Facts about the Case
The case study revolves around a predicament regarding Sarah Hershberger, a ten-year-old girl born in an Amish family. She is diagnosed with lymphoblastic lymphoma, which is a dangerous type of cancer capable of killing her if not treated with chemotherapy. Her parents, Andy and Anna Hershberger want to terminate the treatment in favor of religiously approved practices, such as herbs and vitamins. The doctors object to this notion, saying that without chemotherapy, the girl would die. The court of Ohio sustained the right of the parents to decide what is medically best for their child, whereas the appeals court reversed the decision in favor of the hospital (Bushak, 2013). The ethical dilemmas of this case include the dispute about the right to make health decisions for the child between the family and the hospital as well as the debate between medical science versus religious practices.
Deeper Insights on the Ethical Dilemma
The outlined ethical dilemma addresses the patient’s right to autonomy. A person, be that a grown-up or a child has the right to determine the course of their treatment (Crane, 2018). The imposing of hospital standards of treatment to overrule such intents overrides patient autonomy. At the same time, the child is not the one making the decision, as she is considered too young to make an accurate and self-determined judgment without being influenced by either party.
The parents making the life-or-death decision for their child, however, could also be interpreted as a violation of their autonomy. The issues of nonmaleficence and beneficence are central to the medical side of the argument. Failure to provide life-saving treatment could be considered an act of maleficence, whereas taking actions to ensure the child’s recovery could be constituted for benevolence (Crane, 2018). The issue of fidelity is central to the parental side of the argument, who is Amish, thus deeply religious. Their faith prohibits them from utilizing technology to prolong their lives, meaning that by accepting chemotherapy, they are effectively betraying their faith. The justice part of the argument concerns the right of the child to live a long and healthy life, which is at stake in this debate.
Principles Involved in the Case
The case features a confrontation of religious versus medical principles, rules, and values. Religious principles are concerned about the spiritual more so than the material. Spiritual health and wellness are achieved by strictly following religious teachings to appease their deity (Crane, 2018). Death, in that case, is not seen as the ultimate evil that could happen to a child, since her soul would transcend into a higher plane of existence. On the other hand, applying treatments that contradict religious practices would, while extending the child’s existence, doom her to an eternity of suffering in the afterlife. The Amish oppose their daughter’s treatment based on these principles.
Medical principles oppose religious principles in many ways. The patient is of the primary importance to healthcare providers, who are expected to do everything in their power to preserve their health and longevity (Crane, 2018). While cultural and religious practices are important in the scope of patient autonomy and decision-making, the life of the patient is ultimately more important than their preconceptions about treatment. The hospital opposes the Amish family’s desire to withdraw treatment based on these principles.
Potential Alternative Solutions
The hospital and the family could have explored alternative means of treatment that would satisfy both parties to a degree while maintaining a reasonably high chance of success for treating and curing the child. One of the alternative venues involves stem cell transplantation, which infuses healthy blood-forming stem cells into the patient’s body (“Blood cancers,” n.d.). This method, although frequently coupled with radiation and drug therapy, is less technologically intense and does not place the patient in pain, meaning it alleviate some of the parental concerns about their child being hurt. Alternatively, the parents could consider that the pain their child would have to endure in the further stages of blood cancer would be far greater than whatever discomfort chemotherapy brings.
Religious and Legal Implications
The hospital is not honoring the religious and cultural beliefs of the patient and her family, as it places the physical wellness of the child before the religious considerations of the parents. The reason why the hospital can take a Jehovah’s Witness to court to argue about receiving a medically-needed blood transfusion is that applying the life-saving treatment (versus life-prolonging treatment) is ultimately a medical decision, for which the doctors and nurses bear ultimate responsibility (Crane, 2018). The situation is exacerbated by the fact that the child is underage and incapable of making decisions about her own life, meaning that the argument goes between the hospital and the family, who, despite being close relatives, are not the ones whose life is at stake.
As part of the ethics committee, I would side with the hospital. There have been numerous cases where life-prolonging treatment was refused based on religious grounds. However, there is a difference between life-prolonging and life-saving treatment. I would argue that the child cannot decide her religious views since she had been indoctrinated into the Amish religion since birth. At the same time, the parents should not have the power of life and death over their child in a situation when she could be saved (chemotherapy at this stage of cancer development has an 85% chance of success) (“Blood cancers,” n.d.). It would be unethical to impose the parents’ religious views on a child that is not old enough to make an educated decision.
Blood cancers. (n.d.). Web.
Crane, D. (2018). The sanctity of social life: Physicians treatment of critically ill patients. New York, NY: Routledge.