Healing and Autonomy Case Study

Healing and Autonomy Case Study

Grand Canyon University: PHI-413V

Healing and Autonomy Case Study

It this case study, readers are presented with the scenario of James, an eight-year old with end stage renal disease (ESRD) who requires a kidney transplant in order to save his life. The child had suffered a strep throat infection which due to complications and failure to be dialyzed developed acute glomerulonephritis and, subsequently, ESRD. This case poses several delicate questions. Should parents be allowed to refuse life-saving treatments for their children based on religious beliefs and autonomy, despite a preponderance of evidence-based medicine indicating that kidney transplants can result in life preservation and improve a patient’s quality of life? Should physicians and ethical review boards based on their medical expertise and knowledge be allowed to weigh in on the final decisions to treat minors in order to preserve their lives even if such decisions go against the faith or beliefs of the parents? Should children who are old enough to understand their medical condition in simple layman’s terms be allowed to make decisions about their lives with medical guidance, even if it conflicts with their parent’s decision? At what point should the state intervene? This author will attempt to shed light and answer the above questions based on the Christian biblical perspective and the ethical principles of autonomy, justice, beneficence, and nonmaleficence. It is also important to know that religious freedom is protected by the constitution and that answers to the above questions are difficult to answer as there is not one universal moral view.

From a Christian perspective, men are created in the image of God as rational human beings with free will and decision-making capabilities that can impact their lives and the lives of others. In this case, Mike decided to not dialyze his son, James, who had developed acute glomerulonephritis from strep throat. Instead, Mike decided to trust on his religious faith for a miraculous healing. Many nursing theorists like Leininger affirm the important role that cultural and spiritual beliefs play in determining the acceptance of professional medical treatments. The bible gives many examples of miraculous healings both in the old and new testaments’ books of Jacob, Isaiah, and Mathew. Biblically, Christianity teaches that Jesus performed many miracles and emphasizes the importance of faith in spiritual and physical healing. It appears that based on a sermon, a witnessed healing, and deep religious convictions, Mike made the costly decision not to dialyze his son which resulted in James’ ESRD. Mike and his wife, Joanne, are faced with another critical decision of whether to allow Samuel, James’ twin brother, to donate a compatible kidney.

From a Christian perspective, disease and death is a product of sin which occurred when Eve and Adam disobeyed God and ate from the tree of knowledge (Genesis 3: 1-6 NKJV; & Elder, 2000). Disobedience to God’s directive marked the birth of sin and the fall of man. Sin alienated mankind physically and spiritually from God, and it resulted in the curse of death, sickness, disease, famine, and pain for all of mankind (Genesis 3: 16-19 NKJV). Death, illness, and suffering were not originally created by God but was devised by Satan and executed by man when they ate the forbidden fruit in the Garden of Eden (Genesis 3: 1-6 NKJV).

According to the bible, Jesus died for our sins so that we can be forgiven and attain salvation, health, and eternal life (John 3: 16-17 NKJV). The Bible declares that God is concerned not only with our eternal salvation but also with our well-being, happiness, and health (Revelation 21:4 NKJV; & Stetzer, 2012). Jesus performed many miraculous healings during His ministry (Mathew, Mark, and Luke). It is this author’s perception that Mike made the decision not to dialyze James because he was in spiritual turmoil, and the physician – other than providing medical advice – did not encourage him to seek pastoral/spiritual guidance. Perhaps, if Mike and Joanne had been provided with spiritual counseling, their decision might have been different, and James would not need a transplant. It is this author’s view that in this case, the physician and a medical ethical review board should have intervened on behalf of James so that he could have been dialyzed. This author believes that failure to dialyze James was a violation of his human rights, right to healthcare, and autonomy as a living human being. The physician’s failure to advocate on behalf of his patient, James, did not uphold the ethical principles of justice, beneficence, and nonmaleficence (Lawrence, 2007).

With respect to having Samuel donating a kidney to his brother, I think that his parents should allow him to decide whether he wants to do so. From a bioethical moral perspective, a child is a human being with inalienable rights who can think and experience happiness, pain, and suffering. The principles of autonomy, beneficence, nonmaleficence, and justice are equally important in ethical decision making. This author believes that most children based on the principle of beneficence would want to save their siblings’ lives. Mike should not solely decide for his wife and son whether Samuel should or should not donate a kidney because this violates the autonomy of Samuel, James, and his wife. Failure to receive a kidney could result in James untimely death. Death is harmful and, hence, it violates the principles of justice, beneficence, and nonmaleficence (Lawrence, 2007). A loss of a brother would be far more traumatic to Samuel and the family than the loss of a donated kidney on behalf of Samuel to his brother.

If one reads the New Testament, one sees that Jesus dedicated a large portion of his ministry to healing the sick. From a Christian perspective, a kidney donation from Samuel to James would be a lifesaving, healing measure and an ultimate demonstration of love and compassion to his brother. Jesus stated that there is no greater commandment than love. One should love God above all and one’s neighbor as he loves himself (Mathew 22: 36-40 NKJV; & Mark 12: 30-31 NKJV). It is this author’s perception that based on biblical teachings, a supportive argument for organ donation could be made. Most Christians support organ donation because life is sacred and divine and as such should be cherished and preserved (Elder, 2000). The bible teaches that God gives wisdom and knowledge (science) to man so that His glory could be manifested (Proverbs 2: 6-7 NKJV). In other words, biblically all science comes from God, and He has allowed man to become wise so that he can better himself and the lives of others. A kidney donation from Samuel is an unselfish act of love and would save James’ life, allowing him to live and prosper. On the other hand, failure to donate a kidney will bring death, regrets, and a lifetime of suffering and grief for Samuel and his parents. Mike, Joanne, Samuel, and James with guidance from their physician and spiritual counselors should make the organ donation decision based on the available risk factors and physical and holistic benefits of the donor-recipient. Such a compassionate, collaborative, complex decision-making process would adhere best to the ethical principles of autonomy, justice, beneficence, and nonmaleficence (Lawrence, 2007).

In conclusion, children are human beings that possess inalienable rights and parents should include them in the decision-making process when making decisions that can adversely affect their health. Physicians, healthcare providers, and medical review boards should responsibly advocate for children in cases where parental decision-making places their lives in danger. It is this author’s opinion that the physician taking care of James failed to medically advocate for him. Though Mike, the father, meant well in attempting to trust his faith, the outcome resulted in dire consequences for James, his brother, and the family. This author believes that from a biblical perspective, organ donation is acceptable, and that Samuel should be allowed to donate a kidney to his brother. This is the ultimate expression of love as it adheres to one of the Bible’s most important commandments that one should love his neighbor as he loves himself (Mathew 22: 39 NKJV; & Mark 12: 31 NKJV). The decision to donate an organ is mindful of the ethical principles of autonomy, beneficence, nonmaleficence, and justice (Lawrence, 2007).

References

Elder, H. A. (2000). A biblical perspective on disease, health, and healing. Silver Spring: Institute of Christian Teaching. Retrieved January 5, 2019, from http://fae.adventist.org/essays/26Bcc_267-303.htm

Gordon, J.-S. (n.d.). The idea of moral status in bioethics. Retrieved January 5, 2019, from https://www.iep.utm.edu/bioethic/

Lawrence, D. J. (2007). The four principles of biomedical ethics: a foundation for current bioethical debate. Journal of Chiropractic Humanities, 14, 34-40. Retrieved January 5, 2019, from https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105887311&site=ehost-live&scope=site

Parker, M. E., & Smith, M. C. (2010). Nursing theories & nursing practice. Philadeplphia: F. A. Davis.

Stetzer, E. (2012). The big story of scripture: Creation, fall, redemption, restoration. Retrieved January 11, 2019, from https://www.christianitytoday.com/edstetzer/2012/november/big-story-of-scripture-creation-fall-redemption.html

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