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Biomedical Ethics in the Christian Narrative 5

Biomedical Ethics in the Christian Narrative

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?”

Part 1: Chart (60 points)
Based on the “Healing and Autonomy” case study, fill out all the relevant boxes below. Provide the information using bullet points or a well-structured paragraph in the box. Gather as much data as possible.

Medical Indications

Beneficence and Nonmaleficence

Patient Preferences

Autonomy

James presents to the hospital with kidney failure due to acute glomerulonephritis. This is secondary to a streptococcus infection of the throat. The condition is further worsened by high blood pressure and fluid accumulation. The physician considers dialysis as the most appropriate treatment modality to alleviate his condition. His parents instead choose to go for prayers rather than dialysis.

James is a minor hence he cannot make decisions about his health. His parents discuss the option and opt against dialysis. The physician does not coax them. Instead, the physician respects their decision, and in so doing the physician respects the autonomy of James’ parents.

Quality of Life

Beneficence, Nonmaleficence, Autonomy

Contextual Features

Justice and Fairness

After two days, James’ parents take him back to the physician after his condition worsened. The physician places him on dialysis which should be done regularly. This improves James’ condition as he is now stable. However, he still needs a kidney transplant within a year and the doctor advises his parents that the only compatible donor is James’ twin brother. The physician does not coax them into accepting his idea thus respecting their autonomy.

James’ parents seem to make their healthcare decisions about their ailing son based on religious faith as they opt to take their son to a pastor for prayers rather than having him undergo dialysis sessions. Mike’s fairness to others is also put to test as he prefers to have friends and church members donate a kidney to James rather than his other son Samuel doing so. At the same time, he is still relying on faith to determine whether Samuel should or should not donate a kidney for James.

Biomedical Ethics in the Christian Narrative 1

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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:

1. 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)

In James’ case, all the four principles are at stake and thus need to be put into critical consideration. In this case, the physician practices beneficence as he wants what is good for James when he proposes that James needs immediate dialysis. His parents however exercise autonomy when they decide against the treatment modality but instead decide to take him for prayers. However, this is also an act of beneficence as they believe he shall get cured via prayers and at the same time show non-maleficence as they think dialysis is so painful for their son. When James’ condition does not improve after prayers, his parents take him back to the physician and accept dialysis for James which is an act of beneficence and indeed his condition improves as he is said to be stable after dialysis. However, the doctor finds out that he still needs a kidney transplant within a year and all those who are willing to donate a kidney want what is good for him, but none is compatible. It can only be described as justice and fairness when the doctor identifies Samuel as the only compatible donor. However, his parents grapple with the matter as they ponder on Samuel losing a kidney which they perceive would harm him and thus exercise non-maleficence. Here, James’ life is at stake thus the most important principle, in this case, is beneficence as life needs to be preserved due to its sacred nature at all costs (Beauchamp & Childress, 2001).

2. 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)

According to Christian teachings, the greatest commandment is that of showing love to one another. This directly coincides with doing what is best or good for others which is the principle of beneficence. Considering this particular case, James needs a kidney transplant within a year lest he loses his life (Teven & Gottlieb, 2018). Mike should accept Samuel to donate the kidney to save his brother’s life. Next comes the issue of nonmaleficence which is not harming a person or in this case the patient. In this case, the impact of donating a kidney on Samuel’s life takes center stage. However, if both kidneys are normally functioning, no harm would be done by donation of one since a single kidney is as effective as a pair of them. Upon considering the principle of autonomy where healthcare decisions should be patient-centered, and the patient granted free will and wish. However, it is important for the physician to clearly explain to James’ parents the graveness of the matter to make an informed decision. Although Samuel is a minor, his parents might need to discuss with him the matter since he is the one to lose an organ so as not to just have him donate his kidney without considering his feelings simply because he is a minor. Since justice and fairness deal with equity and treating all persons equally, it is only fair and just for Samuel’s parents to consider him as the next person to donate a kidney to his brother after theirs are found incompatible. By so doing, they will have shown fairness to others by accepting the complications that may arise from the procedure to be felt by the family rather than passing the burden onto nonrelatives.

References:
Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford University Press, USA.

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.