ANTH2026 Medicine Healing and the Body | Principles of Autonomy

Case Study: Healing and Autonomy

Ethics entails the moral principles that govern the behavior of a person on behaviors and philosophies of what is right or wrong a certain situation (Denecke et al., 2015). They can be applied to anyone else despite the difference in ideologies. The “case study: Healing and Autonomy”, Joanne and Mike who are the parents of James and Samuel falls under the category of the Christian and Biblical Narrative visions by what we can call as strict followers. Their strict adherence to these narrative visions has put them in the most difficult situation to make a moral and ethical decision to assist their son James who is in a critical situation. Both parents of James are strong Christian believers that have given them faith to believe in God’s miracles in healing. James who is eight years old was initially diagnosed with streptococcus infection and had high blood pressure which was a condition that could be treated immediately. However, his parents link James’s condition to a case where their close friend who had a stroke was healed by a pastor during a sermon. They decide to forego the dialysis and after two days later, they return with a deteriorated condition of James. Their religious autonomy makes it difficult for them to decide whether they should keep waiting for God’s miracles to take place or they should let James to be treated with the physician.

Issues that are most pressing

There are various issues involved in this case which prompts for application of ethics to make the right the right decision. The first pressing issue is whether one should indulge in believing in God’s miracles in the healing or should allow for treatment from a physician under proven scientific methods. These issues are most experienced under Christian vision and narrative, which puts Joanne and Mike under a difficult dilemma. After James was diagnosed with a streptococcus infection, his parents hoped that God would heal him. Their decisions are based on the bible and Christian teachings which are further influenced by what they saw happening to their close friend. Later on, after they found that his condition was getting worse, they come back to the physician to seek medical attention. Christians who believe in God’s interventions typically practice healing through faith. Some of them do not accept to be treated by physicians while others do not seek medical care when sick. The same scenario depicted by Joanne and Mike who forego the dialysis of James, which led to further deterioration of his health. Their decision is solely unethical due to its detrimental effects on James’s life who all this time had been relying on the decisions made by his parents regarding his health condition.

The case can be attributed to the principles of Autonomy, Beneficence, and Non-maleficence with regard to ethical and moral issues. It can also be linked to the teleological theory that states that the nature of the outcomes rely on whether the action taken is right or wrong (Baumane, Cals & Sumilo, 2016). Under the principle of beneficence, the doctor is mandated with the right of keeping the patient away from harm, emphasize on the benefits and risks to parents as well as respecting the parents’ autonomy regarding the choices of healthcare for James. The principle of autonomy requires the capacities of making decisions to be respected with regard to the person’s autonomy (Entwistle, Carter, Cribb & McCaffery, 2010). Therefore, the physician has the responsibility of respecting the decision made by James’ parents of relying on God for healing and treat James. However, it led to further deterioration of James’s status of health.

According to Christen, Ineichen & Tanner (2014) the principle of Non-maleficence requires that people should not cause harm to others which comes into play when the deterioration of James’s status of health. The suggestions and recommendations made between James’ parents and the physician would have worked out for greater advantage of James. However, this does not work out as the physician suggests for treatment immediately but the parents disputed and opted for seeking God’s intervention based on their Christian beliefs. It leads to an emergence of tension between the recommendations of the physician and the decisions of James’ parents over Christian visions and values.

Another emerging issue in this case study is that of organ transplant regarding the kidney. Some Christian faith does not accept organ transplant at all and to them it a controversial issue because they believe that such transplants are usurping the role of God and can ignore the sanctity of life. After further deterioration James’ health, the only option left for him is for a kidney transplant in order for him to keep surviving. It is an option that relied on the decision of his parents on whether they should allow it or not. Based on their Christian faith, this action would be unethical if they could allow the organ transplant. Furthermore, Mike is in a dilemma of whether this round he would have to rely on or ignore his God. Further dilemma escalates with the doctor’s suggestion that the only compatible donor for a kidney transplant is James’s twin brother Samuel. The issue is that both parents in dilemma of whether they should allow their other son to lose one kidney to save the other child James.

The Process of Decision Making

Generally, parents have the right of making decisions on the welfare of the children until they are mature enough to make their own decisions. However, from this case study, Mike seems to be making irrational decisions that have led to further deterioration of their sick child. At the end of the case study, Mike seems to be ignoring the physician’s recommendation of a kidney transplant that should be donated by James’s brother Samuel and argues that it might be God testing his faith. The physician has the responsibility of ensuring that a patient is well treated and quality care is taken on health on an individual.

Healthcare professionals should be able to resolve conflicts of interest for the safety assurance of the patient and ensure that professional integrity is maintained throughout (Hickey & Lyckholm, 2004). In this case, the action of Mike is out of negligence and hence it requires the action of the physician to avoid further escalation of James’s condition. Mike has right to make a decision over the autonomy of his son, should not be allowed to be exercised to an extent that it endangers and threatens the life of James. Therefore, the physician and the parents of James should work together to find the best course of action to save the life of James.

Analysis of the Case according to the Narrative of Christians

In the case, Mike foregoes dialysis in the first scenario opting for religious interventions rather than perceiving the real benefits. In the end, he also argues that it might be God’s test for his faith. Several questions arise from this case regarding the principles of bioethics rendering it a clinical dilemma that requires ethical considerations. Mike might be perceiving the high cost incurred during the procedure of kidney transplant forcing him to forego the whole procedure. As argued by Musto, Rodney & Vanderheide (2014) the physician in this case, should be able to analyze the whole situation, determine the benefits and effects of a kidney transplant to the involved parties, and advise them appropriately.

Christians believe that God views them the way he wants them to be and hence to them it is unethical in this case and should not acceptable before the Lord (Ankeny, Jordens, Kerridge, Clifford & Benson, 2018). James requires kidney within a year and the only donor compatible in this case is his brother Samuel. However, his parents should not be coerced to accept the kidney transplant because medical practitioners are guided by the autonomy principle of the patient. Hence, the physician can only persuade Mike by trying to depict the positive outcomes but not making decisions on his behalf.

How Christians think about Health and Sickness

Christians perceive sickness and suffering as God’s punishment for sin and one of the ways, that God manifests himself in their life (Dein & Cook, 2015). It is the reason why at the end Mike thinks that the illness of his son might be God’s test on his faith. Christian teachings are that one should always trust in God without giving up especially when it comes to sickness. They believe that God provided healing to those who are faithful in him what is observed in Mike’s actions. In this case, Mike should not perceive the sickness of his child as a punishment from God or test of his faith but should allow the procedure of kidney transplant to proceed and should accept Samuel to donate one of his kidneys.

Conclusion

The case study has various ethical issues, which requires the contribution of the physician, and both parents. My personal opinion is that I do not think whether it was the right decision for the physician to allow James’s parent to take him away without having the kidney dialysis. All the decision of mike all this time were wrong which led to further health deterioration of their eight-year-old boy who ended up losing all his kidney. This time, the physician and the parents should mutually work together for the better benefit of James’s health condition.

References

Ankeny, R., Jordens, C., Kerridge, I., Clifford, R., & Benson, R. (2018). Religious perspectives on withdrawal of treatment from patients with multiple organ failure. Retrieved from https://www.mja.com.au/journal/2005/183/11/religious-perspectives-withdrawal-treatment-patients-multiple-organ-failure

Baumane-Vitolina, I., Cals, I., & Sumilo, E. (2016). Is Ethics Rational? Teleological, Deontological and Virtue Ethics Theories Reconciled in the Context of Traditional Economic Decision Making. Procedia Economics and Finance, 39, 108-114.

Christen, M., Ineichen, C., & Tanner, C. (2014). How “moral” are the principles of biomedical ethics? – A cross-domain evaluation of the common morality hypothesis. BMC Medical Ethics, 15(1).

Dein, S., & Cook, C. (2015). God put a thought into my mind: the charismatic Christian experience of receiving communications from God. Mental Health, Religion & Culture, 18(2), 97-113.

Denecke, K., Bamidis, P., Bond, C., Gabarron, E., Househ, M., Lau, A. Y. . . . Hansen, M. (2015). Ethical Issues of Social Media Usage in Healthcare. IMIA Yearbook, 10(1), 137-147.

Entwistle, V., Carter, S., Cribb, A., & McCaffery, K. (2010). Supporting Patient Autonomy: The Importance of Clinician-patient Relationships. Journal of General Internal Medicine, 25(7), 741-745.

Hickey, K., & Lyckholm, L. (2004). Child Welfare versus Parental Autonomy: Medical Ethics, the Law, and Faith-Based Healing. Theoretical Medicine and Bioethics, 25(4), 265-276.

Musto, L., Rodney, P., & Vanderheide, R. (2014). Toward interventions to address moral distress. Nursing Ethics, 22(1), 91-102.