Benchmark – Patient’s Spiritual Needs :Case Analysis

Benchmark – Patient’s Spiritual Needs: Case Analysis

PHI-413V

Ethical Decision Making and Patient Autonomy

As I have said in my previous paper, it remains unclear as to how much James is involved in the deliberation in these decisions. If it is truly Mike who is making these decisions without James, then it is a clear disrespect for his autonomy. James was, before the decline in his health, a fully healthy individual with no mention of aphasia or deafness in the case study. Therefore, he could fully make these decisions. Respect for autonomy is defined as “A principle that requires respect for the decision making capacities of autonomous persons.” Whether or not these decisions have been helpful or harmful to James, the fact that he can speak for himself and that he is not too young of a child means that he can take part in the decision making process. Even if he was considered too young, or the strain that the now constant dialysis having left him incapacitated in terms of making a decision, from a bioethical standpoint Mike would be considered irresponsible. As stated by (Meilander, 2013 p 99), “Our task is not to judge the worth of this person’s life relative to other possible or actual lives. Our task is to care for the life he has as best we can.” Mike is basing his decisions on faith based healing he has witnessed from others in his community. This is completely irrelevant to James’ case and as in there has been no sign of deliberation seen in the case report, it seems as though there is more of a disrespect to James as a person and James’ autonomy through Mike. Therefore, I believe that the physician allowing Mike to make these harmful decisions is a definite violation of the autonomy of the patient.

The Christian Worldview, Beneficence and Maleficence

Christians in particular should think of sickness as being a means of God working through them. The Gospel of John chapter 9 talks about a man healed by Jesus and who is res[onsible for the man’s ailment. Jesus replies “ Neither this man nor his parents sinned,” said Jesus, “but this happened so that the works of God might be displayed in him.”’ There is a call to people, such as healthcare workers or ministers to care for those around us so that we can reach a state of shalom, that is why those who suffer in the world are part of that vocation. As stated by (Shelly & Miller, 2012 pp 141-142) “He gives to the sufferer the dignity of being united with him in his own suffering, and he gives to all of us the duty of attending to the sick, directing and freeing us thereby to show compassion to all who are ill.”). However, that does not mean that one should aspire to be sick or to not maintain themselves, as sickness seems to be a conduit to God’s actions and grace. We must respect Imago Dei, the concept that we are made in God’s image. Shelly & Miller, 2012 p 73) states “Recognizing the imago Dei in each human being does suggest that we have a special place in God’s plan, with serious moral consequences.” as we are created in God’s image and have a purpose in mind, we should strive to keep ourselves in good health to live out this purpose.

As medical intervention is part of the vocation of those who are called to that care, I believe that a Christian should view medical intervention positively. They should also keep in mind the different principles that a medical professional have in their mind as to make sure that the utmost care is being brought to their patients. Christians should also view medical intervention as something that may be necessary whether or not it may seem counterintuitive to what they consider to be faithful. To trust in God’s plan would also be to trust in how God works through the care of the healthcare workers. Mike as a Christian should at this point allow his son to receive dialysis and favor the possibility of a kidney transplant from James’ twin. A person who has one kidney has no significant decrease in quality of life than a person with two kidneys. Also, though there may be an argument for there being a test of faith, God would not favor putting a life unnecessarily in jeopardy for the purposes of faith (Meilander, 2013 p 23).

The aforementioned paragraphs have gone into depth about the relationship between the Christian narrative and the vocation of healthcare workers, and the principles they hold to care for their patient. This all culminates into evidence that the Christian narrative would compel Mike to trust in the advice of healthcare professionals. It seems as though James is using the fact of faith-based healing to make a determination in his child’s health, though doing so misrepresents the Christian narrative. As (Shelly & Miller, 2012 p 22) states, “Part of the pain of human life is that we sometimes cannot and at other times ought not do for others what they fervently desire…We should not act as if we believe that the negative, destructive powers of the universe are finally victorious.” To believe that matters of faith are the key to end suffering within an individual is against god’s plan. Therefore the desire to do good by James would be misguided in how Mike currently thinks, and may be in conflict with the honoring of both beneficence and nonmaleficence of James. True beneficence would respect the intellect and vocation of the healthcare workers and ultimately see the limit of suffering being ended through faith alone.

Impact of a Spiritual Needs Assessment on Interventions

There seems to be a significant enough difference in opinion between Mike and the physician in terms of intervention for James. All too often this kind of difference of opinion cannot be resolved without proper communication. This is talked about in detail by (Moulton & King, 2019 pp 85-86) who, on the perspective of patient decision making states, “In today’s medical practice, patients frequently receive either too little information to make an informed treatment decision or too little physician opinion to feel confident in their choice. Shared medical decision-making can accomplish this goal by promoting patient autonomy, while also promoting physician beneficence.” The physician may not be communicating the information of the decision in a way that caters to Mike’s worldview. There was no mention of the physician conducting a spiritual assessment, formal or otherwise. Because of this, There may be a chance that Mike makes these faith-based decisions due to his lack of confidence in the treatments outlined. The benefit of a spiritual assessment is twofold. The first benefit is in the information that can be gathered in terms of the patient’s wishes and how they would base their decisions. For example, the Joint commission’s recommended questions in their spiritual assessment include certain leading questions, such as “what does suffering mean to you” and “what helps you get through this healthcare experience”. A physician can use these in collaboration with the Mike and James in order to keep the patient’s best interests in mind while determining the interventions moving forward. Also, given how closely tied Mike is to his religion, the second benefit would be in the connection a spiritual assessment (especially an informal spiritual assessment) can create with him. (Anandarajah, 2005) talks about how important this kind of connection can be for a patient, stating: “If done in a compassionate, culturally sensitive way, it can help provide a great deal of relief to our suffering patients.” This catharsis is clearly something that Mike can need in his time of spiritual crisis, and that in itself can create enough of a connection with the physician that the collaboration in the decision making process can be much easier.

References

Anandarajah, G., M.D. (2005). Doing a Culturally Sensitive Spiritual Assessment: Recognizing Spiritual Themes and Using the HOPE Questions. AMA Journal of Ethics, 7(5). doi:10.1001/virtualmentor.2005.7.5.cprl1-0505

Meilaender, G. (2013). Bioethics: A primer for Christians(3rd ed.). Grand Rapids.

Moulton, B., & King, J. S. (2010). Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice. The Journal of Law, Medicine & Ethics, 38(1), 85-97. doi:10.1111/j.1748-720x.2010.00469.x

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing(2nd ed.). Downers Grove, IL: IVP Academic/InterVarsity Press.