Case Study: Overview
In the case study “Healing and Autonomy,” a Christian family had to decide on the treatment of 8-year-old James suffering from acute glomerulonephritis and kidney failure. The physician recommended temporary dialysis to alleviate the symptoms, yet James’ parents, Mike and Joanne, preferred to refer to faith healing services first. A result of their decision was the deterioration of their son’s condition and a need for a kidney transplant within a one-year period. Among all available donors, only James’ twin brother, Samuel, has a perfect tissue match. Now Mike has to decide whether he would like to prove his faith in God and wait for a miracle to happen this time.
Case Study: The Topic of Discussion
The main issues raised in the case study include patient autonomy and the child’s best interests. Patient autonomy is considered the fundamental principle in modern bioethics. According to Reach (2014), an autonomous person “expresses the will of maintaining control over her actions and denies any other person the possibility of control except if she gives the authorization” (p. 16). At the same time, healthcare practitioners should always respect one’s right to decide for or against any healthcare procedure.
The problem is that children have a limited capacity to make medical decisions. Being a minor, James cannot give his consent for the administration of dialysis, and his caregivers have sole authority in deciding for him and also bear all the legal responsibilities for their choices (Committee on Bioethics, 2013). Nevertheless, it seems Mike and Joanne failed to meet their son’s best interests when refusing dialysis: they did not weigh all health risks against the benefits associated with the procedure rationally. Their choice was primarily driven by personal religious beliefs, and, therefore, it is possible to say that it mainly helped meet their own interests.
Considering that in this case study, the parental decision led to some serious detrimental health outcomes and the necessity for organ transplantation, the issue of paternalism arises as well. Overall, the given concept implies that “the physician makes decisions based on what he or she discerns to be in the patient’s best interests, even for those patients who could make the decisions for themselves” (Murgic, Hébert, Sovic, & Pavlekovic, 2015, p. 66).
Since paternalism is the opposite of patient autonomy, it is often harshly criticized. Nevertheless, the practitioner’s paternalistic approach to patient treatment can be, to some extent, applied to the case of James and his parents.
Overall, the main purpose of paternalism is the prevention of mortality and morbidity in patients. It means that the physician may reduce parents’ autonomy if their behaviors or decisions are potentially harmful. Previously Mike made the decision, which was medically ineffective. However, it will still be impossible to administer any major medical procedures recommended for James without his consent as they are mainly invasive and are associated with some inherent health risks, including bacterial infections, adverse immune responses, and so on.
Thus, the healthcare provider must try to influence parents’ decision-making through education on the nature of James’ disease, as well as all risks and benefits related to the suggestion to use Samuel’s kidney to save his brother. It is possible to say that since Mike and Joanne are very religious people and their decisions are not based merely on numbers and statistical data; it can be recommended for the physician to appeal to the core values in their belief system in order to incline them towards a mutually beneficial resolution of the problem.
Biomedical Ethics: Christian Perspective
The Christian perspective provides a unique view of the given medical case, and one may find a lot of rationales both for and against the treatment and organ transplantation within this narrative. First of all, it is essential to understand how Christians see illness and health. As Newlin Lew, Arbuah, Banach, and Melkus (2015) state, Christians believe that wellness occurs if one is in harmony with God, while “illness may reflect disharmony, sin, or turning away from God” (p. 1158).
Some Christians also see disease as a challenge sent by God “to enable individuals to complete their sanctification by submitting to personal suffering” and to test their faith (Zheng, Wang, & Wang, 2015, p. 115). In either way, the only way to recover health is to engage in spiritual practices such as prayer, as it brings believers closer to God and harmonizes the relationships with him. From the given perspective, a person’s role in health restoration is limited, and he/she has autonomy merely in deciding whether to continue praying and be in relationships with God or to withdraw. The given view on the issue justifies Mike’s decision to refer to faith healing services because, as a faithful Christian, he could not do otherwise.
Although the refusal of treatment on a religious basis poses a significant challenge for healthcare practitioners, the Christian attitude to organ donation may provide a chance for a favorable outcome in James’ case. Overall, organ donation in Christianity is regarded as the demonstration of Christian love and compassion. Such an attitude is altruistic in nature because it implies that “the moral value of an individual’s actions are focused mainly on the beneficial impact to other individuals, without regard to the consequences on the individual herself” (Dalal, 2015, p. 45).
It means that some Christians, including the family friends and church members mentioned in the case study, will likely want to donate their kidneys to James. Nevertheless, it is essential to understand if Samuel, who has a perfect tissue match with his brother, wants to give his kidney to James as it will be highly unethical and wrong to make him do it without consent. It is thus essential to involve the boy in the decision-making process regardless of his minor age and inform him of all possible benefits and risks associated with a choice he will make. The role of the physician in this situation is to elucidate the medical and health-related aspects of the issue, while parents may focus on spiritual and family values.
Ethical Dilemma: Solution
For the healthcare practitioner, it is essential to have the multicultural competence to handle ethical dilemmas like the one discussed in “Healing and Autonomy” and collaborate with patients, as well as their caregivers, instead of confronting them. It would be wrong to make Mike refuse all his religious beliefs especially considering that they may become a source of substantial support during the hardships. Nevertheless, it can be recommended to combine faith with a rational medical approach and evidence.
James should necessarily continue to undergo regular dialysis procedures to maintain his condition while praying, and faith healing services can be used as essential complementary methods of treatment. As for the organ transplantation issue, considering that there is still some time before the actual operation, Mike can exercise his trust in God trying to find another compatible organ donor for James. Nevertheless, it is important to enlist support by obtaining Samuel’s consent to give a kidney to his brother in case of an emergency.
Committee on Bioethics. (2013). Conflicts between religious or spiritual beliefs and pediatric care: Informed refusal, exemptions, and public funding. Pediatrics, 132(5), 962-965. Web.
Dalal, A. R. (2015). Philosophy of organ donation: Review of ethical facets. World Journal of Transplantation, 5(2), 44–51. Web.
Murgic, L., Hébert, P. C., Sovic, S., & Pavlekovic, G. (2015). Paternalism and autonomy: Views of patients and providers in a transitional (post-communist) country. BMC Medical Ethics, 16, 65-73. Web.
Newlin Lew, K., Arbuah, N., Banach, P., & Melkus, G. (2015). Diabetes: Christian worldview, medical distrust & self-management. Journal of Religion and Health, 54(3), 1157–1172. Web.
Reach, G. (2014). Patient autonomy in chronic care: Solving a paradox. Patient Preference and Adherence, 8, 15–24. Web.
Zheng, H., Wang, W., & Wang, L. (2015). Rural Christians’ view of sickness treatment behavior: A case study from a Shandong village, China. Anthropology & Medicine, 22(2), 114-126. Web.