Principles of Bioethics: the Fair Family - Case Study Example

Principles of Bioethics: the Fair Family Abstract Morality and ethical standards are diminishing day by day from the world. Ethical standards are essential for the strength of the society. In every aspect of human life ethical standards play a vital role and healthcare profession is also not an exception. At times it is difficult for the doctors and nurses to take proper decisions regarding the treatment of a patient because of the ethical issues involved in it. Sometimes the interests of the healthcare professionals or the medical interests may not go hand in hand with the interests of the patient. Patients may put forwards some demands to the healthcare professionals which may against the code of conduct of medical science. Patients will conveniently forget the fact that medical science is for saving the life rather than destroying it. There are lot of theories which explain the morality and ethics like the utilitarian theory, Kantian theory, Virtue theory etc. All these theories have lot of significance in medical ethics. This paper explains medical ethics based on the given case study of a Jehovah’s Witness family, the Fair family Introduction The Fair family which belongs to Jehovah’s Witness religion has met a vehicle accident and brought to the emergency care in a critical condition. As per the beliefs of Jehovah’s Witness religion, it is not permissible to receive any contributions from other human beings in the form of body parts or blood in order to survive even if they are in a critical condition. Fair has suffered serious chest injuries from the steering wheel of the car and was in need of blood transfusion which was essential for saving his life, but he denied the offer because of his religious beliefs. On the other hand, Mr. Fair’s two year old daughter was also involved in the accident and has sustained a lacerated liver. She also requires a blood transfusion to save her life. But Mrs. Fair has not agreed to give consent for blood transfusion to save her daughter’s life Problem In the above case the real problems was how to convince the fair family about the need of blood transfusion to save their life. Since Mr. Fair was an elder person, he could be allowed to take decisions on his future. But how can we justify the denial of giving proper medical assistance to Fair’s two year old daughter because of the religious beliefs alone. Another problem is how far Mrs. Fair can be allowed to take decisions upon her daughter’s future. In this case Mrs. Fair’s decision may end up in the loss of life of her daughter. Denial of medical assistance even in a critical condition knowingly is a crime legally. Allowing Mrs. Fair to play with the life of her daughter is not in line with the medical ethics. Finding solutions for the above problems are bit difficult and the healthcare professionals need to act carefully in such situations Facts about the problem Both Fair and his daughter were in critical condition and without blood transfusion their life seems to be in jeopardy. It is a fact that everybody has the right to believe and spread their religion and nobody should create any barriers in preventing somebody from executing their rituals or life styles. Any religious beliefs are advisable provided they would not cause any harm to others. Hot debates are going on in the current world about the mercy killing or physician assisted suicide. Some people argue in favor of it while others arguing against it. Fair’s case was less complicated since he was grown up and can take independent decisions up to certain extent. But Fair’s daughters’ case seems to be more complicated. Since she was a kid, she was not in a position to take decision about her future life. Nobody knows what stance she may take when she grown up. Does she stick with her religious beliefs or not? Does she blame the medical science in future for giving her life back using means which are against her religious beliefs? These questions are hypothetical, but need to be answered before taking decisions about the treatment of her. Principles related to the Problem Autonomy In healthcare decisions, autonomy of the patient mean that the patient has the capacity to act intentionally, with understanding, and without controlling influences that would lessen against a free and voluntary act. (McCormick, & Min, 2008) Informed consent principles are derived from the autonomy principles. Autonomy principle allows the patients to act intentionally and act without under any external influences. In the case of fair family the medical professionals might be confused in allowing the extent of autonomy to the patients. In both the cases of Fair and his daughter, their life is under severe threat and allowing them to take decisions upon their life may end up in the loss of their life. The major obstacle as far as allowing autonomy to the patient remains in the balancing act of the patient’s interest and that of the medical science. It may not be possible for medical science to treat patients based on their interests alone. In most of the circumstances the interests of the patients may not be in line with that of the medical science. For example, nobody wants to admit in the hospital. Everybody likes to stay in their home alone even if they are affected by severe diseases. On the other hand healthcare professionals cannot allow such freedom to a patient in a critical condition. In the given case study, even if the medical science respect the autonomy of Fair in rejecting the blood transfusion treatment up to certain extent, the same principle cannot be applied to the case of his daughter because of her minor stature. The authority of the parents to take actions upon their children is limited. Nobody can argue in favor of killing their child either legally or ethically, only because of the fact that the child happens to be theirs. Moreover, denying the opportunity to live in this world, to the two year child is against the nature’s laws. Life has so much importance that even in the current world of immense advancements; nobody was able to identify the miseries behind the life. We are coming to this world without asking permission to anybody and leaving this world against our will. In other words, only the creator has the moral and ethical right to modify or destroy the creation. Ethically, Mrs.Fair is not the creator of her daughter and hence she has no right to deny her daughter the opportunity to live in this world simply because of the religious beliefs alone. On the other hand if her daughter was in a no hope condition, the case would have been different. But in this case, there is every chance that the kid might survive if the blood transfusion is being done. So autonomy principle cannot be applied at least in the case of Fair’s daughter. “In reality, patient autonomy is not unlimited. There are a number of ways in which it is and should be restricted, all without giving in to the specter of paternalistic physicians. For one thing, patients cannot demand to be treated by non-medical means. Second, patients cannot demand treatment that is scientifically valueless. Finally, patients cannot demand treatment that is inconsistent with the purpose of medicine and the medical profession - that is to say, treatments that are outside the boundaries of accepted medical practice” (Patient Autonomy vs. Medical Values, 2009) Beneficence Beneficence principle is understood as the "first principle" of morality, the saying "do good and avoid evil". It is a "middle principle" as it is partially dependent for its content on how one defines the concepts of the good and goodness. As a middle principle, beneficence is not a specific moral rule and cannot by itself tell us what concrete actions constitute doing good and avoiding evil (Ascension Health, 2007) It is the action done for the benefit of others. It can help to prevent or remove harms and thereby improve the situations. Doctors are generally refrain from actions which causes harm to the patients; but they also have an obligation to help their patients. Ethicists often distinguish between obligatory and ideal beneficence (Pantilat MD, 2008) In Fair’s and his daughter’s case, the action of the doctor is to save their life which must be beneficial to them. Even if the doctor proceeds with the blood transfusion, his actions will be justified at least in the case of the kid. But Fair has every right to either accept or deny the blood transfusion because he is an adult and a matured person. Religion and its beliefs are valued in most of the societies still and the doctor cannot act against the laws in the country he is working. Non- malfeasance Non- malfeasance refers to doing no harm to the patient (Ethical concepts). Medical science is for assistance of the patients rather than creating any harm to their interests. But at the same time the interests of the patient should never contradict with that of the medical science. In Fair’s case, the blood transfusion may not result in any physical harm whereas it can disturb the mental health of the patient at least in the case of Fair. The agony of receiving the blood of another person against the belief of their religion may create psychological problems to the patient. On the other hand same thing may not create any psychological problems to the kid and the doctor’s action will be completely justified at least in the case of the kid. Justice Justice is a relative term. Even a thief or a terrorist may differ in their opinions about the laws of justice once they were punished. For example, some of the terrorists are engage in terrorist activities in order to preserve their religious interests and beliefs. When they get punishment they will accuse the criminal justice system for mishandling their case. Same way, Fair may complain about the denial of justice to him and his family if the healthcare professional forcefully executes the blood transfusion. On the other hand, the medical professional has every right to justify his action on the basis of medical lessons he studied. Ethical conflicts An action is right if it promotes the best consequences as per the beliefs of Utilitarianism. (Ethical Theories Compared) So if the healthcare professionals decide to execute the blood transfusion, it cannot be criticized on the basis of utilitarianism. The medical science need to account for the utility of the action first before considering other obstacles like the religious beliefs. On the other hand, Fair can interpret the doctor’s action in another manner. For him, the blood transfusion may harm his prospects of getting salvation as per his religious beliefs. But when we compare these two perspectives, the doctor’s and the patient’s, we can conclude that the doctor’s interpretation is justifiable since the utility of his actions are measurable and visible immediately. On the other hand Fair’s argument is purely based on some beliefs rather than facts. As per Kantian principle, an action is right if it is in accordance with a moral rule or principle. A moral rule is one that is required by rationality (Ethical Theories Compared). Even though Fair can cite the Kantian ethical theory for his support, it should be remembered that Fair’s moral argument lacks rationality. On the other hand the doctor’s argument is right in every aspects of Kantian ethical theory. The doctor is trying to save a life which is morally right. As per Aristotle’s moral theory, an action is right if it is what a good agent would do in the circumstances. A good agent is one who acts in a good manner (Ethical Theories Compared). We cannot blame the doctor if he execute the blood transfusion with respect to Aristotle’s ethical theory also. Nobody can argue in favor of Fair apart from his religious colleagues for denying the offer of blood transfusion simply on religious grounds. There are lot of beliefs and religions in the world. Most of them differ in their customs, rituals and traditions. Some of them may have contradictory beliefs. For example, Hindu’s believe in multi-God theory whereas the Christians believe in only one God. Either one of the beliefs must be false or both of them might be false. So beliefs cannot be considered as the base for determining the rights and wrongs of an action. Legal concepts about the problem It is difficult to explore the legal aspects of a case when the patient was in critical condition. The first and foremost importance of the doctor and the nursing staff is to do everything possible to save the life of the patient first. Then they can think in terms of the legal and ethical terms. It is impossible for a medical professional to ask about the patient’s beliefs and legal rights before giving the first aid to save the life of the patient. ‘Clinical ethics is definitely an important part of effective Clinical Governance. Clinical governance on the other hand is based on the ethical practices of the healthcare professionals’ (Clinical Ethics). The rights of the patient might be negative- to be left alone, positive-to be assisted in some way or moral-common to all humans (Kaldjian MD et al) In Fair’s case, the demand by the Fair to avoid blood transfusion is a negative one and should be left alone. There are lot of laws related to medical profession and healthcare industry. Some of the laws are related to the general principles of healthcare profession whereas some others are related to medical treatment. (Pelliccioni, J.D., M.P.H., Ph.D) But the interesting thing is that even though Fair and his kid is in the same critical condition, the laws related to their treatment may vary. Fair is an adult who is legally permissible to take actions related to his life and beliefs whereas his kid is a minor and hence only the parents have the right to take decisions upon her future up to certain extent. But again, even the parents are not legally allowed to take any actions which may spoil her life. In this case the denial of blood transfusion may finish her life and the parents don’t have the legal right to take such actions. Conclusions Medical professionals, quite often face with confusing situations in which their interests and the patient’s interest may clash with each other. Even though the patients have some rights which needed to be taken into the account by the medical professionals, such rights should be directed towards the common interests of both the patient and the doctor. The doctor should have the final word, if the patient happens to be in a critical condition. It is meaningless to admit a patient in a hospital and asking the medical professionals to treat them as directed by the patient. Medical professionals are working for the interests of the patients and their profession is for saving the life, not for destroying it. Mr. Fair can be allowed to take decisions upon the topic of blood transfusion since he was an adult. But his kid should be allowed to take blood transfusion since either fair or Mrs. Fair has no legal or moral right to deny their kid the opportunity to live in this world. References 1. Ascension Health, (2007), Principle of Beneficence, Retrieved on 15 October 2009 from http://www.ascensionhealth.org/ethics/public/key_principles/beneficence.asp 2. Clinical Ethics, Retrieved on 15 October 2009 from http://www.hnehealth.nsw.gov.au/cg2/clinical_ethics 3. Ethical Theories Compared, Retrieved on 15 October 2009 from http://www.trinity.edu/cbrown/intro/ethical_theories.html 4. Ethical concepts, Retrieved on 15 October 2009 from http://www.pacwcbt.pitt.edu/Curriculum/202%20Working%20with%20Adolescents%20Juvenile%20Sex%20Offenders/Overheads/oh%203%20ethical%20concepts.pdf 5. Kaldjian Lauris C, MD, PhD, Weir Robert F, PhD, & Duffy Thomas P, MD, (2005) A Clinician's Approach to Clinical Ethical Reasoning, Retrieved on 15 October 2009 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1490072/ 6. McCormick Thomas R.& Min D (2008), Principles of Bioethics, Retrieved on 15 October 2009 from http://depts.washington.edu/bioethx/tools/princpl.html 7. Patient Autonomy vs. Medical Values, (2009), Retrieved on 15 October 2009 from http://atheism.about.com/library/FAQs/phil/blphil_ethbio_autonomy.htm 8. Pantilat Steven, MD., (2008) Ethics Fast Fact, Retrieved on 15 October 2009 from http://missinglink.ucsf.edu/lm/ethics/Content%20Pages/fast_fact_auton_bene.htm 9. Pelliccioni Lori S. Richardson, J.D., M.P.H., Ph.D., Health Law: Legal Environment of Health Services Management, Retrieved on 15 October 2009 from http://docs.google.com/gview?a=v&q=cache:SRPrPB2ndYsJ:www.ph.ucla.edu/hs/hs_437_s04.pdf+legal+concepts+and+laws+in+healthcare&hl=en&sig=AFQjCNGMAakrkF824Ftt9To2UvYjnltdnQ Read More