore his son’s health. He should also consider the physician and other healthcare providers as part of the angels of God. Therefore, he should hold on the belief that God’s intentions will manifest through their medical interventions. Through this, Mike will be promoting beneficence and non-maleficence by ensuring that the safest care is given to his son. Furthermore, the decision will eliminate any future blames if medical interventions prove ineffective in promoting James’s recovery.

How Would Spiritual Needs Assessment Help the Physician Assist Mike Determine Interventions for James and for his Family or Others involved in his Care

Spiritual assessment is an important component in the provision of holistic care to the patients. Spiritual assessment would have benefited the effective management of James’s condition in a number of ways. Firstly, the physician could have learned about the spiritual needs of the family and their relationship with the care needed by the patient. It would have enabled him to explore the manner in which medical interventions can be used in a manner that does not conflict with the interests and expectations of the family. Spiritual assessment could have also enabled the physician to identify the teams that should be involved in making decisions on the care needed by the patient (Doreen, 2016). For example, he would have considered the need for incorporating the efforts of the family’s spiritual leader in deciding on the best treatment approach for the patient.

Spiritual needs assessment would have also enabled the physician to identify the family’s values, beliefs, and practices that are needed to ensure the adoption and sustainability of the adopted interventions. He could have also learned about the ways in which his values, beliefs, and practices are likely to influence the treatment decisions for the patient. For example, being medical personnel, he would have used biblical examples to increase the understanding of the family about the need for medical interventions (Doreen, 2016). Through it, he could have made them understand the interrelationship between medicine and religion.

Conclusion

In summary, the case study has shown the manner in which religion can influence the uptake of health interventions. It has revealed the manner in which the religious beliefs of the patients need to be incorporated into care for optimum health to be achieved. Therefore, it is important that healthcare providers incorporate spiritual assessment into their plans of care. This will enable them to provide care that promotes optimum health, wellbeing, and recovery of their patients.

References

Doreen, A. W. (2016). Spirituality in nursing practice: The basics and beyond. Springer Publishing Company.

Scott, P. A. (Ed.). (2017). Key concepts and issues in nursing ethics. Springer.

Write a 1,200-1,500 word analysis of “Case Study: Healing and Autonomy.” In light of the readings, be sure to address the following questions:

Under the Christian narrative and Christian vision, what sorts of issues are most pressing in this case study?

Should the physician allow Mike to continue making decisions that seem to him to be irrational and harmful to James?

According to the Christian narrative and the discussion of the issues of treatment refusal, patient autonomy, and organ donation in the topic readings, how might one analyze this case?

According to the topic readings and lecture, how ought the Christian think about sickness and health? What should Mike as a Christian do? How should he reason about trusting God and treating James?

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The case study presents a frequent conflict between conventional medical treatment and spiritual beliefs that affect medical decision-making. In this case, Mike’s decision to opt for prayer healing instead of temporary dialysis has influenced his son’s condition and created a need for a kidney transplant. Mike is now contemplating whether to rely on religion or conventional, evidence-based medicine. The physician is also in conflict, as they need to decide on the recommended treatment and future communication with the child’s parents. The paper will seek to define the fundamental concepts involved in the case, explain the situation, and propose solutions based on biomedical ethics

Christian Narrative and Christian Vision
The Christian narrative and Christian vision are evident in the case study, as Mike openly expresses his beliefs about health care and the role of spirituality in it. The central concepts that arise in the case of Christianity are prayer healing, suffering, and abstinence from treatment. Firstly, prayer healing is a significant concept in Christianity, as many Christians believe that illnesses can be alleviated at God’s will (Alberta Health Services [AHS], 2015). Thus, it is not uncommon for Christians to rely on faith healers and prayers to achieve and maintain health. However, it is also notable that the Christian doctrine does not forbid conventional medical treatment (AHS, 2015). Thus, Mike’s decision to rely on prayers and faith healing is guided by his interpretation of Christianity rather than the Christian narrative itself.

Secondly, suffering is among the core tenets of the Christian narrative. The ultimate sacrifice made by Jesus is viewed positively, and thus people’s attitudes to suffering are different than in other religions. Christians often see hardship and suffering as a test of their faith rather than as a punishment for their sins (AHS, 2015). It is also believed that enduring hardship and suffering can help people to understand God’s ways, thus contributing to their spiritual journey. Therefore, the notion of turning to faith at times of suffering is a part of the Christian vision.

Finally, abstinence from medical treatment can be seen as a product of Christian beliefs about suffering and prayer healing. Instead of accepting treatment that provides immediate relief, people choose to experience suffering, thus relating to the image of Jesus. However, the attitude toward medical treatment and the comfort it gives also differs among the different branches of Christianity. For example, Catholicism argues for the rejection of therapy “due to it being too burdensome, risky, ineffective or disproportionate to the expected outcome” (AHS, 2015, p. 33). However, Catholicism encourages treatment that improves patients’ quality of life and longevity, including organ transplantation. In the Eastern Orthodox branch of Christianity, implantation of animal organs is forbidden, whereas interventions that improve health without causing harm to others are supported (AHS, 2015). Therefore, abstinence from medical treatment, including dialysis, is not part of the Christian faith.

Physician’s Actions
Physicians and other health professionals have a significant impact on patients’ decisions, as they can provide information and guidance necessary to make choices regarding treatment and prevention. In the present case, the patient is Mike’s son, and thus the physician should seek to provide advice to Mike. Forbidding Mike to make faith-based treatment decisions would not be possible due to religious exemptions to child abuse and neglect laws (Antommaria et al., 2013). Instead, the physician should seek to share their knowledge about the treatment and advise Mike to proceed with kidney transplantation.

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As evident from the analysis of core issues, a treatment contradicts the Christian vision if it is harmful to others, has high risks, or is ineffective. Therefore, the physician should provide Mike with information about the risks and benefits of the treatment. Also, it would be useful to outline the effects of kidney donation on the patient’s brother to reassure Mike that it is a relatively safe procedure that would have few adverse effects on his quality of life. Indeed, although kidney donation is associated with regular surgery risks, the possibility of serious long-term risks is rather low (Maggiore et al., 2017). Apart from informing about the risks and benefits of the procedure, it would also be useful to analyze it from a spiritual point of view. Compassion, service, and charity are among the fundamental tenets of Christianity, and thus organ donation can be viewed as part of Mike’s son’s spiritual journey.

Analyzing the Case
To analyze the case, it is critical to consider the various options and viewpoints, as well as to investigate their sources. The physician’s position regarding treatment is clear and supported by clinical evidence. A kidney transplant will have a positive effect on James’ quality of life, health, and longevity, and is thus the preferred treatment option. Mike’s motives, on the other hand, are drawn not from the Christian doctrine itself, but a sermon by his pastor and anecdotal evidence. Treatment refusal based on such evidence will harm James, causing severe disability or death.

ints, as well as to investigate their sources. The physician’s position regarding treatment is clear and supported by clinical evidence. A kidney transplant will have a positive effect on James’ quality of life, health, and longevity, and is thus the preferred treatment option. Mike’s motives, on the other hand, are drawn not from the Christian doctrine itself, but a sermon by his pastor and anecdotal evidence. Treatment refusal based on such evidence will harm James, causing severe disability or death.

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The case also relates to the topic of patient autonomy, as discussed in the readings. Typically, patient autonomy is perceived as one of the primary values in culturally competent care (Louw, 2016). Care providers should respect patient autonomy as long as a patient is physically and mentally capable of making informed decisions about their health. In the present case, the patient is a minor, and he is represented by his parents. Therefore, one should also consider the issue of patient autonomy in the context of underage patients.

PHI 413V Week 3 Healing and AutonomyChristianity and Health
Christians’ beliefs about health and sickness are rather complex but can be narrowed down to three core ideas. First of all, life and health are a gift from God that should be maintained by the Christian Doctrine. Secondly, sickness is part of a person’s spiritual journey, as enduring hardship allows a Christian to relate to Jesus. Thirdly, medicine is part of God’s gift to humans, and should thus be used to promote health. According to Christian Enquiry Agency (2018), “Christians rejoice in all the things that bring health working together, whether they are natural, medical or prayerful” (para. 7). Therefore, as a Christian, Mike should rely on medical treatment while also praying for them to work and cause no harm to his second son. This option would allow Mike to save his son’s life while also conforming to the Christian vision of health and healing.

Conclusion
All in all, the case presents an example of a significant issue in biomedical efforts and allows reflecting on the role of spirituality in medical decision-making. Based on the analysis, it appears that Mike’s reasoning somewhat contradicts the Christian doctrine. Therefore, the physician should seek to provide information about treatment while also advising Mike that it adheres to the Christian vision. By cooperating with the parent and engaging in dialogue rather than taking radical action to oppose Mike’s judgment, the physician will be able to provide culturally competent care that serves the patient’s best interests.

References
Alberta Health Services (AHS). (2015). Health care and religious beliefs. Web.

Antommaria, A. H. M., Weise, K. L., Fallat, M. E., Katz, A. L., Mercurio, M. R., Moon, M. R., … Baker, A. (2013). Conflicts between religious or spiritual beliefs and pediatric care: Informed refusal, exemptions, and public funding. Pediatrics, 132(1), 962-965.

Christian Enquiry Agency. (2018). Illness. Web.

Louw, B. (2016). Cultural competence and ethical decision making for health care professionals. Humanities and Social Sciences, 4(2), 41-41.

Maggiore, U., Budde, K., Heemann, U., Hilbrands, L., Oberbauer, R., Oniscu, G. C.,… Abramowicz, D. (2017). Long-term risks of kidney living donation: Review and position paper by the ERA-EDTA DESCARTES working group. Nephrology Dialysis Transplantation, 32(2), 216-223.

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Case Study: Healing and Autonomy

Mike and Joanne are the parents of James and Samuel, identical twins born 8 years ago. James is currently suffering from acute glomerulonephritis, kidney failure. James was originally brought into the hospital for complications associated with a strep throat infection. The spread of the A streptococcus infection led to the subsequent kidney failure. James’s condition was acute enough to warrant immediate treatment. Usually cases of acute glomerulonephritis caused by strep infection tend to improve on their own or with an antibiotic. However, James also had elevated blood pressure and enough fluid buildup that required temporary dialysis to relieve.

The attending physician suggested immediate dialysis. After some time of discussion with Joanne, Mike informs the physician that they are going to forego the dialysis and place their faith in God. Mike and Joanne had been moved by a sermon their pastor had given a week ago, and also had witnessed a close friend regain mobility when she was prayed over at a healing service after a serious stroke. They thought it more prudent to take James immediately to a faith healing service instead of putting James through multiple rounds of dialysis. Yet, Mike and Joanne agreed to return to the hospital after the faith healing services later in the week, and in hopes that James would be healed by then.

Two days later the family returned and was forced to place James on dialysis, as his condition had deteriorated. Mike felt perplexed and tormented by his decision to not treat James earlier. Had he not enough faith? Was God punishing him or James? To make matters worse, James’s kidneys had deteriorated such that his dialysis was now not a temporary matter and was in need of a kidney transplant. Crushed and desperate, Mike and Joanne immediately offered to donate one of their own kidneys to James, but they were not compatible donors. Over the next few weeks, amidst daily rounds of dialysis, some of their close friends and church members also offered to donate a kidney to James. However, none of them were tissue matches.

James’s nephrologist called to schedule a private appointment with Mike and Joanne. James was stable, given the regular dialysis, but would require a kidney transplant within the year. Given the desperate situation, the nephrologist informed Mike and Joanne of a donor that was an ideal tissue match, but as of yet had not been considered—James’s brother Samuel.

Mike vacillates and struggles to decide whether he should have his other son Samuel lose a kidney or perhaps wait for God to do a miracle this time around. Perhaps this is where the real testing of his faith will come in? Mike reasons, “This time around it is a matter of life and death. What could require greater faith than that?”

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:

1. 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.

 

2. 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.