Ethical Dilemmas in Pediatrics - Essay Example

? Health Ethics Case Summary Child N is five years old. On her way to school, she was knocked down by a lorry and sustained a serious injury. She is taken by an ambulance to hospital and presented to the Emergency Department. Doctors establish that child N has a massive haemorrhage of such proportions that, unless blood is transfused, she will die. Her parents are Jehovah's Witnesses, and interpret the bible as saying blood transfusion is a sin. They refuse to allow Child N to receive blood. Introduction This paper presents the clinical case, clearly outlining the ethical dilemma basing on virtue ethical theory and principles that are applicable to this situation. Healthcare providers often deal with ethical questions and dilemmas that, if not resolved adequately, may jeopardize their professional practice, healthcare quality, or even user autonomy. In dealing with the ethical dilemmas, healthcare specialists utilize legal aspects, as well as bioethical principles, as a platform for conflict resolution regarding fundamental rights, analysis of the best treatment, and professional’s share of responsibility. Bioethical concerns are prominent in the arena of healthcare, especially in situations such as execution of blood transfusion to Jehovah Witnesses. It is apparent that Jehovah Witnesses do not accept blood transfusion, even in circumstances where life is threatened. According to Jehovah Witnesses, the refutation to have a blood transfusion is supported in the biblical texts of Genesis and Leviticus, recommending the faithful to refrain from assimilation of blood, whether by mouth or vein. Jehovah Witnesses believe that blood transfusion violates God’s law, thus causing moral, religious, and even existential damage. Blood transfusion to Jehovah Witnesses draws a striking collision of issues such as fundamental rights, the right to life, the dignity of a person, religious freedom, and the right to individual autonomy (Veatch & Haddad 2008, p.284). The case represents an embodiment of two moral evils; performance of blood transfusion that might lead to an embarrassment and a moral evil to the Jehovah Witness, owing to the rules set out in the doctrine. Non-performance of a blood transfusion, on the other hand, often leads to an omission, which exposes healthcare providers to an ethical-legal battle. Hence, one may argue that the ethical-legal obligation should be to solve the inconsistency between the two moral evils. Background The case study presents an ethical dilemma faced by healthcare providers in the course of their duty, especially when treating and caring for Jehovah Witnesses placed in a critical situation owing to medical life-threatening situations. An ethical dilemma refers to the quandary in which people find themselves in circumstances where they have to choose the manner of acting that might aid another individual and, which is the correct thing to do, regardless of whether it might contradict their own self-interest. This may be done in full knowledge that whichever preference they pick will end up harming one party while probably assisting another. People and groups vary in their opinions concerning of what they term as ethical and unethical, grounded in their personal self-interest, attitudes, beliefs, and values (Macklin 2003, p.275). Virtue Ethics Virtue ethics theory acknowledges the society’s ability to highlight, interpret, prioritize, and adjust to moral considerations within a certain context. Virtue ethics highlights what is morally correct from the patient’s point of view, and centres on the patient’s autonomy. Virtue ethics stipulates that both action and character are intertwined, and the capability to act morally is dependent on the individual’s moral character and integrity. Virtue ethics centres on the context of the situation via ethical analysis of a problem through the following steps: (a) identifying the problem (b) analyzing the context (c) investigating options (d) applying the decision process, and (e) formulating a plan and evaluating results. Case Analysis Identifying the Problem The different people involved in the case include child N, Child N parents, and the healthcare provider. The case presents an ethical dilemma, a situation in which one must choose between mutually exclusive alternatives. The value issues presented in the case revolve around the physical survival of child N versus the religious integrity of the parents. In the case, blood transfusion is imperative, but there is no consensual agreement between the physician and the patient’s parents. The three parties approach the ethical dilemma form contrasting angles. The ethical issues in the case revolve around the efficacy of respect of a person’s choice (Franca, Baptista & Brito 2008, 498). The case presents a clash of viewpoints, all of which hold key to the fate of Child N. The parents of the child are justified to refuse as the decision contradicts their beliefs, and secondly, they are the decision makers for the child, as child N lacks autonomy. Hence, they can make a valid decision on behalf of their child who is not yet autonomous. The second significant dilemma in this case represents the predicament faced by healthcare providers whose primary duty is to save lives at all costs. The core question confronting the healthcare providers is whether or not to respect the decision made by child N’s parents. Analyzing the Context In order to understand the decision-making process in the above case, it is critical to factor in ethical principles on autonomy, beneficence, justice, respect, compassion, and nonmaleficence. The parent’s religious beliefs and the impact that their beliefs have on their decision must be taken into account. In child N’s case, the child was experiencing haemorrhage in massive proportions and needed an immediate blood transfusion. The parent’s refusal to have the recommended blood transfusion is grounded in the fear that blood transfusion goes against Bible scripture. According to the beliefs of the parents, blood transfusion or bloods products will make the child cease to be a Jehovah Witness and possibly condemn the child to hell. The child’s parents would rather wish their child to be “embraced in the bosom of Jehovah instead of being condemned for all eternity.” Physicians should draw from the set code of conduct in order to mirror and understand the parent’s perspective, and to respect their wishes. The healthcare providers should honour human dignity and the distinctiveness of the client’s case, regardless of considerations on social, economic status, nature of the health problem, or even personal problems. The case is a contest between healthy life and a premature death whereby both cannot be considered to represent coequal values. One of the values should take precedence, in this case healthy life. The ethical dilemma presented hinges on whether to honour the patient’s autonomy, and make concessions on standards of care or ignore the patient’s desires in an endeavour to save her life. The code of ethics guiding healthcare providers supports the viewpoint that healthcare providers should respect the patient’s wishes and decisions, irrespective of their own personal beliefs (Franca, Baptista & Brito 2008, 499). In the parents’ case, their decision to decline blood transfusion to their daughter has the desired outcome of enabling them to remain true to their religious beliefs. In the event that the parents were to follow the recommendation of physicians, the desirable outcome will be potential survival of the child, although it would have the undesirable outcome of violating the religious principles of the subject. Applying an Ethical Decision Process The healthcare providers should review child N’s (or her parents’) autonomy and their right to decide what they perceive best regardless of the possible outcomes. The child’s parents are competent and capable of making informed decisions not to allow blood transfusion. Based on virtue ethics, the healthcare providers should respect the parent’s autonomy by reflecting on and respecting the parent’s decision grounded in their religious values and beliefs. The healthcare providers should also rely on the principle of beneficence, which rests on promoting the wellbeing of others (Macklin 2003, p.276). In the above case, the wellbeing of others is physiologically and spiritually oriented. Other employable principles include non-maleficence whereby the healthcare providers are not expected to inflict harm on the patient. A violation of the parent’s deeply held beliefs is in essence inflicting harm on the patient. The healthcare providers should also draw from the principles of veracity and respect. Discussion The ethical dilemma faced by the heath care provider, who care for and treat Jehovah witness patients facing medical life-threatening conditions, revolve on whether or not to respect the patient’s consent (Frankel 2005, p.31). Healthcare providers facing such situations have attempted to obtain court orders that would overrule the decision taken by the patient, and which might compel the patient into submitting to the recommended medical treatment. Judicial rulings on some cases challenging individual’s refusal to have a blood transfusion uphold the patient’s decision to refuse transfusions, even if the decision is vital for the patient’s survival. The responsibility of the healthcare provider centres on availing accurate information to the patient, while honouring the patient’s consent to the treatment (Gardiner 2003, p.298). In such cases, advance directives and legal papers are always at hand in the event that an emergency arises. The documents are made available to the healthcare providers so that they can honour their patient’s directives. In so doing, healthcare providers are expected to practice beneficence and non-maleficence, devoid of imposing their beliefs as to the correct thing to do (Macklin 2003, p.276). The principles form the basis of the Term of Consent, a document detailing information and clarification concerning Jehovah Witnesses clinical situation in a concise and decisive way. Nursing practice is guided by the patient’s right to autonomy despite his or her religious beliefs. The guiding principle states that clients have a right to determine what should be done with their own person; they should be given accurate information and all necessary information critical to making an informed judgment. Patients should be also aided in weighing the benefits and burdens of the options available regarding their treatment whereby they are expected to either accept, reject, or terminate treatment devoid of coercion (Franca, Baptista & Brito 2008, 500). My analysis of the case factors in nursing virtues of empathy, moral courage, and self-reliance. It is hard to witness death arising from an individual’s decision to forego care when medical options to sustain life are available. Physicians have a moral right to override the parents’ refusal of a blood transfusion for child N. The child’s interest should come first, and should be determinative in cases in which the parents are the decision makers for a child (Gardiner 2003, p.297). The doctrine of “the best interests” stipulates that it may be essential and attractive to disqualify the presumptive decision makers in certain occasions. In the occasion that the parents’ decision evidently goes against the best interests of the child, it is ethically acceptable and in some instances legally binding to disqualify parent’s decision. Irrespective of the disagreements that may arise on the subject “child’s best interests,” the possibility of eternal salvation is a spiritual matter, about which nothing concrete or certain can be ascertained. In the first scenario, what is open to discussion revolves around what the society regards as the child’s best interest. The critical question in this case is: what are the child’s best interests? It is not clear-cut what the society regards as the child’s best interests and what should be decisive of what genuinely is in the child’s best interests. The criteria that should be employed in determining the child’s best interest is also shrouded in mystery. The parents’ decision to bar blood transfusion to their child is restrictive to social agreement, that the decision is in their child’s best interests or at least they are not way off what the society regards as the child’s best interest. Nevertheless, the parents actions are clearly against the “child’s best interest” and thus it is ethically permissible and legally sound to disqualify them. Although, the application of the premise “social agreement” would entangle the discussion into the chaos of cultural and ethical relativism, the consensus of the majority should be determinative rather than that of a narrow section of the society; that is Jehovah witness adherents. In the second scenario, it may be reasonable for the principle of beneficence to take preference over autonomy. Whereas adult patients should be permitted to choose for themselves whether other, held values override their probable wish for continued healthy life, the case of a child is different. It is apparent that the decision of non autonomous patient should be undertaken by someone else; in this case the Child N parents. The contest dwells on whether there is an objective means of determining whether life or death in within Child N’s best interest. The parents’ wishes for their child should be part of, and not the ultimate decision. It should be considered that child N is yet to develop a belief or value system, which shapes the platform in choosing a hoped for eternal salvation versus continued mortal life. The third scenario demonstrates that the precautionary principle should also take precedence. The stated possibility of eternal salvation is spiritual and thus unverifiable. The principle of beneficence to validate actions on behalf of the non autonomous Child N should be considered. The principle of beneficence avails a realistic justification for saving Child N’s life. Effects of Gender, Ethnicity, Religion, Age, and Sexuality on People’s Response to an Ethical Dilemma Aspects such as gender, ethnicity, religion, age, and sexuality have an immense bearing on how people respond to ethical dilemmas. The elements play a complex role in shaping how people respond to ethical dilemmas. This is essentially true in cases where individuals have diverse variables such as spirituality and religiosity, ethnicity, age, and sexuality. In most instances, there is dissonance between the healthcare provider and the client perceptions owing to cross-cultural distinctiveness in matters regarding race, religion, language, sexual orientation, and the cultural background. As a result, the professional code of ethics forms the bedrock when responding to ethical dilemmas (Post, Blustein & Dubler 2007, p.74). This calls for respect of human diversity in order to respond to the demands appropriately. Variables such as gender, ethnicity, religion, age, and sexuality influence how people understand and interpret their environment; they shape how people perceive their world and how they function within the world. In addition, the variables shape personal and group attitudes, inclusive of their perceptions about circumstances. Gender and age alone do not have a significant effect on ethical decision making even though a combination of both has a significant bearing (Gardiner 2003, p.298). Conclusion Religious freedom is not in essence an absolute value, and the apparent clash of elementary rights demands arrival at a decision, which should be based on legal and moral standards and bioethical principles. The focus in medical practice, when confronted by such occurrences, should be availing care that respects the patient’s cultural beliefs and autonomy, especially the right to self-determination, as well as offering alternative therapies. Social agreement should not be sufficient in determining what is in anybody’s best interest, irrespective of relevance to the society or cultural group. The parent’s view of child N’s best interests may be mistaken; hence, it should be disregarded. Blood transfusion is admissible because of the incompetence of the Child N. The most sound role of physicians and the state alike, should be ensuring that at least Child N reach the age of maturity where he or she can independently shape his or her own best interest. It is at that stage that the doctrine of autonomy can effectively apply. The narrow scientific grounds should be the overriding factors in deciding the child’s best interest, in this case saving his or her life. The perceived “harm” from blood transfusion is unverifiable and thus, immaterial. Therefore, physicians are ethically correct to supersede the parents’ refusal of a blood transfusion to child N. This is supported by the view that metaphysical beliefs cannot be falsified; thus, medical practice should rely on empirical judgments regarding what is right or wrong, and whose consequences are known. References List Franca, I., Baptista, R., & Brito, V. (2008). Ethical dilemmas in blood transfusions in Jehovah’s Witnesses: A legal-bioethical analysis, Acta Paul Enferm 21 (3), pp.498-503. Frankel, L. (2005). Ethical dilemmas in pediatrics: Cases and commentaries, Cambridge, Cambridge University Press. pp.31-32. Gardiner, P. (2003). A virtue ethics approach to moral dilemmas in medicine, Journal of Medical Ethics 29 (5), pp.297-302. Macklin, R. (2003). Applying the four principles, Journal of Medical Ethics 29 (1), pp. 275-280. Post, L., Blustein, J. & Dubler, L. (2007). Handbook for health care ethics committees, Baltimore, Johns Hopkins University Press. pp.74-75. Veatch, R. & Haddad, M. (2008). Case studies in Pharmacy, Oxford, Oxford University Press. pp.284. Read More