Case Study on Biomedical Ethics in the Christian Narrative Assignment

The provision of care requires physicians, nurses, and other health care practitioners to follow the four biomedical principles that include beneficence, autonomy, justice, and non-maleficence. In the case, “,” it is evident that the providers tackle different aspects that include medical indications, patient preferences, quality of life and contextual issues that impact healthcare delivery. Using the chart, the assignment evaluates the application of the four principles in the case in its first part. The second part addresses the application of the principles.

Part 1: Chart (60 points).

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

Medical indications denote to diagnosis, prognosis, suggested measures for evaluation and treatment and expected results from treatment interventions Medical indications concern the need for providers to make professional judgment and entails application of principles of beneficence and non-maleficence (Teven & Gottlieb, 2018). Through beneficence, providers should offer care that bring good to patients while reducing potential harm as indicated by non-maleficence principle.

The case study shows that James needs immediate treatment interventions that include a dialysis and later on a kidney transplant as a long-term solution to his condition that deteriorated due to delays in treatment interventions.

In this case, Mike and Joanne act in the best interest of the child, James who requires immediate treatment to recover from glomerulonephritis. The actions by the parents have no malice or intention to harm James even though they knew that the condition could get worse if treatment is not provided immediately. As Christians, they were faithful since an individual had been healed from stroke. However, when the healing service could not offer recovery to James, they brought him back for medical attention. The decision by the parents may have affected immediate treatment by the healthcare team which could have prevented the current medical indications that are not pleasing. However, physicians and other providers have a duty to exercise the principles of beneficence and non-maleficence and ensure that James’ condition gets better and should involve the parents in decision making since the patient is a minor.

Patient preferences refer to the choices that individuals make when they encounter decisions about health and medical treatment. These choices reflect the individual patient’s experiences, values, and beliefs based on the provider’s recommendations (Teven & Gottlieb, 2018). When a patient has decision-making abilities, physicians and other providers should respect their preferences and use them to guide care and medical plans. The implication is that patient preferences arise from the principle of autonomy which implores providers to respect any decisions or care interventions informed by a patient’s beliefs, values, and experiences. A core aspect of the principle of autonomy is getting informed consent from patients based on their decision-making capacities. Minor patients like James may not have the decision-making capacity to exercise their autonomy as demonstrated in the case. In such situations, parents assume the role of making critical decisions.

In this case, the physician (nephrologist) gave the family full information when James was brought to the facility for treatment. However, the parents exercised his autonomy since he is a minor and decided to take him to church for a healing service. The physician respected the autonomy and could not offer treatment without their consent but allowed them to go to church due to their faith preference.

The pursuit for miracle healing was not effective and when the parents made the decision to return James for medical intervention, it was based on their preferences, informed consent, and autonomy.

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

Illness or medical and health condition can have negative effects on quality of life. Since a principle goal in medicine is the preservation, restoration, and improvement in quality of life, both patients and healthcare providers must discuss how treatment will impact the quality of life, in this case for James. The discussion should focus on the three principles of beneficence, non-maleficence, and respect for autonomy. Quality of life assess the level of satisfaction that patients experience and value about their lives as a whole based on the three principles (Teven & Gottlieb, 2018). Physicians, nurses, and other healthcare providers should use evidence-based practice interventions to enhance a patient’s quality of life but by ensuring that it is based on their autonomy and need to prevent harm while offering benefits.

In this case study, James’ quality of life deteriorated due to delays in treatment interventions after a diagnosis. The healthcare team exercises the principle of autonomy by allowing Mike and Joanne to make the decision to take James to their church for healing. However, this did not lead to recovery and the patient was brought back. James is now on dialysis to help him function well but the long-term solution is a kidney transplant where parents need to make a critical decision. The matching kidney for James comes from his twin brother, Samuel after all other donors’ kidneys failed to match. The parents want the best for James but are worried about having Samuel donate a kidney to him. The implication is that both parents and the physician should act in the best interest of the pediatric patient and agree to the recommendations by the physicians to save the boy’s life and prevent further health risks.

The parents should also engage both James and Samuel so that they understand what is happening despite their young ages. Beneficence is not just acting in ways that help other individuals in need through treating or curing illness, but entails acting in ways that bring satisfaction to others. The implication is that the parents should involve their sons to ensure that they are satisfied about the actions that they intend to take in the proposed procedure for James’s better prognosis.

According to Gillon (2018)), clinical cases do not occur in isolation as they are part of broader circumstance that are critical to ethical analysis of care cases. contextual features affect the decision-making process and include patient specific factors like family dynamics, financial resources, and cultural and religious identity (Teven & Gottlieb, 2018). These features may also comprise of possible legal ramifications in care provision, and personal bias of those involved in patient care.

In this case, James is a minor and the parents and physician have a responsibility to offer influence the treatment options. For instance, the decision to opt for spiritual intervention through miracle prayer demonstrates the religious factors that impact care plan in the case. Further, the parents come back and the physician shows that a transplant is the long-term intervention. However, the parents are skeptical after James’s twin brother’s kidney becomes the matching kidney. The implication is that the physician can only opt for the intervention if the parents’ consent to having Samuel donate his kidney to save James’s life.

Imperatively, the parents must involve Samuel while the physician should implement recommendations based on the best interests of James and implore the parents to consider long-term effects of any actions that they take now.

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 view advances that God gives life and sustains it. From the perspective, the specification and weighing of the principles should encompass Christian beliefs and teachings as advanced in the Bible. The principles would be specified and weighted based on the need to protect the inherent human dignity and value that man has and given by God. The first principle would be autonomy followed by beneficence and non-maleficence and lastly justice. Autonomy should be specified first since respect of freedom is an imperative because man was created to be free and exercise their freedom to choose based on the Christian values and teachings (Carr & Winslow, 2017). Autonomy advances that after a physician diagnoses a patient, they should inform them or the family and then respect the free choice that they make. In this case, the physician informed Mike and Joanne about the treatment interventions and allowed them to make their decisions on behalf of James since he is a minor.

Non-maleficence is the second principle as it provides a caregiver a moral obligation to ensure that no harm occurs a patient by making the best decision and acting in the best interests of a patient. Beneficence is specified and weighted third as it is God’s command to love others as one loves themselves. The principle dictates how physicians and healthcare providers should treat and interact with their patients. caregivers should also seek to benefit patients with reduce risk of harm. The fourth principle is justice as it implores on healthcare providers and systems to treat patients equally and share available resources equitably. They should treat patients with compassion and dignity despite their diversity as all people are equal before God and made in his image.

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 advances that one must demonstrate love and ensure that they benefit others without causing harm or undue suffering. According to the Christian worldview, man is created in God’s image and love should drive all actions, including care given to patients by healthcare providers (Carr & Winslow, 2017). In this case, a Christian will balance each of the principles by basing their actions or decisions on teaching, values and beliefs. Consequently, the first aspect is to consider beneficence which one should balance with non-maleficence and the need to do good. Beneficence is the most pressing principle as all involved should focus on James’ interest and ensuring that he gets quality life. While James’ parents opted for miracle service, one cannot blame them since they had faith in prayers than treatment. They acted with best intentions and interests to benefit James even when they realized that the healing service could not solve the issue.

The second aspect is ensuring that no harm happens to an individual as demonstrated in the case where the decision to have a transplant for the patient would bring benefits to him. The parents have opted for dialysis to prevent any harm to James. They believe that their choices are based on their faith in God. Autonomy becomes a third aspect in balancing the principles as it shows that while patients have the freedom to choose, they must consider different spiritual aspects that affect their perspectives on issues (Gillon, 2018). For instance, the parents have a choice to make on whether James will receive a kidney from his twin brother, Samuel or not, and the impact of the decision. The final principle to balance is justice as it is not a much of a concern to the parents but critical in ensuring that James gets treatment to prevent deterioration of his condition.

Conclusion

The need to balance different biomedical principles requires healthcare providers to use the four box approach and understand other aspects that may impact or influence the delivery of care. The case study shows that factors like contextual features, patient preferences, medical indications and quality of life impact care decisions and interactions with patients. As such, making decisions requires the stakeholders to consider all these issues.

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.

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 four principles, especially in the context of bioethics in the United States, has often been critiqued for raising the to the highest place, such that it trumps all other principles or values. How would you rank the importance of each of the four principles? How do you believe they would be ordered in the context of the Christian biblical narrative? Refer to the topic Resources in your response

The four principles of medical ethics are respect for autonomy, beneficence, nonmaleficence, and justice. Respect for autonomy is the right for an individual to have complete control over their body and mind. Beneficence is the obligation to act for the benefit of another person. “The principle calls for not just avoiding harm, but also to benefit patients and to promote their welfare” (Varkey, 2021). Nonmaleficence “requires one not to cause harm to another” (Hoehner, 2018). “The practical application of nonmaleficence is for the physician to weigh the benefits against burdens of all interventions and treatments, to eschew those that are inappropriately burdensome, and to choose the best course of action for the patient” (Varkey, 2021). Lastly, justice is the fairness of benefits and risks to the general population. “These are distribution to each person (i) an equal share, (ii) according to need, (iii) according to effort, (iv) according to contribution, (v) according to merit, and (vi) according to free-market exchanges” (Varkey, 2021).

In my opinion, I believe the order of importance in which the four principles stand are as follows (most important to least) nonmaleficence, respect for autonomy, beneficence, and justice. The Christian biblical narrative would rank the priority of the four principles: beneficence, justice, nonmaleficence, and respect for autonomy. “In the New Testament, beneficence is often referred to as charity. Christians are implored to works of beneficence, or charity, by the example of Jesus and to God’s ways of dealing benevolently with his creation” (Hoehner, 2018). “The Bible certainly supports the concept of justice. The real purpose of civil law is to guarantee an ordered social coexistence in true justice, so “that we may lead a peaceful and quiet life, godly and dignified in every way” (1 Timothy 2:2)” (Hoehner, 2018). “. According to the Christian worldview, each of these individuals is made in the image of God and is thereby afforded equal moral status. Each of them has significant moral status that obligates one to protect them (nonmaleficence) and care for them (beneficence), even if they cannot make decisions for themselves” (Hoehner, 2018).

Hoehner, P. J. (2018). Biomedical Ethics in the Christian Narrative. Practicing dignity: An introduction to Christian values and decision making in Health Care. Retrieved January 12, 2022, from https://lc.gcumedia.com/phi413v/practicing-dignity-an-introduction-to-christian-values-and-decision-making-in-health-care/v1.1/#/chapter/3

Varkey, B. (2021, June 4). Principles of clinical ethics and their application to practice. Medical Principles and Practice. Retrieved January 12, 2022, from https://www.karger.com/Article/FullText/509119

Case Study on Biomedical Ethics in the Christian Narrative Assignment