Healing and Autonomy: Four Medical Ethics Principles

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Healing and Autonomy: Four Medical Ethics Principles

Medical Indications: Beneficence and Nonmaleficence

James, an eight-year-old boy, was accepted to a medical facility with kidney failure and elevated blood pressure. The condition was acute enough to suggest immediate dialysis as a temporary measure. The boys parents decided to forego the treatment, and the patient was let go. After two days, James was readmitted to the facility as his kidneys deteriorated. He was put on dialysis that was no longer a temporary measure. The family was informed that the boy needed a kidney transplant within a year, and the only tissue match was his identical twin, Samuel.

Patient Preferences: Autonomy

The patients preferences were expressed by the boys parents and included several crucial points. First, Mike and Joanne decided to forego the dialyzes, causing the deterioration of the boys condition. Second, they preferred that either Mikes or Joannes kidney was transplanted, but none of them were matches. Third, they were forced to decide if they wanted Samuel, their second son, to donate a kidney to his brother. In short, the patients were given the autonomy to balance their beliefs with the recommendations provided by physicians.

Quality of Life: Beneficence, Nonmaleficence, Autonomy

The condition described in the case scenario has implications for Jamess and possibly Samuels quality of life. First, James is forced to go through occasional dialysis to ensure the stability of his condition. Second, James is required to have a kidney transplant, which will result in standard limitations in eating and physical activity before and after the surgery. Additionally, James and Samuel, if Mike and Joanne decide so, will have to live with one kidney. Even though it is generally considered that living the condition does not have considerable implications, Schreuder (2017) states that living with one kidney can lead to lead to renal injury with hypertension and albuminuria (p. 596). In short, the situation has two clear implications for the twins quality of life.

Contextual Features: Justice and Fairness

The contextual features described in the case include three aspects. On the one hand, the patients parents are Christians and strongly believe in healing by prayer. This fact has led to the deterioration of Jamess condition and can influence Mike and Joannes decision about kidney transplantation. Second, James has a twin brother who is the ideal match for being a donor. Additionally, even though not mentioned in the scenario, the cost of intensive therapy, dialysis sessions, and possible surgery are not insignificant and may influence the parents decisions. In summary, the contextual features influence the patients condition both positively and negatively.

The Most Pressing Principle: Medical Indications, Patient Preferences, Quality of Life, or Contextual Features

The pressing principle presented in the case scenario is patient preferences. According to Biggar (2015), religion may be a source of liberal virtues. It teaches that every person has a right to be heard and his or her views to be considered while making any decision about the future. Christianity teaches patience, openness to being educated and corrected, respect for others as potential speakers of truth, and readiness to confess dishonesty (Biggar, 2015). These virtues honor every persons right to shared decision-making while considering peoples values. Therefore, patient preferences are the principle most valued by people with a Christian worldview.

However, the principle is a matter of controversy in the case, as it has become a reason for condition deterioration. First, personal preferences inclined Mike and Joanne to avoid dialysis, which lead to the need for kidney transplantation.

Such a problem would not have existed if the decision was made purely on evidence and a combination of three other principles. Second, the same issue may lead to further rejection of the proposed surgery, as parents may view the situation as a test of faith. However, this matter differs from the first point, as the parents have to decide whether it is right to make Samuel donate a kidney, as he would face issues concerning his quality of life. In summary, the primary concern in the scenario is individual preferences, as it was the most impactful matter that is valued by Christians.

Ranking the Priority of the Four Principles: Medical Indications, Patient Preferences, Quality of Life, or Contextual Features

The Christian viewpoint dictates a different placement of priorities in the four principles. The top priority is more likely to be a patient preference, as religion promotes a humanistic approach, where a persons will is treated with honor. According to Biggar (2015), Christians believe in universal human dignity, which is crucial for modern patient-centered medicine, as its primary concern is patient well-being. This may differ from health status, as a person may be physically healthy and emotionally unwell at the same time. Therefore, the primary concern, according to the Cristian way of thinking, is personal attitude and preference.

Even though it may seem contra-intuitive, second in the ranking are medical indications. Biggar (2017) states that religious people are open to learning and understand that every person can be a medium of Gods Word. Therefore, Christians, like all the other rational individuals, understand the limits of their competencies and take into consideration doctors opinions that believe medical indications to be the most objective and accurate source of information.

The matter least valued by Christians and many other confessions is the quality of life, as religious people tend to accept their fate and can deal with discomfort. Thus, one can conclude that the principle that is the third in ranking is contextual features. In short, the most distinctive characteristics of the Christian viewpoint that influence the priority of the principles are humanism and patience.

References

Biggar, N. (2015). Why religion deserves a place in secular medicine. Journal of Medical Ethics, 41(3), 229-233.

Schreuder, M. (2017). Life with one kidney. Pediatric Nephrology, 33(4), 595-604. Web.

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