Case Study – Applying the Four Principles

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

• Medical indications dictate the need for a diagnosis or treatment. 
• James suffers from kidney failure which has led to high blood pressure and fluid buildup.
• According to the physician, James needs temporary dialysis to relieve the pressure and the buildup.
• However, James’ parents are reluctant for their child to undergo dialysis and prefer to rely on Christian faith, but James’ conditions worsen, and he requires a kidney transplant.
• Meanwhile, James is placed under multiple dialysis procedures to stabilize and improve his condition.

·         Samuel, James’ twin brother is the only compatible donor, meaning he has to lose a kidney and undergo surgery, which can be life-threatening. 

• The principle of autonomy allows the patient to make decisions uncoerced.
• The physician allows the parents to proceed and apply their God’s faith to restore James’ health and normal functions.
• James is a minor, and the parents make most of the medical decisions.
• The father seems to have strong decision-making power in the family and little is said about the mother’s preferences.
• Normally, James and Samuel should be consulted before making any decision, especially about the dialysis and the kidney transplant.

·         James’ father is in a dilemma about Samuel’s donor possibilities, but that is the only way to save James’ life. 

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

• Medical issues impact the quality of life.
• James’ kidney failure has affected his quality of life significantly.
• However, medical procedures such as the dialysis and kidney transplant can improve his wellness.
• The parents have the absolute power to make uncompelled decisions. The situation is challenging since the twins are minors and have little knowledge about medical issues. Right decisions can improve James’ quality of life.
• The parents also believed that Christian faith can relieve James from the ailment, but his conditions worsened.
• To stabilize the condition, James has to undergo multiple rounds of dialysis and within a year, he would require a kidney transplant that would probably make his life better.

·         The surgery and the transplant can affect Samuel’s quality of life. The surgery can be life-threatening, the recovery process can be tiresome, and he would require a transplant too if his only kidney suffers from complications in the future. 

•  Legal, social, and familial factors can impact our medical decisions and preferences. But, it is ethical to do what is just and fair to the patient. 
• Justice and fairness are part of quality life and James’ parents needed to act at his best interests. 
• It is good to believe in God, but in such a circumstance, allowing James to undergo dialysis would be just and fair. 
• All Mike’s decisions should not be on his own best interests but on James’ and Samuel’s best interests.
• The situation is more complex when it appears that Samuel has to offer his kidney. It is ethical to ascertain whether the deal is fair for Samuel. 
• Undoubtedly, James deserves the right to proper treatment, including the transplant, and many people want to donate, only that they are not compatible. 
• It is also fair to consider Joanne’s perspectives on the matter since an inclusive decision-making approach leads to better decisions.    

The principles of beneficence, non-maleficence, autonomy, justice, and fairness dictate most of the medical decisions (Principles of Medical Ethics. 2019). All these principles are medically significant, but Christian world views consider some as more significant than the others. The Bible expects Christian to do what is right and avoid harm. Also, the teachings require people to treat each other fairly and ensure justice to everyone. God gave people the power to make individual decisions (Reilly, 2006). In this perspective, autonomy seems to bear more weight since the parents made uninformed decisions to place the life of their son under Christian Faith rather than allowing him to undergo dialysis.  Physicians are required to respect the patient’s autonomy in making healthcare decisions (Parsapoor, Parsapoor, Rezaei, and Adghari, Iranian Jouranal Of Pediatrics, 2014). Throughout the case study, decision making has appeared to be very significant in any situation. Making the right decision is hard, especially when there is a conflict of interest. The Bible teaches that people should pray to God who would help them make the right choices.

Christians should do what is right and bring no harm. The principles of beneficence and non-maleficence seem to bear a lot of weight too. James’ parents think it is right to place faith in God. However, the decisions worsen James’ conditions. Parents are reluctant to let James undergo dialysis as it can be harmful. Also, the parents are not willing to let Samuel give out his kidney since it can be harmful. There have been cases where parents refuse medical treatment basing on faith affiliations (Black, 2006). Religious objectives and legal precedents correspond, and many scenarios can be seen in the bible. The Bible expects us to respect the authority of the scissor who dictates rules and laws on earth. The constitutions require justice and fairness for everyone, and seemingly, Christians also emphasize a lot on justice and fairness. 

All the principals are essential for Christians, but creating the right balance can help make the right decisions. The Bible says that faith without action is dead. It is fair to think that Christians should believe that God can heal, but medical treatments should be part of the action, instead of leaning on faith alone. Many doctors are Christians, and they believe they can offer treatment, but the healing comes from God. As the principles impact decisions, Christians should relate them with the immediate circumstance. In every choice, it is vital to determine if it is ethical, just, and fair to the subject. Especially in cases where the parents have to make decisions for their kids, they have to ascertain whether the decisions are right for them or their children. They should ask themselves, “If the kid was in a position to decide, what would he want?” Creating the right balance is a challenge as many Christians fear being perceived as people of little faith. Kidney failure is mostly a matter between life and death if proper treatment is not administered.

Beneficence imposes on people to do what is right. In such a circumstance, a Christian needs to determine whether medical treatment is right and can improve the quality of life. If medical treatment is the best option, they can go ahead. Non-Malificence refers to no harm, but some medical procedures such as surgeries bring harm for the better (Carr & Winslow, 2017). In this case, parents fear the dialysis procedure as it can be harmful. However, the procedure is the only intervention, and as Christians, they should consider it since it can save a life and improve James’ well-being. Autonomy involves individuals’ decisions, and Christians should make decisions that impact others positively. In this case, leaning on faith alone was risking life, and Mike should have decided what is right for the child. The temporary dialysis was the only option to relieve James from high blood pressure and fluid buildup. Christians are also expected to treat others fairly, and every decision made should be just (Gillon, 2018). Mike needed to ask himself if refusing the medical procedure was just and fair to James. Critical decisions should be made according to circumstance and not believes of what is right or wrong because we might as well be wrong thinking we are doing the right thing.