PHI 413 Case Study on Biomedical Ethics in the Christian Narrative

Applying the Four Principles: Case Study

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:

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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.

PHI 413 Case Study on Biomedical Ethics in the Christian Narrative

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.

PHI 413 Case Study on Biomedical Ethics in the Christian Narrative