Ethical Theories and Approaches Case Study 2022

University
Case Study
Ethical theories and Approaches
Student Credentials
1/21/2020

Law and Ethics 1
Introduction
Healthcare is a complex field, covering various aspects, and this complexity results in
different ethical dilemmas. One of such complexity stems from the clash between autonomy
and paternalism. There is the case of consent of the patients covered in autonomy principles
and the education/experience levels of doctors covered in paternalism principles (Conly,
2013). The ethical dilemma underlining this clash is the question of whether the patient
should be allowed to make choices for their health even when this puts them in danger,
specifically when the doctors are aware of such danger, both based on their knowledge and
experience. In such a case, a doctor is bound to work in favour of the patient, based on the
Hippocratic Oath. However, if they do so, the consent of the patient or the right which the
patient has to deny a treatment owing to the principle of autonomy, is put at risk (Maehle &
Geyer-Kordesch, 2017).
This very clash between autonomy and paternalism is evident in the case study of this
discussion. This case involved a patient who had been admitted for a caesarean operation in
hospital. This situation raises many questions, touching upon the base of ethical dilemma
covered in previous part. Here, the doctors accepted the autonomy of the patient, and yet had
to bear the consequences of this decision. This discussion focuses on analysing the case
study, based on the varied ethical principles present in healthcare field, including a discussion
on autonomy, beneficence, non - maleficence and justice (Kirchhoffer & Richards, 2019).
In order to understand the below mentioned data, one needs to understand what is ethical
dilemma and how it affects the decision making of individuals while dealing with crucial
situations. An ethical dilemma is a kind of a paradox where there are two moral
circumstances which are both a possible way to deal with the situation in question. There is
no certain way or specific manner to deal with these kinds of situations (Macklin, 2019). The

Law and Ethics 2
situation becomes complex or harder to deal with when following one way with in any way
impact as a negative thing over the other. These kind of conflicting scenarios are a common
sight in moral philosophy and inflict upon how one channelizes their morals. This is widely
known as ethical paradoxes. These kinds of dilemmas generally are used in order to prove
any kind of moral code or even an ethical thinking in circumstances as such or also in cases
where such other or similar paradoxes are there and to resolve them as well (Naeem, 2019).
Autonomy
Autonomy in general relates to three major things, individual responsibility, consent and the
person without the capacity to consent. These things are covered under the UDBHR of
UNESCO under the articles 5, 6 and 7 (Rippel et al., 2016). The principle behind autonomy is
taking a step towards the benefit of oneself. It plays a vital role in regards with bioethics.
Wherever autonomy is concerned or studied, there are various clashes as to what constitutes
autonomy. According to a few, two major conditions are necessary which includes: the status
as a specialist and the freedom as well. In relation with the freedom regarding the choice,
there needs to be an absence of any kind of controlling or coercive aspect which influences
the other to take a certain decision out of their will (Dauber, 2020).
To explain it further, in a medical or clinical context, medical professionals should not in any
way try to influence the decision making of another individual or the patient in this case. By
the consent, one specifically agrees to the knowing what procedure or treatment is going to be
provided to that particular patient or individual in question (Griffith, 2016).
Ethics in itself is a criterion that needs to be rendered to in certain scenarios (Feldman et al.,
2018). Dilemmas such as, the one where a person has to take a certain decisions so as to
ensure the wellness of the other or to take care of the best interest of the person in question
are generally pursued after the analysis regarding the circumstance is made (Nakazawa et al.,

Law and Ethics 3
2016). This analysis is done on the basis of some ethical theories and approaches. These help
in the proper decision –making in crucial circumstances (Wilkinson & Savulescu, 2018).
It is a fact that consent is necessary and similarly is a human right to be heard and be able to
take decision that is not forced in any manner very important. However, they can be
considered only to an extent (JPAC, 2014). The physicians in general and the medical
practitioners are in many ways ethically as well as legally responsible for their patients
(Sacks & Koppe, 2019). (City Hospital, 2020). (Albuquerque & Garrafa, 2016).
In the above mentioned situation, ethical thing here would be to tell the husband as well as
the wife who was going to face the treatment that what will be repercussions regarding the
non – treatment. As soon as the doctor or the medical practitioner found out about the critical
situation, the ethical thing to be done here was to discuss the whole scenario in detail with the
couple. Though the autonomy was in the hands of the wife here and the death could have
been prevented by providing apt treatment then and there.
Consent
Consent plays a very important role in every case. Specifically in the cases, that in some or
the other manner relate to the medical profession it plays the role of a life saver as well as
provides the assistance to the medical professionals as in how the patient wants things to be
done (Heywood & Macaskill, 2010). Though in most of the cases, the medical practitioners
have to work along the lines of instructions of the patient or their family, but in certain cases,
it can be forced upon to the patient as well (Murgic et al., 2015).
Human Rights
Human Rights are very necessary and they play another very important role in the medical
profession as according to them one can decide upon what kind of treatment they want and
there are several options from which they can opt (Knox, 2017). Article 3 of the Human

Law and Ethics 4
Rights Convention talks about the treatment when done upon a patient, it needs to be with the
consent of the person or the patient or their family member else, it shall be considered an
inhumane or torturous treatment on part of the medical practitioner (Morawska, 2016).
In a case quite similar to this scenario is the case of Herczegfalvy v Austria 10533/83, [1992]
ECHR 58, (1992) 15 EHRR 437, [1992] ECHR 83, in which it was declared that breach of
this article can lead to the treat being declared as inhumane (European Court of Human
Rights, 2020). Though there are exceptions to this also, when the justification provided by the
medical practitioner is valid, or the court finds that the patient indeed required such treatment,
then court may decide things in favour of the practitioner as well (Griffith, 2016).
Association between the two
In critical situations where both consent and human rights cannot be considered or there is a
dilemma regarding the decision that has to be taken, in these situations, ethical approaches
can actually help with the decision making, however, only to an extent these can be used to
make decisions (Müller & Schaber, 2018).
Consent of a patient related to the medical treatment they are going ahead with is provided by
the patient on their own. Next of Kin or the so called NOK and the DNR as well or the Do
not Resuscitate are two another aspects that can be rendered to where treatment or medical
aspect is there (Korc-Grodzick & Tew, 2017). It is a choice or consent to permit an
intercession and is definitely not a solitary occasion however a constantly advancing
procedure. The capacity to settle on such a choice is characterized as limit. This must be
educated and liberated from coercion, which may appear to be troublesome given varieties in
individuals and how they take or consider the situation at that time. Grown-ups are expected
to have a certain limit until demonstrated generally and have the right to settle on choices that

Law and Ethics 5
others may believe are unwise as specified in the Mental Capacity Act 2005
(Legislation.gov.uk, 2020).
There is no doubt, that in the modern world, there are widespread options or alternatives that
can be certainly opted for or any other methods used when there are scenarios where
dilemmas are concerned (Bogaert & Ogunbanjo, 2014). Here in such cases, there is an ethical
dilemma that revolves around the attending doctor (Kirchhoffer & Richards, 2019).
Especially in cases where there is emergency and there is no one to give consent.
(Albuquerque & Garrafa, 2016). In the situation mentioned, the doctor clearly took the
consent from the wife and it was her decision to not get a transfusion done. Even when the
doctor in this scenario followed the consent of the wife or the patient here, faced the charges
filed by the husband. The ethical scenario here is even if the doctor worked as per the consent
of the patient, he still gets sued and if he does not follow the consent and works as per the
best interest of the individual in emergency situation, still gets sued for breaching human
rights.
Beneficence
Beneficence refers to merciful and charitable act done with the objective of attaining moral
good (Colgrove, 2019). The present case study is not the only instance where the fact that a
person cited their religion to avoid a treatment resulted in negative impact for them; and this
has been discussed time and again (Richardson, 2017). In this scenario, the act of the doctors
could be considered as a merciful one as they worked in accordance with the wish of the
patient and did not imply their own theories. If they would have transfused the blood and
saved the life of the patient, even then it was not sure that as a result of everything patient
would have been fine. She could have had a mental breakdown and things could have
impacted her on a psychological level as well.

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When consent cannot be provided in such cases or actions need to be taken as an emergency,
then, the medical practitioners confide in the one who holds the power of attorney in these
cases. Power of attorney is another very important instrument that can be helpful in making
necessary decisions (Practical Bioethics, 2020).
The Fraser Guidelines and the Gillick Competency is another very necessary mode to
understand as to how the treatment needs to be provided as such to the patients. In order to
maintaining a balance between both, the wishes of the patients as well as doing what is best
for them. These guidelines and ways help out the medical practitioners to take apt decisions
in critical situations (Pemberton & Macpherson, 2018).
Justice
There are chances as to contend that in scenarios that concern such kind of dilemmas, there is
no specific way to deal with in ethical manner. When all is said in done it is acknowledged
that Beauchamp and Childress' four standards are a sound premise on which a moral issue
can be evaluated (ORCA, 2013). Every part is similarly evaluated and to be obeyed, except if
it clashes with the others.
In taking care of justice, one can take reference from utilitarianism principles which demand
the best for majority, or from Kantism which demand that the course of actions decide if
something is ethical or not (Sandel, 2009). Applying utilitarianism principles to the case
study of this discussion, the good here would have been doctors upholding the patient’s right
to autonomy, particularly when underpinned by a religious sentiment. Furthermore,
upholding their choices was the right course of action as per the Kantism principles as that
made the act ethical for the patient as well as for the doctor. Hence, despite the backlash from
the husband, the act of the doctors in this case was just, based on both utilitarianism
principles and Kantism principles (Herschel & Miori, 2017).

Law and Ethics 7
There are certain ethical as well as legal considerations according to which these scenarios
are dealt with. The first one relates to autonomy, along with the skill being included, best
interest of the individual, personal satisfaction and logical components, such as a strict
foundation of the religion; in spite of the proposal by Muramoto according to which the
person's desires are of essential significance and strict contemplations relating to religion
ought to be auxiliary (Bogaert & Ogunbanjo, 2014). The next one is related to beneficence
(actions taken in accordance with the best interest of a person), considering the potential
psychosocial repercussions for a Jehovah's Witness with respect to transfusion. There is also
the involvement of non- maleficence; shirking of causing hurt lopsided to the advantage of
treatment (Martins et al., 2017). Lastly, there is also a need to abide by the principle of justice
that covers all the aspects such as the human rights as well as the legal position
(Chandrasekhar, 2018). Comparable positions with the Mental Capacity Act 2005 are
maintained in Europe (for instance as specified in the Articles 2 and 32 of the Italian
constitutions as well as the German constitution) (NHS, 2020).
As far as the advanced directives are concerned, these are legitimately restricting archives
sketching out the medical attentiveness that an individual would not agree to later on. It can
be made by anybody who is above the age of 18 years while, this changes to just 16 years of
age as specified by the law of Scotland and are normally kept by the patient's general expert,
family, or companions (Coleman, 2013). So as to be legitimate, the accompanying
stipulations must be met. On the off chance that any of these conditions is not met, the
directive as received at the time of emergency might be invalid. Likewise, the specialized
language of a propelled order might be hard for specific people to understand, which could
prompt erroneous documentation of a patient's desires. Therefore, when finishing propelled
mandates patients ought to be advised by doctors as well as prepared experts that are
altogether acquainted with the field of patient blood the executives (N et al., 2014).

Law and Ethics 8
Administration of blood items against the desires of a capable patient is a conceivably
criminal act subject to arraignment. In 1990, Canadian doctors were effectively sued
subsequent to managing blood transfusions ignoring a will of such patient (Maehle & Geyer-
Kordesch, 2017).
There are several major cases which render to the issue here, but the major two cases that
formed the basis of the current laws in relation with the patients in United Kingdom were
settled in nineteenth century itself (Neill, 2017). These include the Poor Law Amendment Act
26 of 1868 according to which the elders or the guardians who are ‘neglecting their kids in
different ways’ these people might be at risk and might be charged upon, including the
scenarios where medical treatments are concerned (Owen, 2019). Queen versus Robert
Downes is another one where the culprit Downes was condemned for the homicide after not
searching for restorative assumption or treatment (an action subject to severe objections),
which was felt that finally provoked the death of his child (United Settlement, 2019).
Non – Maleficence
This aspect refers to the non –harming or the way in which one reacts, which is in the best
interest of another individual. Literally, this associates with an activity which inflicts the
possibility of least harm in order to achieve an outcome that is beneficial. Since, after effects
of harm and harm in itself are something that one analyses in order to take any decision in
ethics related scenarios (de Andrade et al., 2017).
In the above case, non –maleficence is implied as the doctors decided upon not harming the
patient further and respected her will. Even if the doctor would have saved her life by
working in accordance with the best interest, there was no surety that she would have been
saved without any harm. It could have resulted in a much worse scenario as harming an
individual’s religious practice could be taken in any manner by people following it.

Law and Ethics 9
During the decision making process, it is necessary for the person taking decision to critically
analyse the situation and by doing this one can actually contemplate if it is something that is
necessary or not or even harmful or not (LaSala & Goldblatt Hyatt, 2019). When taking a
decision, one needs to make sure that the risk it entails is least and preferably no harm should
be caused due to it. This concept actually assists in reducing the level of harm that can be
caused or will be caused to an individual and the priority here becomes that the other person
does not face any kind of harm or as such (Francis, 2017).
Conclusion
As stated above, there are several methods of completing the treatment, but at the situations
where decisions need to be taken, then the law is always going to support the decision taken
as per the best interest of the patient. Ethical dilemmas are quite common in medical field.
Often, medical practitioners find themselves in scenarios where they have to choose from the
will of the patient and the practical aspect as well which refers to the current situation of the
patient as in the treatments it requires and the kind of consent that is required by the person
upon whom the treatment has to be done.
Though there is a very much need of a specific lead or a certain common law to be taken in
consideration with the cases as such. Still there can be no certain decision taken as it is a
scenario where any decision taken will either violate the basic laws of medical practice or on
the other side deprive civilians of their basic rights to practice religion based upon their
choice. Any strict law in this case will be resulting in either of the side being violated. Under
these scenarios, the medical practitioners or the people associated with it might face another
level of consequences in relation with the same. This will directly or indirectly affect the
other civilians or the other people as well. This bioethical dilemma is what makes the issue
surrounding certain patients so controversial. In the above scenario, it was definitely the

Law and Ethics 10
autonomy of the patient yet the husband also holds certain rights. Doctors could have
thoroughly explained the whole scenario revolving around the treatment to not just one which
is the patient but to the husband as well. Doctors always go through this dilemma when
treating certain patients. Each situation has to be analysed properly in order to take particular
decision.

Law and Ethics 11
Bibliography
Albuquerque, R. & Garrafa, V., 2016. Autonomy and individuals without the capacity to.
Scientific Electronic Library, 24(3), p.452.
Bogaert, D.K.v. & Ogunbanjo, , 2014. Ethics and medicine: Jehovah's Witnesses and the new
blood transfusion rules. South African Family Practice.
Chandrasekhar, S., 2018. Jehovah’s Witnesses. In In Consults in Obstetric Anesthesiology.
Springer. pp.335-37.
City Hospital, 2020. Advanced Directives and Bioethics. [Online] Available at:
https://www.elch.org/Patients-Visitors/Patient-Right-to-Comfort/Advanced-Directives-and-
Bioethics.aspx [Accessed 29 January 2020].
Coleman, A.M., 2013. Physician attitudes toward advanced directives: a literature review of
variables impacting on physicians attitude toward advance directives. American Journal of
Hospice and Palliative Medicine, 30(7), pp.696-706.
Colgrove, J., 2019. Immunization and Ethics: Beneficence, Coercion, Public Health, and the
State. In The Oxford Handbook of Public Health Ethics. p.435.
Conly, S., 2013. Against Autonomy: Justifying Coercive Paternalism. Cambridge: Cambridge
University Press.
Dauber, M.S., 2020. Few Americans Plan For End-of-Life Decisions, Even If They Are Sick.
[Online] Available at: https://bioethics.georgetown.edu/tag/living-wills/ [Accessed 29
January 2020].
de Andrade, J.S., Almeida, M.M. & Pinho-Reis, C., 2017. Bioethical principles and nutrition
in palliative care.. Acta Portuguesa de Nutrição, 9, pp.12-16.
European Court of Human Rights, 2020. Herczegfalvy v Austria. [Online] Available at:
https://hudoc.echr.coe.int/eng# [Accessed 06 January 2020].
Feldman, E.A., Lynch, H.F. & Joffe, S., 2018. Informed Consent and the Role of the Treating
Physician. New England Journal of Medicine, 378(25), pp.19-01.
Francis, L., 2017. The Significance of Injustice for Bioethics. Teaching Ethics, 17(1), pp.1-8.

Law and Ethics 12
Griffith, R., 2016. Using restraint: legal and professional considerations. British Journal of
Neuroscience Nursing, 12(2), pp.94-95.
Herschel, R. & Miori, V.M., 2017. Ethics & big data. Technology in Society, 49, pp.31-36.
Heywood, R. & Macaskill, A., 2010. Informed consent in hospital practice: health
professionals' perspectives and legal reflections. Medical Law Review, 18(2), p.152.
JPAC, 2014. Jehovah’s Witnesses and blood transfusion. In Handbook of Transfusion
Medicine. 5th ed.
Kirchhoffer, D.G. & Richards, B.J., 2019. Beyond Autonomy: Limits and Alternatives to
Informed Consent in Research Ethics and Law. Cambridge University Press.
Knox, Z., 2017. The history of the Jehovah's Witnesses: an appraisal of recent scholarship.
Journal of Religious History, 41(2), pp.251-60.
Korc-Grodzick, B. & Tew, W.P., 2017. Handbook of Geriatric Oncology. Springer
Publishing Company.
LaSala, M.C. & Goldblatt Hyatt, E.D., 2019. A Bioethics Approach to Social Work Practice
With Transgender Clients. Journal of Gay & Lesbian Social Services, 31(4), pp.501-20.
Legislation.gov.uk, 2020. Mental Capacity Act 2005. [Online] Available at:
http://www.legislation.gov.uk/ukpga/2005/9/contents [Accessed 24 January 2020].
Macklin, R., 2019. Common morality and medical ethics: not so different after all. Journal of
medical ethics, 45(12), pp.780-81.
Maehle, A.-H. & Geyer-Kordesch, J., 2017. Historical and Philosophical Perspectives on
Biomedical Ethics: From Paternalism to Autonomy?: From Paternalism to Autonomy? Oxon:
Routledge.
Martins, R., Barreto, J. & Elias, F., 2017. Methods For Ethical Analysis In The Health
Technology Assessment. International Journal of Technology Assessment in Health Care,
33, pp.213-14.
Morawska, E.H., 2016. THE COMPLEX STRUCTURE OF THE ABSOLUTE
PROHIBITION OF TORTURE. COMMENTS IN THE LIGHT OF THE REGULATION

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OF ARTICLE 3 OF THE EUROPEAN CONVENTION ON HUMAN RIGHTS. Espaço
Jurídico: Journal of Law, 17(3).
Müller, A. & Schaber, P., 2018. The Routledge Handbook of the Ethics of Consent.
Routledge.
Murgic, L., Hébert, P., Sovic, S. & Pavlekovic, G., 2015. Paternalism and autonomy: views
of patients and providers in a transitional (post-communist) country. BMC Med Ethics., 16(1),
p.65.
Naeem, M., 2019. Books: Tough Choices: Stories from the Front Line of Medical Ethics.
British Journal of General Practice, 69(681), pp.200-01.
Nakazawa, E. et al., 2016. Ethics of decoded neurofeedback in clinical research, treatment,
and moral enhancement. AJOB Neuroscience, 7(2), pp.110-17.
Neill, C.O., 2017. Jehovah’s Witnesses and Blood Transfusions: An Analysis of the Legal
Protections Afforded to Adults and Children in European/English Human Rights Contexts.
European Journal of Health Law, 24(4).
NHS, 2020. Mental Capacity Act. [Online] Available at:
https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-
else/mental-capacity-act/ [Accessed 06 January 2020].
N, N. et al., 2014. Responses of advanced directives by Jehovah's Witnesses on a gynecologic
oncology service. Journal of Blood Medicine, 6, p.17—23.
ORCA, 2013. A Genealogical Critique of Beauchamp and Childress’ Four Principles
Approach to Medical Ethics. [Online] Available at: http://orca.cf.ac.uk/54192/1/U564710.pdf
[Accessed 24 January 2020].
Owen, S.H., 2019. The Poor Law Amendment Act, 1868. Great Britain: Knight & Company.
Pemberton, M.N. & Macpherson, A., 2018. Patient safety: Never say never. British dental
journal, 225(8), pp.685-85.
Practical Bioethics, 2020. Durable Power of Attorney for Healthcare Decisions. [Online]
Available at: https://practicalbioethics.org/files/caring-conversations/durable-power-of-
attorney.pdf [Accessed 29 January 2020].

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Richardson, J.T., 2017. Update on Jehovah’s Witness cases before the European Court of
Human Rights: implications of a surprising partnership. Religion, State and Society, 45(3-4),
pp.232-248.
Rippel, J.A., Medeiros, C.A.d. & Maluf, F., 2016. Universal Declaration on Bioethics and
Human Rights and CNS Resolution 466/12: a comparative analysis. Rev. Bioét, 24(3).
Sacks, D.A. & Koppe, R.H., 2019. Blood transfusion and Jehovah's Witnesses: Medical and
legal issues in obstetrics and gynecology. American Journal of Obstetrics and Gynecology,
154(3), pp.483-86.
Samanta, A. & Samanta, J., 2015. Medical Law. 2nd ed. Macmillan International Higher
Education.
Sandel, M.J., 2009. Justice: What's the Right Thing to Do? London: Penguin UK.
United Settlement, 2019. THE QUEEN v. ROBERT DOWNES. [Online] Available at:
http://www.uniset.ca/other/cs5/1QBD25.html [Accessed 22 January 2020].
Wilkinson, D. & Savulescu, J., 2018. Ethics, conflict and medical treatment for children:
from disagreement to dissensus. Elsevier.