Applying the Four Principles: Case Study

This case study explores the application of the four principles of medical ethics in a healthcare setting. It discusses the principles of beneficence, non-maleficence, autonomy, and justice and their relevance in making ethical decisions. The study focuses on a specific case where the principle of autonomy conflicts with the principle of beneficence.

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.
Medical Indications
Beneficence and Non-maleficence
Patient Preferences
Autonomy
Beneficence, refers to do the treatment and services given to
patients intended to do good to the patient. The doctor should
apply knowledge, skills and experiences to deliver the best
treatment and care to the patients. James was put into dialysis
and later was instructed for kidney transplant by his
nephrologist within a year. Being unaware of medical
treatment, his parents took him for a faith health service that
was complete against medications required at that vital stage.
The doctors should have advised them to make rational
decisions that will not be harmful for James. The doctors are
much aware of James’s physical condition that the requirement
of kidney transplant within the same year. Nephrologists are
even aware of the consequences if he is devoid of the required
treatment. Therefore, being experienced and having expertise,
the doctors should have taken further actions to save the
patient’s life. The doctors should have been responded
following the principles of ethics in health care. Medical
indications are given interpreting about physical status of the
patients justifying clinical judgments and aims to fulfill the
overall goals of medicines. Therefore, the doctors should have
acted and made the parents realize the importance of
medication and treat him accordingly.
The above case study is a perfect illustration of ethical
dilemma faced by the doctor since it is their primary
responsibility to support autonomy and they cannot put
pressure to manipulate the patient’s decisions. The
principle of autonomy has become important in terms of
providing quality care to the patient by respecting the
patient’s choice (Beever, 2016). However, exceptions are
there where doctors makes the patients aware of the
consequences they might face against the wrong decision
they take (Meilaender, 2013). The case study, thus, should
be treated as an exception, where the doctor should let
Mike and Joanne know their son’s condition considering
his health status and make them aware of what should be
done. To have faith in God is what Bible teaches us, but, it
should not contradict with medical science. Knowing the
fact that James will be shifted to faith healing service, the
doctors should have responded and interfered with the
decisions they took considering James condition which
was deteriorating progressively. The case study brings
about a dilemma based on ethical considerations a medical
professional should bring about while treating a patient.
Human beings should possess values and ethics and should
act according their sense of morality.
Quality of Life Contextual Features
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Beneficence, No maleficence, Autonomy Justice and Fairness
Beneficence strikes a balance between the benefits of treatment
against the health issues and the costs involved. Non-
maleficence deals with preventing the causes of harm. Since, a
lot of treatments involve harm in any way, the principle of no-
maleficence implies that the harm should not be proportionate
to the benefit of treatment (Carr, 2017). In order to respect and
value these two principles, patient’s autonomy sometimes put
at stake since the treatment necessary to be provided may not
be desired by the patients and could lead to serious health
injuries. Clinical decisions impacts the quality of life and
therefore must be taken care of under the guidance of
registered physicians (Page, 2012). However, in this case, the
nephrologist should inform the patients on the risk associated
with the refusal and opting for spiritual healing. The physicians
respect the autonomy of the patient having in mind the risks
associated with the treatment pathway they are choosing for
James. Therefore, on the basis of Christian narrative regarding
autonomy of the patient, patients have the right to choose organ
transplantation and treatment refusal. However, in this case, the
decisions made were irrational and associated with impact on
the quality of life and therefore, ethical dilemma seems to exist
between autonomy of patients. Beneficence must be focused in
order to provide services and treatment intended to benefit
patient’s overall health.
Contextual features describes the social, religious, legal
and familial settings influencing one’s clinical decisions
(Gillon, 2018). The ethical dilemma raised here is in the
religious context that made the situation more complicated.
The principle of Justice and Fairness do not imply in this
case. The blind faith of James parents have influenced
them to take the decision to opt for a spiritual healing
service. The decisions had a negative impact on James
health as his condition deteriorated later on. The parents
seems to have a blind faith depending upon which they
gave priority in spiritual healing than what should have
considered to be better for James allowing his kidney to be
transplanted from his brother. The conflict came up when
the ideal match was found from his brother’s kidney which
made difficult for the parents to accept and allow him to
have the transplant. His parents therefore were also willing
to allow transplant from other people including themselves.
However, it can be considered unjust and unfair for James
parents who relied heavily on God for the wellbeing of
their son and made detrimental decisions that eventually
had a negative impact on James health.
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Part 2: Evaluation
Answer each of the following questions about how principlism would be applied:
1. In 200-250 words answer the following: According to the Christian worldview, which of the
four principles is most pressing in this case? Explain why. (45 points)
The principle of beneficence is most persistent in the Christian overview. Christians are
intended to so good and help others (The Bible Project, 2018). However, in this scenario,
the principle of autonomy has been given more importance. The doctors and medical care
services should have taken into account the belief of the parents and incorporate into them
the need of treatment considering his health condition. Christians have faith in spiritual
healing through heavenly intervention more than they have in medical science. Most
Christians have faith in miracles that can happen through spiritual healing. The parents
intended to do good to their son. Therefore, the principle of autonomy relates closely to the
principle of beneficence in Christian Worldview where both the patient’s interests and
development in their health status are considered to be essential (The Bible Project, 2018).
In the case study, James parents depended hugely on God for their son and were motivated
by the healing of their neighbor who was miraculously healed through prayers and faith on
God. The case study represents an ethical dilemma between maintaining autonomy of the
patients and the principle of beneficence. Beneficence obliges physicians to help and treat
the patients aimed at improving their health and intend to do everything within their
control to preserve life. Considering the scenario, the physicians should have guided the
parents who took decisions on his behalf to choose the treatment plan what is beneficial for
the patient since James was minor and has not reach to the age for making autonomous
decision.
2. In 200-250 words answer the following: According to the Christian worldview, how might a
Christian rank the priority of the four principles? Explain why. (45 points)
The ranking is done in such a way that beneficence comes first followed by non-
maleficence, then justice and fairness and autonomy. However, in this case study
autonomy has been given more importance. The doctors respected the decisions of the
parents irrespective of its irrationality. Despite of being aware of the health condition, the
doctors did not guide the parents regarding the treatment he actually needs. Christians
view the principle of helping others through kindness and mercy. The most crucial issue
identified here is the faith they are having in the spiritual healing that comes from
believing God. The parents thought that James would get well though the spiritual healing
by trusting God. However, the healing process did not act accordingly and worsened James
condition. On knowing the fact that James condition, instead of getting better, become
worse, the parents immediately shifted him back to the hospital, therefore, they cannot be
blamed fully. Christians are ought to have practice in justice and fairness in everything.
Christians also allows one another to take decisions associated with autonomy (The Bible
Project, 2018). The parents are faithful on matters that has to do with Christianity and
religion. Therefore, it can be concluded from the above case study the view of the parents
on diseases is from the Christian perspective. They seeks help from God and has faith that
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God only has the healing power. The parents are blind followers of God, but they should
also understand that God helps those who helps themselves (The Bible Project, 2018).
Therefore, when it comes to health and sickness, they should opt for medical assistance.
References:
Beever, J., & Brightman, A. O. (2016). Reflexive principlism as an effective approach for
developing ethical reasoning in engineering. Science and engineering ethics, 22(1), 275-
291
Carr, M. F., & Winslow, G. R. (2017). From conceptual to concrete. In World Religions for
Healthcare Professionals (pp. 31-45). Routledge.
Eby, R. A., Hartley, P. L., Hodges, P. J., & Hoffpauir, R. B. (2017). Fostering ethical integrity in
nursing education. Journal of Christian Nursing, 34(4), 250-255.
Gillon, R. (2018). Principlism, virtuism, and the spirit of oneness. In Healthcare Ethics, Law and
Professionalism (pp. 45-59). Routledge
Manson, L. (2018). Ethical Integrated Healthcare. In Training to Deliver Integrated Care (pp.
213-224). Springer, Cham.
Meilaender, G. (2013). Bioethics: A primer for Christians (3rd ed.). Grand Rapids, MI: Wm. B.
Eerdmans Publishing Company.
Page, K. (2012). The four principles: Can they be measured and do they predict ethical decision
making?. BMC Medical Ethics, 13(1). doi:10.1186/1472-6939-13-10
The Bible Project . (2018, May April ). To understand sacrifice, we must understand evil.
Retrieved from https://thebibleproject.com/explore/sacrifice-atonement/
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