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QUESTION
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Case study
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?”
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| Subject |
Nursing |
Pages |
11 |
Style |
APA |
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Answer
Applying the Four Principles: Case Study
Part 1: Chart (60 points)
Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information by means of bullet points or a well-structured paragraph in the box. Gather as much data as possible.
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Medical Indications
Beneficence and Nonmaleficence
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Patient Preferences
Autonomy
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· Early dialysis for James at onset of acute glomerulonephritis to avoid further complications.
· Not denied James appropriate therapy.
· Advising James’ parents about the need of kidney injury after diagnosis of kidney failure.
· Giving proper education to James’ parents.
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· Allowing James’ parents to take James to a faith healer regardless of best medical advice that James required temporary dialysis.
· Allowing James’ parent to give consent on whether they Samuel, James’ twin, will donate one kidney to James.
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Quality of Life
Beneficence, Nonmaleficence, Autonomy
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Contextual Features
Justice and Fairness
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· Providing James with daily rounds of dialysis till Mike and Joanne give consent to allowed medical team to extract one kidney from Samuel to help safe James’ life.
· Not performing kidney transplant until James’ parent’s give consent.
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· James has a right to life, therefore, daily rounds of dialysis to be provided with the hope that kidney transplant will be performed within one year.
· James should not be refused appropriate care and treatment to punish Mike and Joanne for refusing best medical advice earlier in favor of faith-based healing.
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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)
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According to the Christian worldview, four ethical principles need to be redefined and weighted to address James’ current healthcare needs. The four boxes approach can help in redefining and weighting the four ethical principles. Considering that James is now critically ill and in need of a kidney transplant to save his life for the long-term, ethical principle of beneficence comes in first in this case. Interventions should point towards saving James’ life and improving his health and wellbeing. The ethical principle of non-maleficence should come second with education of Mike and Joanne that their earlier decision of refusing temporary dialysis in favor of faith-based healing led to deterioration of James’ condition; therefore, they should consent to kidney transplant this time round to the best medical advice to save James’ life. The ethical principle of justice and fairness should come third since Mike and Joanne need to be informed to make decisions in a way that they will be just and fair to their son to save his life rather than stick to their faith-based healing option, which has not shown better results previously. The ethical principle of autonomy comes in last since the decision to perform kidney transplant depends on whether James’ parents will give informed consent for the procedure (Millum & Bromwich, 2021). Failure to consent means that the family will incur heavy medical costs of care for dialysis as long as James is alive, with no hope for recovery in the future.
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- 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)
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According to the Christian worldview, many considerations are required in order to balance each of the four ethical principles with relevance to the provided case. First of all, one needs to balance the ethical principle of beneficence and non-maleficence. With focus on religious views, one should do good for others (beneficence) and not plan or do evil or harm others since it contravenes religious beliefs. In this case, James’ parents and the medical team need to act in a way that they are doing good to James and not to harm him. In which case, James’ parents need to be convinced to allow for kidney transplant to go on and apply their religious beliefs and faith that they will realize better outcomes in James and that Samuel will not be harmed as a result of donating one kidney to his twin brother (James). As a Christian, God gave human beings the ability to make their own decisions and making a decision (ethical principle of autonomy) to give informed consent for kidney transplant is inline with God’s will since it will result in good outcomes (Shah et al., 2021). On the other hand, according to the Christian worldview and the ethical principle of justice and fairness, God gives and takes life and as such, James has a right to live; hence, James’s parents should make a decision that favors James’s survival rather than his demise so as to fulfil God’s will. In which case, they ought to give consent for kidney transplant.
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References
Millum, J., & Bromwich, D. (2021). Informed consent: what must be disclosed and what must be understood? The American Journal of Bioethics, 21(973), 1-19. http://dx.doi.org/10.1080/15265161.2020.1863511
Shah, P., Thornton, I., Turrin, D., & Hipskind, J. E. (2021). Informed consent. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430827/
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